Modification of both the injection and surgical
technique might have an impact upon how these
methods fare in our comparison. For example if sub-
cutaneous injection is indeed efficacious, it might
make nonoperative management more attractive,
since we presume that a large part of the discomfort
associa~ed with traditional injection is related to dis-
tention of the tendon sheath. On the other hand,
simplification of the operative procedure, such as
subcutaneous or percutaneous pulley release, may
make surgery even less expensive and consequently
more attractive than injection. Tanaka et al.lO
reported a 74% good or excellent result with subcu-
taneous release, and Eastwood et al.-Il have reported
a 94% success rate with a percutaneous procedure.
If these methods prove to be safe and reliable, it
ultimately might be possible to perform them in the
physician's office; this would significantly reduce
the cost associated with operative care. However, we
have no experience with subcutaneous or percuta-
neous Al pulley release. Furthermore, we believe
that issues of safety and efficacy must be carefully