US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases

Abstract

).q RSNA, 2016 Purpose:To evaluate the efficacy of ultrasonographically (US)-guided percutaneous treatment of the trigger finger by releasing the A1 pulley with a 21-gauge needle. Materials and Methods:This two-part study was approved by the ethics committee, and written consent was obtained from all patients. The first part consisted of 10 procedures on cadaver digits followed by dissection to analyze the effectiveness of the A1 pulley release and detect any collateral damage to the A2 pulley, interdigital nerves, or underlying flexor tendons. The second part was performed during an 18-month period starting in March 2013. It was a prospective clinical study of 60 procedures performed in 48 patients. Outcomes were evaluated through a clinical examination at day 0 and during a 6-month follow-up visit, where the trigger digit was evaluated clinically and the Quick Disabilities of the Arm, Shoulder and Hand outcome measure, or QuickDASH, and patient satisfaction questionnaires were administered. Results:No complications were found during the cadaver study. However, the release was considered "partial" in all fingers. In the clinical study, the trigger finger was completely resolved in 81.7% (49 of 60) of cases immediately after the procedure. Moderate trigger finger persisted in 10 cases, and one thumb pulley could not be released. A US-guided corticosteroid injection was subsequently performed in these 11 cases. At 6-month follow-up, only two cases still had moderate trigger finger and there were no late complications. The mean QuickDASH questionnaire score was 4; all patients said they were satisfied. Conclusion:US-guided treatment of the trigger finger by using a 21-gauge needle is feasible in current practice, with minimal complications.q RSNA, 2016

US-guided percutaneous release of the first extensor tendon compartment using a 21-gauge needle in de Quervain’s disease: a prospective study of 35 cases

“…US-guided percutaneous release with a needle has been performed successfully with another common type of stenosing tenosynovitis: trigger finger with A1 pulley transection [28][29][30][31]. In the context of trigger finger [28], the same technique induced partial anatomical release that was clinically effective. To our knowledge, there are few studies on percutaneous release of the first extensor tendon compartment with a needle.…”

“…Very few studies apply US-guided percutaneous release in the case of de Quervain's tenosynovitis [11,27]. The purpose of our study was to evaluate the effectiveness of US-guided release using a 21-gauge (G; 0.8mm) needle in this pathology, based on our experience with treating trigger finger using this technique [28].…”

Tendinosis in Trigger Finger

“…Few complications and figures of 82% to 100% relief of triggering are reported [228][229][230] . Multiple techniques have been presented, with or without the support of sonography.…”

“…Multiple techniques have been presented, with or without the support of sonography. There are indications that the postoperative pain is less in comparison to open surgery 230 , and that the active range of motion is recovered faster 231 , but no differences are found after the first postoperative week 228,229 .…”

“…In summary both percutaneous and open techniques have high success rates, few adverse effects 214,[228][229][230][231][232] and evidence that there is a difference between them are weak and conflicting 152 .…”