The percutaneous release approach has significantly better rehabilitation results than the open surgical techniques (Gilberts et al, 2001), but historically there has been concern that the percutaneous release has inherent risk not associated with the open release, including injury to adjacent structures such as the neurovascular bundle or tendon.

Study Results

This cadaveric study, tested whether ultrasound visualization would allow direct visualization of the A1 pulley and adjacent structures in addition to real-time guidance during the release. Chern et al (2005) performed ultrasound guided A1 pulley releases on 10 cadavers. In this study, there was a complete release in 48 of the 50 digits released (96 percent). In the partial releases, less than 2mm of the A1 pulley remained. There was no significant flexor tendon injury or laceration of the tendon. In 3 of the digits (6 percent), there was mild surface scratches noted. There was no digital nerve injury in any digit or significant injury to the A1 pulley.

In this study, Chern et al also performed 28 trigger finger releases in 20 patients and inn all cases there was complete relief of triggering symptoms with no complications noted and no recurrence.

Conclusion

This study demonstrated that percutaneous release of trigger digits can be effective in releasing the A1 pulley and is comparable to the release achieve by a traditional open release, but with several advantage:

• Can be performed under local anesthesia without a tourniquet
• Takes less time
• Produces less postoperative pain
• Requires less recovery time
• Allows patients to return to work sooner
• Precludes the possibility of a painful palmar scar
• Significantly less expensive

In clinical review, whether using a needle or other cutting devices the claimed rates of success were between 73.8 and 100% with the percutaneous release (Lorthioir, 1959; Tanaka et al, 1990; Eastwood et al, 1992; Lyu, 1992; Pope & Wolfe, 1995; Patel & Moradia, 1997; Cihantimur et al, 1998; Ha et a, 2001; Blumberg et al, 2001; Gilberts et al, 2001). The success of a percutaneous release in other cadaveric studies using similar techniques has not been as successful (Dunn & Pess, 1999; Bain et a, 1995; Pope & Wolfe, 1995). The authors found that using ultrasound guidance improves the rate of complete releases in this cadaveric study. Pecutaneous releases techniques using vague and subjective landmarks of skin creases and performed blind without guidance may account for the complications associated with unguided percutaneous techniques according to Chern et al, and in the present report ultrasound assisted percutaneous release of the A1 pulley produces minimal risks.

References

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