A1 Pulley Release of Locked Trigger Digit by Percutaneous Technique

Park, Myeongjin; Oh, Irvin; Ha, Kwon Ick

doi:10.1016/j.jhsb.2004.03.015

Cited by 44 publications

(41 citation statements)

References 15 publications

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“…Similar results were reported in previous studies using clinical observations or telephone interviews. 7,9,11,13,[28][29][30] Subsequently, each joint's ROM showed improvement. Although most studies reported that the majority of trigger digit patients had regained full or normal ROM after treatment, 1,7,9,11,13,[28][29][30][31][32] the recovery rate of the workspace and joint ROM in this study was 87-92% of the performances of the intact hand 12 weeks postoperatively.…”

Section: Discussionmentioning

confidence: 94%

“…7,9,11,13,[28][29][30] Subsequently, each joint's ROM showed improvement. Although most studies reported that the majority of trigger digit patients had regained full or normal ROM after treatment, 1,7,9,11,13,[28][29][30][31][32] the recovery rate of the workspace and joint ROM in this study was 87-92% of the performances of the intact hand 12 weeks postoperatively. This might be because ROM evaluations in previous studies were based on direct observations or the clients' self-reported outcomes, 1,7,11,13,[28][29][30][31][32] so the 10% difference in full or normal ROM might not have been detected visually.…”

Section: Discussionmentioning

confidence: 94%

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Kinematical and functional improvements of trigger digits after sonographically assisted percutaneous release of the A1 pulley

Kuo

Tung

et al. 2008

Journal Orthopaedic Research

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We present evidence of kinematic and functional improvements of the trigger digit after sonographically assisted percutaneous release using quantitative motion analyses and functional assessments, respectively. Twenty-two patients with idiopathic trigger digits, who received the surgery, were recruited. A motion tracking system was used to measure the assigned kinematics parameters at the presurgical visit and at 1, 4, and 12 weeks after surgery. The hand strength and functional outcome were also obtained using dynamometer and selfreport questionnaire assessments. The hand strength, maximal workspace, and joint range of motion of the involved digit were significantly smaller than that of the intact finger on the contralateral hand before surgery. The triggering phenomenon of the involved digit was significantly higher than that of the corresponding finger in the intact hand using a subscribed angular acceleration factor. The repeated measures showed that the workspace, joint range of motion, hand strength, and triggering effect of the involved hand significantly improved in follow-up examinations after the surgical intervention. Painful movement or insufficient tendon excursion of the trigger digit can cause loss of movement and strength, thus interfering with functional performance. After the disappearance of the pain and triggering by sonographically assisted percutaneous release, improvements in kinematics and function were objectively quantified in this study. Keywords: trigger digits; kinematics; sonographically assisted percutaneous release; motion analysis A change in anatomical structure can alter movement into improper or malaligned patterns. The trigger digit is a common example that symptomatically shows a catching or snapping phenomenon owing to a mismatched anatomical relationship between the flexor tendon and A1 pulley.1-5 The severity of the disease is usually graded based on the levels of these triggering effects and the location of tenderness. In prior studies, researchers usually used simple physical examinations, such as clinical observations of range of motion (ROM) or movement abnormality and pain rating and selfreported satisfaction questionnaires to evaluate conditions before and after treatment.1,6-14 With these methods, clinicians can easily and conveniently assess treatment outcomes; however, little research has focused on objectively assessing the efficacy of surgical release based on quantifiable measures. To describe hand movements thoroughly, uses of three-dimensional and dynamic goniometric measures to represent thumb and finger ROM based on computer-aided motion analysis techniques were recently reported.15-18 These methods provide objective spatial and temporal assessment rather than the static indication using conventional goniometric measurements. To date, however, limited reports exist on the objective description of the trigger digit movement.Recent years have seen increased research into percutaneous release methods for treating triggering problems of digits. A son...

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Kinematical and functional improvements of trigger digits after sonographically assisted percutaneous release of the A1 pulley

Kuo

Tung

et al. 2008

Journal Orthopaedic Research

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“…The procedure was successful in 107 patients (success rate, 90.6%), while the remaining 11 patients were switched to open surgery without encountering any neurovascular injury [13]. Blumberg et al performed percutaneous release under local anaesthesia using 18 G injector needles and reported a 93.5% (n=29) success rate.…”

Section: Discussionmentioning

confidence: 99%

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

Kurt¹,

Kalender²,

Sevimli³

et al. 2017

Med-Science

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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.

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“…[2] Current treatment options include either conservative management by splinting, [1] treatment with anti-inflammatory drugs or corticosteroid injection (usually with local anesthetic) in the flexor tendon sheath, [2][3][4][5][6][7][8][9][10] or surgical release of the A1 pulley (via an open or percutaneous approach). [11][12][13][14] Although there are no well controlled studies comparing treatment modalities, corticosteroid injection is widely accepted as first-line treatment of TF; surgery is generally reserved for cases of corticosteroid treatment failure or for patients with more severe articular locking and joint rigidity. [2,4,9,13] Certainly surgery is the definitive treatment, providing permanent resolution of symptoms, [4,13] but corticosteroid injection is often preferred, not only because a single injection is effective in a large proportion of patients, but also because it can be given in an office setting and is a relatively simple, low-cost procedure.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Injection of a Corticosteroid and Hyaluronic Acid

et al. 2011

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Background and Objectives: Stenosing tenosynovitis (trigger finger) is one of the most common causes of pain and disability in the hand, which may often require treatment with anti-inflammatory drugs, corticosteroid injection, or open surgery. However, there is still large room for improvement in the treatment of this condition by corticosteroid injection. The mechanical, viscoelastic, and antinociceptive properties of hyaluronic acid may potentially support the use of this molecule in association with corticosteroids for the treatment of trigger finger. This study examines the feasibility and safety of ultrasound-guided injection of a corticosteroid and hyaluronic acid compared, for the first time, with open surgery for the treatment of trigger finger. Methods: This was a monocentric, open-label, randomized study. Consecutive patients aged between 35 and 70 years with ultrasound-confirmed diagnosis of trigger finger were included. Patients were randomly assigned to either ultrasound-guided injection of methylprednisolone acetate 40 mg/mL with 0.8 mL lidocaine into the flexor sheath plus injection of 1 mL hyaluronic acid 0.8% 10 days later (n = 15; group A), or to open surgical release of the first annular pulley (n = 15; group B). Clinical assessment of the digital articular chain was conducted prior to treatment and after 6 weeks, and 3, 6, and 12 months. The duration of abstention from work and/or sports activity, and any treatment complications or additional treatment requirements (e.g. physiotherapy, compression, medication) were also recorded. Results: Fourteen patients (93.3%) in group A had complete symptom resolution at 6 months, which persisted for 12 months in 11 patients (73.3%), while three patients experienced recurrences and one experienced no symptom improvements. No patients in group A reported major or minor complications during or after corticosteroid injection, or required a compression bandage. All 15 patients in group B achieved complete resolution of articular impairment by 3 weeks after surgery, but ten patients were assigned to physiotherapy and local

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A1 Pulley Release of Locked Trigger Digit by Percutaneous Technique

Cited by 44 publications

References 15 publications

Kinematical and functional improvements of trigger digits after sonographically assisted percutaneous release of the A1 pulley

Kinematical and functional improvements of trigger digits after sonographically assisted percutaneous release of the A1 pulley

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

Ultrasound-Guided Injection of a Corticosteroid and Hyaluronic Acid

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