Abstract
The purpose of this study was to describe and evaluate a new technique for ultrasound-guided percutaneous release of the annular pulley in trigger digit using a modified hypodermic needle. A total of 35 ultrasound-guided percutaneous releases were performed on 25 patients diagnosed and referred by hand surgeons in our institution over 16 months from October 2006. Inclusion criteria were as follows: adulthood, triggering present for at least 4 months, failure to respond to conservative management or steroid injections, no previous history of pulley release in the affected digit. Under ultrasound guidance, the affected pulley was released using a standard 19-gauge hypodermic needle bent at two points as the cutting device. Follow-up took place at 12 weeks and 6 months with improvement in triggering and clinically graded pain. At follow-up, no complications had occurred and all patients demonstrated improvement in their triggering, with complete resolution in 32 digits (91%), good improvement in 2 digits (6%) and some improvement in 1 digit (3%). This new technique uses a widely available and safe cutting device and is safe and can be used to provide definitive management for trigger finger, allowing the procedure to be performed in a variety of clinical settings.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Notta A (1850) Recherches sur une affection particulière des gaines tendineuses de la main. Arch Gen Med 24:142
Fleisch SB, Spindler KP, Lee DH (2007) Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review. J Am Acad Orthop Surg 15(3):166–171
Ryzewicz M, Wolf JM (2006) Trigger digits: principles, management, and complications. J Hand Surg [Am] 31(1):135–46
Jou IM, Chern TC (2006) Sonographically assisted percutaneous release of the A1 pulley: a new surgical technique for treating trigger digit. J Hand Surg [Br] 31(2):191–199
Lee JC, Healy JC (2006) Normal sonographic anatomy of the hand and wrist. Radiographics 25(6):1577–1590
Patel MR, Bassini L (1992) Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg [Am] 17(1):110–113
Turowski GA, Zdankiewicz PD, Thomson JG (1997) The results of surgical treatment of trigger finger. J Hand Surg [Am] 22(1):145–149
Gilberts EC, Beekman WH, Stevens HJ, Wereldsma JC (2001) Prospective randomized trial of open versus percutaneous surgery for trigger digits. J Hand Surg [Am] 26(3):497–500
Saldana MJ (2001) Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg 9(4):246–252
Panayotopoulos E, Fortis AP, Armoni A, Dimakopoulos P, Lambiris E (1992) Trigger digit: the needle or the knife? J Hand Surg [Br] 17(2):239–240
Lorthioir J Jr (1958) Surgical treatment of trigger-finger by a subcutaneous method. J Bone Joint Surg Am 40-A(4):793–795
Peterson WW, Manske PR, Bollinger BA, Lesker PA, McCarthy JA (1986) Effect of pulley excision on flexor tendon biomechanics. J Orthop Res 4(1):96–101
Bain GI, Turnbull J, Charles MN, Roth JH, Richards RS (1995) Percutaneous A1 pulley release: a cadaveric study. J Hand Surg [Am] 20(5):781–784 discussion 785–786
Cihantimur B, Akin S, Ozcan M (1998) Percutaneous treatment of trigger finger. 34 fingers followed 0.5–2 years. Acta Orthop Scand 69(2):167–168
Carrozzella J, Stern PJ, Von Kuster LC (1989) Transection of radial digital nerve of the thumb during trigger release. J Hand Surg [Am] 14(2 Pt 1):198–200
Dunn MJ, Pess GM (1999) Percutaneous trigger finger release: a comparison of a new push knife and a 19-gauge needle in a cadaveric model. J Hand Surg [Am] 24(4):860–865
Eastwood DM, Gupta KJ, Johnson DP (1992) Percutaneous release of the trigger finger: an office procedure. J Hand Surg [Am] 17(1):114–117
Ha KI, Park MJ, Ha CW (2001) Percutaneous release of trigger digits. J Bone Joint Surg Br 83(1):75–77
Heithoff SJ, Millender LH, Helman J (1988) Bowstringing as a complication of trigger finger release. J Hand Surg [Am] 13(4):567–570
Lyu SR (1992) Closed division of the flexor tendon sheath for trigger finger. J Bone Joint Surg Br 74(3):418–420
Pope DF, Wolfe SW (1995) Safety and efficacy of percutaneous trigger finger release. J Hand Surg [Am] 20(2):280–283
Stothard J, Kumar A (1994) A safe percutaneous procedure for trigger finger release. J R Coll Surg Edinb 39(2):116–117
Tanaka J, Muraji M, Negoro H, Yamashita H, Nakano T, Nakano K (1990) Subcutaneous release of trigger thumb and fingers in 210 fingers. J Hand Surg [Br] 15(4):463–465
Patel MR, Moradia VJ (1997) Percutaneous release of trigger digit with and without cortisone injection. J Hand Surg [Am] 22(1):150–155
Wilhelmi BJ, Mowlavi A, Neumeister MW, Bueno R, Ketchum J, Lee WP (2003) Surface landmarks to locate the thenar branch of the median nerve: an anatomical study. Plast Reconstr Surg 111(5):1612–1615
Lane LB (1995) Percutaneous release of the first annular pulley. J Hand Surg [Am] 20(5):785–786
Chern TC, Jou IM, Yen SH, Lai KA, Shao CJ (2005) Cadaveric study of sonographically assisted percutaneous release of the A1 pulley. Plast Reconstr Surg 115(3):811–822
Cebesoy O, Kose KC, Baltaci ET, Isik M (2007) Percutaneous release of the trigger thumb: is it safe, cheap and effective? Int Orthop 31(3):345–349
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rajeswaran, G., Lee, J.C., Eckersley, R. et al. Ultrasound-guided percutaneous release of the annular pulley in trigger digit. Eur Radiol 19, 2232–2237 (2009). https://doi.org/10.1007/s00330-009-1397-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-009-1397-3