Outcome of percutaneous trigger finger release technique using a 20-gauge hypodermic needle

Abstract

Background: Trigger finger or stenosing tenosynovitis is a disproportion between the volume of the tendon sheath and its contents. This disproportion prevents gliding of the tendon as it moves freely through the annular pulley. The technique of percutaneous release of the annular pulley for trigger finger has been described well in the literature, which has undergone several modifications, like use of hypodermic needle, tenotome or specially designed knives. Method: We performed percutaneous trigger finger release using a 20-gauge hypodermic needle to know the outcome and efficacy of the technique post release. A Prospective cohort study was conducted in 80 consecutive trigger fingers of 67 patients who were treated by percutaneous release using 20-gauge hypodermic needle. Quinell's grading system was used to quantify severity of triggering and pain was assessed using visual analogue scale (VAS) before and after the procedure. Patients were evaluated based on these two parameters at timely interval and final outcome was assessed at the end of one year. Results: Out of 80 digits treated, most of the subjects were in the age group 40e50 years (39.07%). Most common grade of trigger finger observed was Grade 3 (60%) followed by Grade 4 (30%) with VAS score of 8 (46%) followed by VAS score of 7 (24%) before release. At a year follow-up 95% of patients improved to grade 0 and mean VAS score was 0.44. Three patients developed scar tenderness, which gradually subsided by analgesics and physiotherapy with no other major complications. Conclusion: Our technique of percutaneous release of trigger digit with 20 G needle is effective and can be performed safely with ease. It is cost efficient and has a short learning curve with great acceptance being an outpatient procedure.

Trigger Finger: Evaluation, Management, and Outcomes

“…Release of the pulley is assessed by loss of a grating sensation along the pulley and by having the patient actively range the finger. 15 OPEN RELEASE Open surgical trigger finger release remains the most effective treatment modality, with success rates nearing 100%. 16 Patients with a long duration of preoperative symptoms, flexion contracture of the PIP joint, and fraying or partial tear of the flexor tendon may be at increased risk of prolonged symptoms such as pain, reduced range of motion, catching and locking, among others despite surgical release.…”

Ultrasonography-guided percutaneous release of A3 pulley of the fifth finger to treat trigger finger: Description of the technique, with reference to a specific case

“…The prolonged inflammation leads to a swelling of the tendon sheath at the intersection with the pulley (usually in the A1 pulley), preventing the tendon from sliding smoothly through the channel during movements of flexion and extension. 1 Its clinical manifestation can vary from an occasional blockage to complete entrapment of the tendon in flexion, sometimes occurring even in extension. 2 …”

Failure rates and analysis of risk factors for percutaneous A1 pulley release of trigger digits

“…Percutaneous trigger digit release has the advantage of giving similar results to open release and has fewer complications (Gilberts et al., 2001; Wang et al., 2013). Many studies have reported a success rate of over 90% for percutaneous A1 pulley release (Bamroongshawgasame, 2010; Blumberg et al., 2001; Panghate et al., 2021; Rojo-Manaute et al., 2012). After pulley release, steroid injection can be administered to treat postoperative pain and swelling (Jegal et al., 2019; Levine et al., 2022).…”