Percutaneous Release Research Articles

Epidermal Inclusion Cyst Following Percutaneous Trigger Finger Release: A Case Report

Epidermal inclusion cyst is a benign lesion that commonly occurs due to inclusion of epidermal cells into the dermal or deeper layers in a trauma event. Percutaneous release is a minimally invasive technique and good surgical outcomes can be achieved. However, the percutaneous procedure is a puncture injury and the epidermal inclusion cyst is reasonable to become a possible complication. In this article, we presented a case of trigger finger in left middle finger. She underwent percutaneous release as the treatment and a second percutaneous release 5 months later due to recurrence of the symptoms. An epidermal inclusion cyst was noted 5 months thereafter and it was treated with excision. With this case, we need to be more aware of this possibility if a mass lesion without infection signs occurs in the released area.

Percutaneous Release of Trigger Finger: A Safe And Cost Effective Procedure

Introduction: Trigger finger is a common cause of pain and disability of the hand. Trigger finger (or thumb) arises either from thickening of the flexor tendon sheath (which occurs following tenosynovitis of infective, traumatic or rheumatolgical origin) or from nodular thickening of the flexor tendon itself which may be congenital. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a cost-effective and rapid method which saves a surgical procedure and results in a better functional outcome. KeyWords: Trigger finger, percutaneous release, outpatient treatment, cost-benefit analysis.

Percutaneous surgery using Admix NoKorTM Non-Coring 16 G needle in cases with trigger finger

In this study mid- and long-term outcomes of the cases with trigger finger we treated using Admix NoKorTM have been presented. Percutaneous release procedures were applied for 24 fingers of 22 (19 female, 3 male patients; mean age, 57; range, 39-72) patients between May 2009 and May 2011. Preoperatively US was performed so as to confirm the presence of trigger finger. Diameters of the tendons of the affected and intact hands measured using US, were compared so as to be able to demonstrate thickening of the tendon of the trigger finger. The patients were monitored for an average period of 25.2 (range, 14-36) months. During surgery, clinically loss of the catching sensation was observed. In two patients percutaneous trigger finger release failed, so we have to proceed with open surgery. During open surgery, we observed longitudinal wounds on the tendon. One patient developed unilateral radial digital nerve damage. Percutaneous release of the trigger finger using Admix NoKorTM 16-G gauge needle can be preferred in the treatment of trigger finger. Trigger finger of the first digit requires more attentive approach and one should be aware of the complications. If required open surgery can be preferred.

Ultrasound-Assisted Percutaneous Release in Carpal Tunnel Syndrome and Trigger Digits: A Over 1000-Case Series

Ultrasound-Assisted Percutaneous Release in Carpal Tunnel Syndrome and Trigger Digits: A Over 1000-Case Series

Percutaneous release of the plantar fascia. New surgical procedure.

Plantar fasciopathy presents with pain at the plantar and medial aspect of the heel. If chronic, it can negatively impact on quality of life. Plantar fasciopathy is not always self-limiting, and can be debilitating. Surgical management involves different procedures. We describe a percutaneous plantar fascia release. A minimally invasive access to the plantar tuberosity of the calcaneus is performed, and a small scalpel blade is used to release the fascia. With this procedure, skin healing problems, nerve injuries, infection and prolonged recovery time are minimised, allowing early return to normal activities. V.

Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger.

AIMTo investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique.METHODSIn this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade II-IV according to Green classification system, were recruited. Two groups were formed; Group A (16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B (16 patients) underwent an open surgical release of the A1 pulley, through a 10-15 mm incision. Patients were assessed pre- and postoperatively (follow-up: 2, 4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering (primary variable of interest) was expressed as the “success rate” per digit. The time for taking postoperative pain killers, range of motion recovery, QuickDASH test scores (Greek version), return to normal activities (including work), complications and cosmetic results were assessed.RESULTSThe success rate in group A was 93.75% (15/16) and in group B 100% (16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean QuickDASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickDASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5% (14/16) of group A patients, while in 56.25% (9/16) of group B patients were evaluated as fair or poor.CONCLUSIONTreatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger’s disease.

Percutaneous Release Procedures: Trigger Finger and Carpal Tunnel.

Trigger digit and carpal tunnel syndrome are both conditions traditionally treated with open surgery but are potentially amenable to curative treatment using percutaneous techniques. The advantages of minimally invasive techniques are lower risk of wound breakdown and infection, quicker healing, reduced postprocedural pain, reduced complications, and a quicker return to normal activity. The advent of high-resolution ultrasound has allowed percutaneous release procedures for these conditions to be developed and performed with a potential for a reduced risk of complications and an increased likelihood of success. This article reviews the literature as well as our institutional experience in performing ultrasound-guided percutaneous release for trigger digit and carpal tunnel syndrome.

Evidence-based management of adult trigger digits.

I.

Ultrasound-guided trigger finger release: A new surgical procedure (50 cases)

Ultrasound-assisted percutaneous trigger finger release, with needles, has shown some incomplete releases and morbidities on tendons and bundles. Some authors have used blades, underlining the necessity of a specially designed blade, which could allow a peroperative ultrasound control with the benefits of percutaneous procedures. Our objective was to analyze the outcomes of a new specific blade to perform an ultrasound-guided percutaneous trigger finger release. Methods Blade specifications: a blunt tip to penetrate intrasheath followed by a sharp blade to cut the pulley, percutaneous (< 2 mm), cheap (no disposable). Cadaveric lab: 6 specimens were operated on both sides, on each fingers except thumbs (48 fingers). We used our specific blade and a Logic GE ultrasound device with a high frequency transducer. We performed a 2 mm incision in the MP skinfold enabling a retrograde section of the A1 pulley during an in-plane approach. Then, we evaluated the tendons and the neurovascular bundles with an open technique. Prospective clinical series: under local anesthesia, 30 consecutive patients were included, 16 grade III–IV, 7 failures of steroid injection in grade I–II and 7 grade I–II diabetic patients without previous injection: 2 forefingers, 19 thirds, 7 middles and 2 littles. Ultrasound-guided steroid injection was done at the end of the procedure in each case. A dressing was kept for two days and a clinical examination was performed after 1 and 3 months. Results Cadaveric (n = 48) none impairment of bundles, 2 superficial tendons lacerations, incomplete section of A1 pulley was observed in only 2 fingers (little). Peroperative (n = 30) duration of surgery was 10 minutes (5–18), trigger release was obtained immediately in all grade III & IV. Clinical outcomes (n = 30): no recurrence of trigger finger was noticed, none sensitive disorders. The satisfaction rate was 96%. Three patients were still painful after 3 months but improved in all three cases: one was a grade IV, two grades I, two littles and one forefinger. Discussion In order to improve our results, we concentrated our work on a dedicated blade, a retrograde section so that we strictly avoided impairment of the A2 pulley an in-plane ultrasound approach to get a continuous and direct visualization of the A1 pulley section, a steroid injection at the end of the procedure to improve pain relief and efficiency. Ultrasound-guided trigger finger release, with this procedure, is reliable and efficient on trigger release, without specific morbidity.

Ultrasound-guided de Quervain tendon release: Feasibility study and preliminary clinical results

Background De Quervain's syndrome is one of the main tendonitis of the wrist. The hypothesis of authors was the de Quervain's syndrome could be successfully treated with a specific ultrasound-guided percutaneous procedure, as it is for trigger finger. Surgical technique identification of the sub-compartimentalisation of the first extensor compartment was performed first using the Hiranuma classification prior to the surgery. Then, through a continuous ultrasound in-plane control, we performed a percutaneous retrograde section of each part of the first compartment of the extensor. Methods and technique In a cadaveric study, authors proposed to assess the feasibility and safety of a new and specific procedure to perform an ultasound-guided percutaneous release for de Quervain's syndrome and then assessed their preliminary clinical results. Fourteen specimen wrists were analysed with ultrasound and the procedure was performed prior to an open control of the efficiency of the release and safety for the superficial nerves. Then, we reported our results concerning the three first patients included in the prospective clinical series. Results In cadaver lab, authors were able to identify with ultrasound the type of first compartment septation (sub-compartimentalization) in 13 cases ( n = 14). The misidentification induced one incomplete release. No damages of the superficial radial nerve were observed despite close relationship. In the preliminary clinical series, the duration of surgery was 10 min (5–18) and no kind of morbidities was noticed. Conclusion Ultrasound-guided percutaneous release in the de Quervain's disease is a safe and reliable procedure without specific morbidity but many care should be taken to avoid superficial nerves and to identify with ultrasound the correct type of sub-compartimentalization prior to the surgery.

Outcomes of percutaneous trigger finger release with concurrent steroid injection

Percutaneous release (PR) of the A1 pulley is a quick, safe, and minimally invasive procedure for treating trigger fingers. The purpose of this study is to identify if PR with additional steroid injections can shorten the recovery to reach unlimited range of motion. Between January 2013 and December 2013, we included 432 trigger fingers with actively correctable triggering or severer symptoms without previous surgical release or steroid injections from two hand clinic offices (A and B). The same experienced surgeon performed PR at the office. Patients from Clinic A received PR with steroid injections and those from Clinic B received PR without steroid injections. Patients returned for follow-up 1 week, 6 weeks, and 12 weeks after the procedure. Between the steroid group and the nonsteroid group, there is no significant difference in the mean time for patients to return to normal work and the rate of residual extensor lag. Middle fingers showed a 5.09-fold chance of having a residual extensor lag over that of the other fingers. High grade trigger fingers recovered more slowly than low grade ones. The success rate of a 12-week follow-up was 98.4%. There was no significant difference between the steroid group (97.5%) and the nonsteroid group (99.1%). PR can treat trigger fingers effectively, but additional steroid injection does not provide more benefit. Some fingers showed temporary extensor lag, especially in middle fingers and high grade trigger fingers, but 85% of those will eventually reach full recovery after self-rehabilitation without another surgical release.

Libération écho-guidée dans les tendinites de de Quervain : étude de faisabilité et résultats préliminaires

Background De Quervain's syndrome is one of the main tendonitis of the wrist. The hypothesis of authors was the de Quervain's syndrome could be successfully treated with a specific ultrasound-guided percutaneous procedure, as it is for trigger finger. Surgical technique identification of the sub-compartimentalisation of the first extensor compartment was performed first, using the Hiranuma classification, prior to the surgery. Through a continuous ultrasound in-plane control, we performed a percutaneous retrograde section of each part of the first compartment of the extensor. Methods and technique In a cadaveric study, authors proposed to assess the feasibility and safety of a new and specific procedure to perform an ultrasound-guided percutaneous release for de Quervain's syndrome and then assessed their preliminary clinical results. Fourteen specimen wrists were analysed with ultrasound and the procedure was performed prior to an open control of the efficiency of the release, and safety for the superficial nerves. We reported the results, concerning the morbidity, of the 3 first patients included in the clinical series. Results In cadaver lab, authors were able to identify with ultrasound the type of first compartment septation (sub-compartimentalization) in 13 cases (n = 14). The misidentification induced one incomplete release. No damages of the superficial radial nerve were observed despite close relationship. In the preliminary series, the duration of surgery was 10 min (5–18) and no kind of morbidities was noticed. Conclusion Ultrasound-guided percutaneous release in the de Quervain's disease is a safe and reliable procedure without specific morbidity but many care should be taken to avoid superficial nerves and to identify with ultrasound the correct type of sub-compartimentalization.

Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study.

Background:To evaluate the efficiency of the percutaneous 18-G needle technique in releasing the fibro-osseous sheath over the first dorsal extensor compartment of the hand.Methods:Using anatomic landmarks, percutaneous release was performed with an 18-G needle on 48 wrists of 24 cadavers. The specimens were then dissected and examined for the completeness of the first dorsal extensor compartment release and any tendon or neurovascular injuries. The tunnel length, number of abductor pollicis longus and extensor pollicis brevis tendons, presence of an intertendinous septum, and the effects of these parameters on percutaneous release were evaluated.Results:Percutaneous release was performed on all of the wrists, and the evaluation of the adequacy of release revealed 25 complete releases, 21 partial releases, and 2 missed releases. There were 19 cases of tendon complications. No neurovascular injuries were noted. The mean tunnel length was 2.66 ± 30 cm, and the mean number of tendons was 2.75 ± 0.86. A septum was present in 33.3% of cases. Tunnel length and tendon number had no statistically significant effect on release, whereas the presence of a septum was significantly associated with inadequate tunnel release and the development of tendon complications.Conclusions:Percutaneous release of the first dorsal extensor compartment using an 18-G needle was associated with high rates of incomplete release and tendon damage in the presence of an intertendinous septum. Further study is required under ultrasound guidance to determine the usefulness of percutaneous release in the first dorsal extensor compartment.Clinical Relevance:Release with a percutaneous needle tip in De Quervain’s syndrome may provide the advantages of better cosmetic results with less scar formation and an early return to work.

Percutaneous Release of Trigger Fingers: Comparing Multiple Digits with Single Digit Involvement.

To evaluate safety and efficacy of percutaneous release of trigger finger in multiple digits involvement in comparison with single digit involvement. A number of 100 patients (131 fingers) were treated by percutaneous release and divided into two groups: single digit (group A) and multiple digits (group B). They were followed up for one year. Success rate, pain, complications and duration of analgesic use were studied and then compared in both groups. All patients in both groups were treated successfully without any recurrence in a one-year follow-up. No complication was observed, but postoperative duration of pain was significantly different between the two groups. Period of painkiller use was also different between the two groups. Percutaneous release is a safe and effective treatment for trigger fingers even if multiple digits are involved. It is also safe in thumb and index finger involvement and diabetic patients.

Ultrasound-Assisted Endoscopic Carpal Tunnel Release

Various surgical procedures for carpal tunnel syndrome exist, such as open release, ultrasound-guided percutaneous release, and endoscopic release. Postoperative pain, scarring, and slow recovery to normal function are reported complications of open release. Damage to vessels and the median nerve and its branches underlying the transverse carpal ligament is a reported complication of ultrasound-guided percutaneous release. Damage to the superficial palmar arch and incomplete release are reported complications of endoscopic release. By performing endoscopic carpal tunnel release with ultrasound assistance, we could visualize neurovascular structures directly with the endoscope and also indirectly with ultrasound to minimize complications. We could also evaluate the morphologic changes of the median nerve dynamically before and after the release. We discuss the technique for this procedure and outline pearls and pitfalls for success.

Evaluation of Percutaneous First Annular Pulley Release: Efficacy and Complications in a Perfused Cadaveric Study

Trigger finger is the most common entrapment tendinopathy, with a lifetime risk of 2% to 3%. Open surgical release of the flexor tendon sheath is a commonly performed procedure associated with a high rate of success. Despite reported success rates of over 94%, percutaneous trigger finger release (PFTR) remains a controversial procedure because of the risk of iatrogenic digital neurovascular injury. This study aimed to evaluate the safety and efficacy of traditional percutaneous and ultrasound (US)-guided first annular (A1) pulley releases performed on a perfused cadaveric model. First annular pulley releases were performed percutaneously using an 18-gauge needle in 155 digits (124 fingers and 31 thumbs) of un-embalmed cadavers with restored perfusion. A total of 45 digits were completed with US guidance and 110 digits were completed without it. Each digit was dissected and assessed regarding the amount of release as well as neurovascular, flexor tendon, and A2 pulley injury. Overall, 114 A1 pulleys were completely released (74%). There were 38 partial releases (24%) and 3 complete misses (2%). No significant flexor tendon injury was seen. Longitudinal scoring of the flexor tendon was found in 35 fingers (23%). There were no lacerations to digital nerves and one ulnar digital artery was partially lacerated (1%) in a middle finger with a partial flexion contracture that prevented appropriate hyperextension. The ultrasound-assisted and blind PTFR techniques had similar complete pulley release and injury rates. Both traditional and US-assisted percutaneous release of the A1 pulley can be performed for all fingers. Perfusion of cadaver digits enhances surgical simulation and evaluation of PTFR beyond those of previous cadaveric studies. The addition of vascular flow to the digits during percutaneous release allows for Doppler flow assessment of the neurovascular bundle and evaluation of vascular injury. Our cadaveric data align with those of published clinical investigations for percutaneous A1 pulley release.

Functional Outcome of Open Surgical Release Versus Percutaneous Release of Tennis Elbow.

Introduction: Tennis Elbow is a familiar term used to describe myriad of symptoms around the lateral aspect of the elbow. It occurs more frequently in non-athletes than athletes. Tennis elbow has a reported prevalence of 2% in the general population. It is most commonly seen in patients between the ages of 30 and 50 years. Tennis Elbow is considered resistant if it fails to respond to conservative means of treatment for at least six months.Methods: Patients meeting the criteria were divided randomly into two groups of open surgical release and percutaneous release using random number generator software and respective surgery was done. Functional score, time to return to pre-injury status and patient satisfaction were noted at two months and six months follow up.Results: Among 62 patients (34 female, 28 male) enrolled, 32 patients (mean age 42.5 years) were allocated to open group and 30 patients (mean age 44.2 years) were allocated to percutaneous group. At two months follow up, 81% of open group had excellent to good score and 19% of cases had fair score as compared to 90% cases of percutaneous group with excellent to good score and 10%with fair score (p = 0.376). At six months follow up, both open and percutaneous group had 90% excellent to good results and 10% fair results (p = 0.596). The mean time to return to work of open release was 6.03 weeks and percutaneous release was 2.3 weeks (p = 0.0001).Conclusions: Percutaneous release and open surgical release in surgical management of resistant tennis elbow have statistically similar functional outcome. The time to return to work after percutaneous release is significantly earlier.

To compare the outcome of local infiltration of corticosteroid and percutaneous release of pulley in treatment of trigger finger

Background: Stenosing tenosynovitis of fingers is one of the common tendinopathy attended in orthopaedic practice. A number of methods have been described for the treatment of this problem. Treatment ranges from conservative management to surgical procedures. Stenosing tenosynovit is also known as Trigger finger. Material & Methods: in this Prospective study all patients presented with trigger finger Grade 2 and 3 were randomly allocated into 2 groups. One group received local corticosteroid injection and in the other group, percutaneous release of pulley was performed as treatment option. These patients were then followed and assessed weekly over a period of two month and their progress noted. Results: We studied a total of 42 patients. Majority (71.4%) were females. The commonest age group is 40-50 years olds (56.6%).The most common presenting symptom was pain with triggering (52.3%). There was significant improvement in pain in the first two weeks in both groups but there was better improvement of pain in the corticosteroid group initially especially after first week. As for the triggering, there was significant improvement noted in first week in corticosteroid group but there was no difference in degree of improvement between both the groups after four week. The corticosteroid group had a complication rate of 10% whereas the percutaneous release group complication rate was 18.1%%. The recurrence rate was comparable in both the groups. Conclusion: Trigger finger is a common condition in orthopaedic practice. The commonly affected fingers are the centrally located on the palm. Local infiltration corticosteroid percutaneous release of pulley gives comparable results in long follow-up however corticosteroid injection gives better result initially with less complication.

Open versus percutaneous release for trigger digits: Reversal between short-term and long-term outcomes

BackgroundThere have been excellent outcomes reported with both open and percutaneous release of trigger finger. However, a comparison of short- and long-term outcomes between these two techniques has not been performed. The purpose of this study is to compare the short-term (3 months) and long-term (2 years) outcomes between open surgical release and percutaneous needle release of trigger finger. MethodsBetween 2009 and 2012, a total of 198 patients with trigger finger treated with either open (n = 72) or percutaneous (n = 126) release of the A1 pulley were enrolled in the study. Both short-term and long-term outcomes were evaluated, using the criteria established through Gilberts et al's questionnaire. ResultsThe short-term satisfaction of patients with their results was significantly better in the percutaneous release group, whereas the long-term satisfaction rates were better in the open-release group, although not at a statistically significant level. ConclusionThe percutaneous release method to release trigger finger does not have a better long-term satisfaction rate than the open release approach, although percutaneous release has a significantly better short-term satisfaction rate.

Modified percutaneous trigger finger release

Stenosing tenosynovitis or trigger finger is one of the most common disorders that affect the flexor tendon apparatus of the hand. Percutaneous release has been previously reported to be easier, quicker, less invasive and less costly than open surgery. The purpose of this study was to report the outcome of an alternative percutaneous trigger finger release technique. From March 2008 to January 2014, 92 patients (128 fingers) who underwent the alternative percutaneous trigger finger release, with a minimum of 6 months follow-up were included. Outcomes included size of skin incision, pain, residual symptoms, satisfaction and complications. Percutaneous release was achieved in all fingers, except 1 for which an opening of the skin was necessary to complete the release of the pulley. Eight fingers (6%) required revision open surgery because of persistence of their symptoms. At 1 week after the procedure, no finger swelling was reported, however 4 fingers (3%) were painful and 45 (35%) were stiff and required physiotherapy. Percutaneous release was successful in 120 fingers (94%). At the final follow-up, all the patients were satisfied by the procedure (95 rated their result as much better and 32 as better). This study shows that our alternative percutaneous trigger finger release is a reliable and safe procedure with high patient satisfaction. Level of evidenceLevel IV, clinical study, therapeutic study.