Sonographically Guided Intrasheath Percutaneous Release of the First Annular Pulley for Trigger Digits, Part 1

Abstract

With adequate anatomic knowledge, technical training, and a basic ultrasound machine, sonographically guided A1 pulley release can be performed safely and successfully, offering an alternative to classic open surgery in the ambulatory setting.

One Digit Interruption: The Altered Force Patterns during Functionally Cylindrical Grasping Tasks in Patients with Trigger Digits

“…In addition, the digit force patterns were also found to be altered in patients with impaired tactile sensation [8]. Although the impacts of TD have been shown in a number of clinical evaluations [1]–[3], it remains unknown whether this condition affects the subtle force coordination among digits during hand manipulations. Clinical experience also indicates that TD is seen as a condition in which function-related issues regarding hand performance tend to be neglected, due to the lack of any apparent trauma or change in appearance of the hand.…”

“…The maximal grip strength is generally used as an indicator to evaluate the severity [1] or treatment effect [2], [3] of patients with TD. In addition to the power grip of hand, subtle coordination among the applied forces of the digits is also critical in various daily activities.…”

Sonographically Guided Intrasheath Percutaneous Release of the First Annular Pulley for Trigger Digits, Part 2

“…Patients were initially allocated (1:1:1 ratio) by blocked computer‐generated randomization to 1 of 3 groups (sonographically guided–office‐based, wide‐awake–office‐based, or classic open–day surgery) to receive surgical treatment for trigger digits; however, this allocation was used only until stability in turnover times was assessed with the coefficient of determination ( R 2 ) for a linear regression. Clinical inclusion and exclusion criteria were described previously 4 . Criteria for ambulatory surgical care exclusion were age (>84 years), 8 allergies (latex or local anesthesia), smoking (>20 cigarettes per day), alcohol consumption (>60 g per day), oral anticoagulation, rheumatic disease, fibromyalgia, active psychiatric disease, blood pressure (>155/95 mm Hg), morbid obesity (body mass index 340), pregnancy, cardiovascular, noncontrolled renal, hepatic, or hematologic disease, and a hospital admission 6 months before surgery 8 , 13 .…”

“…Additionally, we included a descriptive study for the turnover analysis of the entire sonographically guided group (n = 48), which was clinically described in part 1 4 …”

“…Advancements in minimally invasive surgery and anesthesia are enhancing perioperative management in ambulatory surgical care 1 – 3 . Recently, percutaneous intrasheath sonographically guided first annular (A1) pulley release has been shown to be safe and effective experimentally 3 and clinically 4 in trigger digits.…”