The Safety of Percutaneous Trigger Finger Release

Abstract

This study attempted to determine the safety of percutaneous release of trigger fingers, with particular attention given to border digits and the thumb. We performed percutaneous release of the A1 pulley in six fresh frozen cadaveric hands utilizing established surface landmarks. After freezing all specimens, we performed cross-sections at the A1 pulley, avoiding dissection of soft tissues, which could alter the natural position of the digital nerves. There was no difference in the distance from the needle tract to the neurovascular bundle when comparing between digits, and the closest distance was 2.7 mm. There was no significant difference between the needle tract and the radial and ulnar digital nerves. Based on our findings, percutaneous trigger finger release can safely be performed on all digits, including the thumb, small fingers, and index fingers.

Identification of the location of the A1 pulley combining palpation technique with palm landmarks and percutaneous release of A1 pulley with a 19-gauge needle: A cadaveric study

“…Further investigation is required as there were no cadaveric hands with trigger fingers available during this study. Flexor tendon injury is common in percutaneous release using the needle technique, 6,12,16,17 but Pope and Wolfe claimed it is not a sufficient complication. 18 To reduce the risk of flexor tendon injury, it is necessary to locate the needle tip superficially to the tendon, as described in this study.…”

“…If there is no paradoxical movement of the needle, it is safe to push the needle parallel to the A1 pulley, but not deep down. In concern about thumb nerve injury, 7,[16][17][18] we preciously used marked guidelines, the needle was inserted at the midline point of the flexor tendon, and approximation to the radial side was avoided. 17,19,20 In this study, no digital nerves were injured.…”

Sonographically Guided Percutaneous First Annular Pulley Release

“…20,36,41,43,49,58 The transducer was placed longitudinally over the metacarpophalangeal joint. 30,37,42,50,51 From this position, and using long-and short-axis views, all relevant structures were identified. The transducer was then moved over the A1 pulley, long axis to the tendons, providing a sonographic view of the proximal-distal extent of the pulley.…”

“…Since that time, multiple clinical and cadaveric studies have described percutaneous A1 pulley releases using large-gauge needles, scalpel blades, or specially designed cutting devices. 4,10,[18][19][20][21][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Proposed advantages of percutaneous A1 pulley release include the ability to perform the procedure in an office setting, reduced procedural time and costs, faster recovery time, and the avoidance of a potentially painful palmar incision. 10,19,21,25,30,32,34,36,41,50,51 Although percutaneous release has resolved triggering in 74% to 100% of reported cases, continued safety concerns have likely impeded more widespread adoption of this procedure.…”

Liberação percutânea do dedo em gatilho com micro bisturi oftalmológico vitreorretiniano de lâmina 19

“…Various methods using several instruments were reported afterwards. 3,[6][7][8][9][10] We used a knife designed for ophthalmologic surgery for the percutaneous release of trigger finger. We released 50 trigger fingers percutaneously with this blade.…”