Background

Surgery for trigger finger involves surgically dividing the A1 pulley, and this can be performed with an open or percutaneous approach. The open approach has long been considered the “gold standard” because the flexor tendons and sheath can directly be visualized. However, complications with open surgery, including wound infection, scar tenderness, flexor tendon bowstring, and a long recovery time (Finsen & Hagen, 2003).

Percutaneous trigger finger release can be performed using different instruments and needles (Rajeswaran et al, 2009; Eastwood et al, 1992; Lapègue et al, 2016; Saengnipanthkulet al, 2014; Colberg et al, 2022). There are only a few publications regarding a limited-open trigger finger release. It is also sometimes confused with the percutaneous approach, but typically involve an incision and knife (Lorthioir, 1958; Nikolaou et al, 2017; Dunn & Pess, 1999; Pan et al, 2019; Lee et al, 2018). In addition, few studies have compared the success rate with using ultrasound guidance for trigger finger release compared to an unguided or blind approach (Lee et al, 2018).

Unguided blind percutaneous A1 pulley release was introduced by Lorthioir in 1958. With unguided blind releases the surgeon cannot visualize the surrounding structures directly, and there is a potential risk of injury to the tendon, nerves or blood vessels. In addition, without direct visualization the surgeon cannot confirm that a full release has been performed.

Ultrasound is clearly a valuable tool to resolve this problem. The first paper on ultrasound-guided percutaneous trigger figner release was published by Jou and Chern in 2006. A recent systematic review found that percutaneous release using the ultrasound-guided technique had a higher success rate compared to a blind release (Lee et al, 2018).

Study Results:

In a recent paper by Muramatsu et al (2022), the authors compared a limited-open release using a Yasunaga knife with ultrasound-guidance compared to an unguided release. The authors performed 138 trigger finger releases on 111 patients. In this study, triggering disappeared in all patients that underwent the US-guided group, while six patients in the blinded group had residual triggering. This difference was statistically significant (p = 0.03). In this study with the limited-open release patients averaged approximately 1-week of post-operative pain with the majority of patient reporting being satisfied with the outcomes.

Conclusions:

Our results show that US-guided A1 and proximal A2 pulley release using the Yasunaga knife had an excellent success rate. Complete release of finger triggering occurred in 100% of the patients with the US-guided technique, while the rate of incomplete release was lower when the procedure was performed blind and without ultrasound guidance.

What treatment options do you have with trigger finger?

The management of trigger finger has 3 main options: nonoperative care, traditional surigcal release or percutaneous release.

What are the advantages of the percutaneous trigger finger release?

The advantages of a percutaneous trigger finger release is that it is performed in the outpatient setting, uses local anesthetic and can be performed in several minutes with some studies reporting a 97% success rate (Bain and Wallwork). The small incision also allows for a faster return to activity or work.

References:

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2. Colberg RE, Jurado Vélez JA, Garrett WH, Hart K, Fleisig GS. Ultrasound-guided microinvasive trigger finger release technique usingan 18-gauge needle with a blade at the tip: A prospective study. PM R. 2022 Aug;14(8):963-970.
3. Dunn MJ, Pess GM. Percutaneous trigger finger release: Acomparison of a new push knife and a 19-gauge needle in a cadaveric model. J Hand Surg Am. 1999;24(4):860–865.
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