The effect of percutaneous trigger finger release on normal anatomic structures and long-term results of the procedure
| Acta Orthop Traumatol Turc. 2002;36(3):256-8. | Related Articles, Links |
The effect of percutaneous trigger finger release on normal anatomic structures and long-term results of the procedure
[Article in Turkish]
Kilic BA, Kiter AE, Selcuk Y.
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Medicine Faculty of Pamukkale University, Denizli, Turkey. [email protected]
OBJECTIVES: To evaluate the long-term results and possible complications of percutaneous release in the treatment of trigger finger. METHODS: We performed percutaneous pulley release with the use of a 16 gauge needle in 25 fingers of 22 patients (16 females, 6 males; mean age 54 years; range 45 to 72 years). Open exploration was added to the procedure in 10 patients to determine the efficacy and safety of the technique. The mean follow-up was 24 months (range 18 to 35 months). RESULTS: Triggering and pain were eliminated in all fingers postoperatively. Exploration showed that a complete anatomical release of the pulley was obtained in all fingers. Apart from some superficial abrasions, there were no tendinous injury or other complications. In one case, an unintentional skin incision occurred during manipulation of the needle. CONCLUSION: Due to low complication rates and ease of the procedure with a successful release, percutaneous technique proved an appropriate alternative in the treatment of trigger finger.
ความเห็น (9)
Percutaneous release of trigger digit with and without cortisone injection
Patel MR. Moradia VJ. Journal of Hand Surgery - American Volume. 22(1):150-5, 1997 Jan. Percutaneous release was done using the tip of an 18-gauge, 2.5-cm-long needle, mounted on a 3-mL3 syringe in 225 trigger digits. It was successful in 92 (89%) of the digits without cortisone injection (n = 105) and in 115 (96%) of the digits with cortisone injection (n = 120). Negligible or intermittent pain persisted for 8 weeks in the noncortisone group and 6 weeks in the cortisone group after percutaneous release. Of the first 10 digits, 2 needed repeat percutaneous release. With modification of technique, the incidence of repeat percutaneous release was zero in both groups. Open release was needed in 8% in the noncortisone group and 3% in the cortisone group. The procedure was done under local infiltration anesthesia in the office. This reduced patient anxiety, inconvenience and hospital cost.
Percutaneous release of the trigger finger: an office procedure
Eastwood-D-M. Gupta-K-J. Johnson-D-P. Department of Orthopaedic Surgery, University of Bristol, England. J-Hand-Surg-[Am]. 1992 Jan. 17(1). P 114-7. A new technique for percutaneous release of the trigger finger is described. A 21-gauge hypodermic needle is used to release the A1 pulley. The technique is effective, convenient, safe, and well tolerated by patients. Thirty-three of 35 procedures (94%) led to complete relief of symptoms, and in the remaining two digits partial symptomatic relief was achieved. There were no significant complications. After a mean follow-up of 13 months, there had been no recurrences. This technique should be the treatment of choice for the established trigger finger with symptoms of more than 4 months' duration. Author-abstract
Closed division of the flexor tendon sheath for trigger finger
Lyu-S-R. J-Bone-Joint-Surg- [m[Br]. 1992 [1mMay [m. 74(3). P 418-20. Closed tenotomy was used to treat triggering of the fingers and thumb in 54 patients. In 56 digits the method was successful; in seven it was a simple matter to proceed to open tenotomy. With experience, the closed procedure can be completed within minutes without risk of damaging the digital nerves. Author-abstract.
Trigger Fingers in Children
Ninety percent of pediatric trigger digits are trigger thumbs. It is a rare condition affecting less than 0.05% of children. In children trigger thumbs do not trigger but remain locked in a flexed position. Palpation of a Notta’s node on the flexor pollicis longus tendon in the area of the thumb A-1 pulley is an important clinical sign differentiating a trigger thumb from other more severe clasped thumb anomalies. Controversy remains concerning the congenital versus acquired nature of pediatric trigger thumbs and the rate of spontaneous resolution. Most patients who present with a trigger thumb are older than 6 months of age.
The reported rate of spontaneous resolution of pediatric trigger thumbs has varied between 0% and 49%. There are multiple conflicting reports in which some documented a marked rate of spontaneous resolution, with other investigators noting that nearly all trigger thumbs persisted. The rate of successful conservative treatment is increased with splinting of the MCP joint in some studies.
Pediatric trigger thumbs respond predictably to a simple A-1 pulley release. A thumb with normal range of motion can be expected immediately after the procedure. McAdams et al 27 investigated the long-term results of pediatric A-1 pulley release at an average of 15 years after surgery. There was no recurrence of triggering. Five of 21 patients had an average of 15° reduced interphalangeal joint motion and 4 of 21 patients showed MCP joint hyperextension; however, no patient complained of functional limitation. The most common concern was scar appearance, which was associated with a longitudinal instead of a transverse incision in the skin crease.
A delay in surgical intervention does not have adverse consequences. Multiple studies have documented good outcomes even in patients for whom surgical release was delayed up to 4 years after the onset of symptoms. Although the existing literature is far from conclusive, a trial of splint therapy is appropriate before performing an A-1 pulley release for pediatric trigger thumb.
Pediatric trigger finger is about one tenth as common as trigger thumb. 28 Some patients present with a fixed flexion deformity. Similar to adult trigger digits, however, snapping and triggering is often the chief complaint. Cardon et al 28 reported a high incidence of flexor tendon abnormalities in these children. In their series of 33 trigger fingers in 18 patients, 8 patients had continued triggering after A-1 pulley release. Documented abnormalities included a more proximal than normal decussation of the FDS, a slip of FDS that inserted into the FDP tendon, nodules in the tendon, and a stenotic A-3 pulley. These patients were treated with USSR, with 2 patients also having an A-3 pulley release. No patient had recurrence of triggering.
Percutaneous trigger finger release was suggested as early as 1850 by Notta, A.. Without direct visualization, damage to the neurovascular structure is possible. The potential benefits be weighed against the potential risk. Since April, 1994 to May, 1996. Percutaneous release of trigger finger were done in 97 patients, including 23 male 74 female, mean age was 48, there are 65digits in right hand, 37 digits in left, including 63 thumb, 2 index, 30 middle finger and 7 ring finger. All the cases were performed as office procedure, patient sit in front of surgeon, under 2 ml 2% Xylocaine, a 18or 19 gauge needle is placed perpendicular to palm skin and touch down to Al pulley, cut the hypertrophied pulley longitudinally, till the locking or snapping disappear. There is no nerve injury, 10 cases with subcutaneous hematoma, but no circulatory problem, 3 incomplete release that needs second procedure. All cases improved except one case with Rheumatoid arthritis and combined with hyperuricemia, the did not subside until anti-gout therapy carried out.
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AUTORS:EDSON SASAHARA SATO, WALTER MANNA ALBERTONI, VILNEI MATTIOLI LEITE, JOÃO BAPTISTA GOMES DOS SANTOS, FLAVIO FALOPPA The purpose of this work is to assess, in a prospective study the results from the treatment of trigger finger by the percutaneous release of A1 pulley, and the complications associated to the method used. This prospective assessment was performed at the Disciplina de Cirurgia da Mão e Membro Superior do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina da Universidade Federal de São Paulo (DCMMS-DOT-EPM-Unifesp), from October 1999 to April 2002. The material comprised 76 trigger fingers of 65 patients, who had had an outpatient-based percutaneous release of A1 pulley with a hypodermic 40 x 12 gauge needle. The authors employed as inclusion criteria cases from type I to type IV trigger fingers. They excluded trigger fingers of the congenital type and the thumb trigger digit. After the percutaneous release of the trigger finger, they achieved symptom remission. There was no need to convert any intervention to the open method. There were three (4%) recurrences. All patients had complained of non-disabling pain around the region where the needle was introduced for a period that ranged from one to four weeks. The authors observed the formation of a small hematoma on the puncture site in all patients, which spontaneously receded during the first week. The treatment method by percutaneous approach has demonstrated to be efficient, resulting in a 100% pathology correction. They noticed three (4%) fingers with trigger recurrence during the follow-up. There were no complications such as nerve injury or flexor tendon dysfunction. |
| Percutaneous release of trigger fingers and thumbs | |
| Authors: | Anuntaseree, S; Vichachai, K |
| Source: | Songklanakarin Medical Journal 1993 Jul-Sep; 11(3): 155-9 |
| Summary: | A modified Tanaka's percutaneous releasing technique for stenosed flexor tendon sheaths of the hands were performed in 17 trigger fingers and 3 trigger thumbs. After an average of 30 days follow-up, the use of Tanaka's scoring system resulted 60 percent excellent, 25 percent good, 10 percent fair and 5 percent poor, Fourteen minor complications were detected :- Tenderness at scar in 7, stiff finger in 5 and painful finger on motion in 2. The authors feel that this technique is good and quite simple for surgeons who are used to the anatomy of the hands. |
| Subjects: | Fingers; Tenosynovitis |
Percutaneous trigger finger release: the ‘lift-cut’ technique
R. Ragoowansi
, 
, A. Acornley and C.T. Khoo
Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Slough SL2 4HL, UK
Received 2 November 2004; accepted 6 April 2005. Available online 3 June 2005.
Summary
One hundred and eighty patients with 240 trigger digits were treated by percutaneous release using a ‘lift-cut’ technique. All patients were reviewed at 3 months following release. Overall, 94% achieved an excellent or good result. Ten patients experienced recurrent symptoms and required a subsequent open release. There was no clinical evidence of digital nerve or flexor tendon injury. We recommend this technique as a safe and effective outpatient procedure.
Keywords: Trigger finger; Stenosing tenosynovitis; Percutaneous release 
This paper was presented at the British Association of Plastic Surgeons Winter Meeting—December 2002.Corresponding author. Address: 70 St John's Wood Court, St John's Wood Road, London NW8 8QS, UK. Tel.: +44 7775 712739; fax: +44 207 486 5248.
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Vichai Vijitpornkul
Percutaneous Soft Tissue Procedures
Percutaneous procedures for soft tissue injuries include treatment for trigger finger, a condition in which a tendon becomes entrapped within a tight sheath in the palm, and painfully snaps during routine use of the hand. Release is provided by dividing the stenotic sheath. In traditional surgery, this required an open incision in the palm of the hand. Percutaneous technique allows the surgeon to accomplish the same surgical result without an incision, using a special needle.
 Illustration of trigger finger |
 Illustration of percutaneous trigger finger release |
Treatment for carpal tunnel syndrome, while not strictly defined as a percutaneous procedure, is somewhat similar. In this condition, the patient experiences pain and numbness in the hand as a result of compression of the median nerve in the carpal tunnel of the wrist. To alleviate this pressure, some hand surgeons utilize an endoscopic technique rather than the traditional open surgery. Small instruments are inserted beneath the skin to identify and release the transverse carpal ligament. The procedure creates more room in the carpal tunnel and relieves nerve compression.
These mini-incision techniques have been shown to provide comparable long-term results to traditional, open surgery and provide a quicker return to activities in the short-term. It also provides a good option for patients who cannot tolerate a large incision in the palm of the hand, such as those who rely on a cane or crutches for ambulation.
Complications, Outcomes and Advanced Procedures
Minimally invasive surgery has been shown to be safe and effective for a number of hand and wrist conditions. However, no surgery is without risk. The surgeries, not unlike their open counterparts, still involve the possibility of nerve or blood vessel injury. According to Dr. Wolfe, the best way to ensure a successful outcome and minimize that risk is to seek care from an orthopaedic surgeon with specialized training and experience in surgery of the hand.
"These procedures are not replacing traditional surgery," he adds. "While they may ultimately prove to result in better and faster recovery, they are not appropriate for everyone. Electing to have minimally-invasive hand or wrist surgery is a patient and surgeon-guided decision."
Advanced Procedures
With the growing interest in, and successful outcomes of minimally invasive surgery, Dr. Wolfe anticipates that more procedures will become available in the future, including-with the development of smaller instrumentation-use of arthroscopy in smaller, tighter joints.
Dr.Scott W. Wolfe