Outpatient Percutaneous Release of Trigger Finger: A Cost Effective and Safe Procedure

Ultrasound-guided acupotomy release of A1 pulley in the treatment of trigger thumb: A case report

RATIONALE

Trigger thumb, characterized by A1 pulley thickening secondary to tendon sheath stenosis, represents a common clinical entity. While multiple therapeutic options exist, ultrasound-guided acupotomy has gained significant clinical adoption in China yet remains inadequately documented in the scientific literature. This study reports a case of trigger thumb managed with ultrasound-guided acupotomy.

PATIENT CONCERNS

A 49-year-old female presented with a 3-month history of audible clicking and discomfort during flexion-extension of the left thumb. Physical examination revealed pain, swelling, and persistent tenderness localized to the base and palmar aspect of the affected thumb, exacerbated by routine manual activities. No antecedent trauma was reported. A significant reduction in the left thumb's range of motion was objectively documented.

DIAGNOSES

The patient was diagnosed with trigger thumb (stenosing tenosynovitis) based on characteristic clinical manifestations and physical findings.

INTERVENTIONS

Ultrasound-guided acupotomy was performed to release the stenosed A1 pulley of the left thumb.

OUTCOMES

Postintervention outcomes included immediate pain resolution, complete cessation of clicking sounds, significant restoration of thumb range of motion, and functional recovery of the affected digit.

LESSONS

This case demonstrates that ultrasound-guided acupotomy achieves rapid and substantial therapeutic efficacy in trigger thumb management. The technique preserves tendon integrity while minimizing procedural risks, establishing its potential as a valuable clinical intervention warranting broader investigation and application.

Comparative results of percutaneous and open surgery for trigger fingers: a propensity score analysis

Background and objectives

Trigger finger is a common hand condition characterized by the locking of a digit, often requiring surgical intervention when conservative treatments fail. This study aimed to compare the outcomes of a modified percutaneous release technique with those of traditional open release surgery.

Materials and methods

A retrospective cohort study was conducted on 245 patients (287 digits), of which 161 digits underwent open release and 126 underwent percutaneous release. A modified technique for percutaneous release was described. Propensity score matching was used to balance the data. Cox regression and Laplace regression were applied to analyze the hazard ratio and median survival time for pain relief and time to return to work. Adverse events were also reported.

Results

The duration of pain relief in the percutaneous release group was shorter than that in the open release group (hazard ratio = 1.73, 95% CI: 0.98-3.06; p = 0.057). Fifty percent of patients in the percutaneous release group experienced pain relief within two days, compared to seven days in the open release group (p = 0.003). Time to return to work was significantly shorter in the percutaneous release group than in the open release group (hazard ratio = 2.93, 95% CI: 2.08-4.13; p < 0.001). Fifty percent of patients in the percutaneous release group returned to work within three days, compared to 15 days in the open release group (p < 0.001). Three digits (2.4%) required conversion to open release due to the failure of percutaneous release. No nerve injuries or recurrences were observed at a follow-up of 42.2 ± 2.2 months.

Conclusions

Percutaneous release resulted in an earlier return to work and a high success rate (97.6%) with no nerve injuries or recurrences over 42 months. Despite a 2.4% failure rate, careful technique minimized complications. Further randomized trials are needed to confirm these findings and optimize patient selection.

An innovation percutaneous needle knife use for trigger finger: A retrospective cohort study

Objectives

This study retrospectively evaluated the effectiveness of percutaneous pulley release by our newly designed needle knife in terms of cure, relapse, and complication rates.

Materials and Methods

Two hundred and fifty-seven patients were allocated into male and female groups between October 2014 and September 2021. We included patients >15 years of age with a trigger finger (TF) (types II-VI). The primary outcome was the absence of a TF and pain-free movement. In contrast, the secondary outcome included second-time surgery and the number of complications such as infection and admission for antibiotics.

Results

One hundred patients were male, and 157 patients were female. Males and females had mean ages of 62.45 ± 11.76 and 61.50 ± 8.57 years, respectively. The operative time was significantly longer in males than in females (7.88 ± 6.02 vs. 6.52 ± 3.74 min in males and females, respectively, P = 0.027). However, the percentages of diabetes mellitus and gout were the same in both groups. For the percutaneous methods with our needle knife, remission of the trigger was achieved in all cases. In addition, seven patients received revision and three patients with complications. After needle surgery, topical and joint pain scores were improved in both groups (from 5.09 ± 1.31 to 0.80 ± 1.56).

Conclusion

The percutaneous methods with our needle knife displayed effectiveness. The cure rate was high, and the relapse rate was low. Further large-scale clinical trials comparing percutaneous needle to open surgery for releasing the TF will be needed to confirm our results.

Treatment of Trigger finger by ultrasound-guided needle release of a1 pulley: A series of 105 cases

INTRODUCTION

We aimed to evaluate the efficacy and tolerance of A1 pulley release using the needle technique, under ultrasound guidance, in patients with symptomatic trigger finger.

METHODS

All patients with symptomatic trigger finger underwent A1 pulley release using an intramuscular 21 gauge (G) needle. Quinnell grade (I-IV), Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score (0-100) and pain score on a visual analog scale (VAS: 0-10mm) were recorded at inclusion. The primary endpoint was complete resolution of the trigger finger at 6 months.

RESULTS

Eighty-four patients totaling 105 treated digits were included. Mean age was 63.3±10.7 years. Prior to treatment, mean VAS pain score was 5.8±2.6mm, and mean QuickDASH score was 44.3±19.1. At 6 months, disappearance of symptoms was achieved in 85 of 91 digits with follow-up (93.4%), and in 85.7% at 12 months. The absolute reduction in VAS pain and QuickDASH scores at 6 months was respectively 4.1±3.1 (P<0.001) and 36.1±20.7 (P<0.001), and 90% of patients reported being satisfied or very satisfied at 6 months. Long duration of symptoms was significantly associated with persistent trigger finger at 6 months after intervention. Complications were rare and minor. Tenosynovitis occurred in 5.7% of cases, for which a corticosteroid injection into the tendon sheath rapidly led to favorable resolution.

CONCLUSION

Treatment of trigger finger by release of the A1 pulley under ultrasound guidance using the needle technique is a mildly invasive technique that yields rapid and effective symptom resolution with good tolerance up to 12 months.

Diagnosis and Treatment of Trigger Finger in Brazil - A Cross-Sectional Study

Objective  The present paper aims to evaluate the therapeutic planning for trigger finger by Brazilian orthopedists. Methods  This is a cross-sectional study with a population composed of participants from the 2018 Brazilian Congress on Orthopedics and Traumatology (CBOT-2018, in the Portuguese acronym), who answered a questionnaire about the conduct adopted for trigger finger diagnosis and treatment. Results  A total of 243 participants were analyzed, with an average age of 37.46 years old; most participants were male (88%), with at least 1 year of experience (55.6%) and from Southeast Brazil (68.3%). Questionnaire analysis revealed a consensus on the following issues: diagnosis based on physical examination alone (73.3%), use of the Quinnell classification modified by Green (58.4%), initial nonsurgical treatment (91.4%), infiltration of steroids combined with an anesthetic agent (61.7%), nonsurgical treatment time ranging from 1 to 3 months (52.3%), surgical treatment using the open approach (84.4%), mainly the transverse open approach (51%), triggering recurrence as the main nonsurgical complication (58%), and open surgery success in > 90% of the cases (63%), with healing intercurrences (54%) as the main complication. There was no consensus on the remaining variables. Orthopedists with different practicing times disagree on treatment duration ( p  = 0.013) and on the complication rate of open surgery ( p  = 0.010). Conclusions  Brazilian orthopedists prefer to diagnose trigger finger with physical examination alone, to classify it according to the Quinnell method modified by Green, to institute an initial nonsurgical treatment, to perform infiltrations with steroids and local anesthetic agents, to sustain the nonsurgical treatment for 1 to 3 months, and to perform the surgical treatment using a transverse open approach; in addition, they state that the main nonsurgical complication was triggering recurrence, and report open surgery success in > 90% of the cases, with healing intercurrences as the main complication.

Efficacy Analysis of Day Surgery A1 Pulley Release for Pediatric Trigger Thumb

Objective: To investigate clinical application of day surgery A1 pulley release for pediatric trigger thumb. Methods: We retrospectively analyzed the clinical data of 1,642 children with trigger thumb who were treated with day surgery A1 pulley release at our hospital, including satisfaction surveys, functional recovery, and complications. Results: The operative time for unilateral and bilateral tenolysis was 4.8 ± 3.1 and 9.2 ± 3.8 min, respectively. Three children had postoperative fever and were discharged on the 2nd day after surgery. The rest of the children were discharged on the day of surgery. All incisions healed primarily, and no complications of vascular and nerve injury were reported. The patients' degree of satisfaction with the medical treatment process, diagnosis and treatment workflow, treatment effectiveness, length of hospital stay and hospitalization cost, and discharge guidance were 97.9, 96.1, 99.3, 91.1, and 98.5%, respectively. The follow-up period was between 5 months and 3 years and 1 month. Four children experienced symptom relapse after the operation, and re-tenolysis was performed in one of them. At the final follow-up, the appearance and function of the thumb had recovered well in all cases. Conclusion: Day surgery A1 pulley release can effectively release tendon sheaths and has a short operative time, no complications of vascular and nerve injury, and good recovery of thumb function. It is a safe and reliable procedure with high patient satisfaction, and it is worthy of clinical promotion.

Ultrasound-Guided Microinvasive Trigger Finger Release Technique Combined With Three Tests to Confirm a Complete Release

OBJECTIVE

Trigger finger at the A1 pulley is a common cause of hand pain leading to functional limitations. This study evaluated the outcomes of patients treated with a microinvasive ultrasound-guided trigger finger release technique using an 18 blade and described three tests that confirm a complete release.

DESIGN

A retrospective chart review and cross-sectional study of 46 cases of A1 pulley trigger finger releases in 28 patients performed at a private, sports medicine clinic using this technique were completed, meeting power criteria. The primary outcome measure was the resolution of mechanical catching/locking; secondary outcome measures were reduction in visual analog scale for pain and improvement of function in the modified Nirschl scale.

RESULTS

Complete release was achieved in all patients, with no recurrence of catching/locking during the first year (P < 0.0001). Ninety-eight percent of patients had significant pain and functional improvement (P < 0.0001). There were no complications perioperatively and postoperatively. The three confirmatory tests ensured that all cases obtained a successful outcome.

CONCLUSION

This technique combined with confirmatory tests resulted in full resolution of the locking for all patients and statistically significant reduction in pain and improvement in function.

A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook

Trigger finger (TF) is a common referral to a hand surgeon, with people with diabetess being the most at-risk population. Abnormal thickening, scarring, and inflammation occur at the A1 pulley and flexor tendon, and histological changes correlate well with the clinical severity of TF. Corticosteroid injections decrease the thickness of the A1 pulley and are considered a first-line treatment. However, corticosteroids are only moderately effective, especially for people with diabetes. Patients may elect for surgery if nonoperative treatments prove ineffective; some may choose immediate surgical release instead. To release the A1 pulley, patients have the option of an open or percutaneous approach. The open approach has a greater risk of infection and scar tissue formation in the short run but an overall superior long-term outcome compared with the percutaneous approach.

METHODS

We critically reviewed the efficacy and cost-effectiveness of the treatment methods for TF through a comprehensive search of the PubMed Database from 2003 to 2019.

RESULTS

To reduce costs, while still delivering the best possible care, it is critical to consider the likelihood of success for each treatment method in each subpopulation. Furthermore, some patients may need to return to work promptly, which ultimately may influence their desired treatment method.

CONCLUSIONS

Currently, there is no universal treatment algorithm for TF. From a purely financial standpoint, women without diabetes presenting with a single triggering thumb should attempt 2 corticosteroid trials before percutaneous release. It is the most cost-effective for all other subpopulations to elect for immediate percutaneous release.

Outcome of Percutaneous Release for Trigger Digits in Diabetic and Non-diabetic Patients

Introduction

Trigger finger (TF) is a common cause of hand pain, swelling, and limited motion. It is common in women and in the thumb. Diabetes mellitus (DM) increases the risk of TF. Individuals with DM who develop TF are resistant to both medical and surgical interventions. The aim of this study is to compare the outcomes of percutaneous trigger release in diabetic and nondiabetic patients.

Methods

Fifty diabetic and 50 non-diabetic patients with a clinical diagnosis of TF were included after informed consent. Percutaneous trigger release was performed in all of them. Follow-ups for pain and/or neurovascular complications were taken after one week, one month, and six months. Data were entered and analyzed using SPSS v. 22 (IBM Corp., Armonk, NY, US).

Results

In the diabetic group, 86% of patients had TF of grade III or above and in the non-diabetic group, 76% of patients had TF of grade III or above. At the one-week follow-up, 79.2% diabetic patients still had mild to severe pain and 60.4% non-diabetic patients had mild to severe pain. By one month, 40% patients in the diabetic group still reported mild to moderate pain, however, all patients in the non-diabetic group reported no pain. By six months, nine (20%) diabetic patients reported mild pain. There was no incidence of infection or neurovascular damage at any follow-up in the non-diabetic group, and in the diabetic group, 4.2% of patients had an infection on the one-week follow-up.

Conclusion

Percutaneous trigger finger release is a safe, reliable, time-saving, and cost-effective procedure for the management of trigger finger in both diabetic and non-diabetic patients.

Surgical Treatment of Supracondylar Humeral Fractures in a Freestanding Ambulatory Surgery Center is as Safe as and Faster and More Cost-Effective Than in a Children's Hospital

BACKGROUND

Despite an 88% increase in the number of pediatric fractures treated in ambulatory surgery centers (ASCs) over a 10-year period, few studies have compared outcomes of fracture treatment performed in a freestanding ASC compared with those performed in the hospital (HOSP) or hospital outpatient department (HOPD). The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of Gartland type II supracondylar humeral (SCH) fracture in the ASC, HOSP, and HOPD.

METHODS

Retrospective review identified pediatric patients with isolated Gartland type II SCH fractures who had closed reduction and percutaneous pinning (CRPP) by board-certified orthopaedic surgeons from January 2012 to September 2016. On the basis of the location of their treatment, patients were divided into 3 groups: HOSP, HOPD, and ASC. All fractures were treated with CRPP under fluoroscopic guidance using 2 parallel or divergent smooth Kirschner wires. Radiographs obtained before and after CRPP and at final follow-up noted the anterior humeral line index (HLI) and Baumann angle. Statistical analysis compared all 3 groups for outcomes, complications, treatment time/efficiency, and charges.

RESULTS

Record review identified 231 treated in HOSP, 35 in HOPD, and 50 in ASC. Radiographic outcomes in terms of Baumann angle and HLI did not differ significantly between the groups at any time point except preoperatively when the HLI for the HOSP patients was lower (P=0.02), indicating slightly greater displacement than the other groups. Overall complication rates were not significantly different among the groups, nor were occurrences of individual complications. The mean surgical time was significantly shorter (P<0.0001) in ASC patients than in HOPD and HOSP patients, and total charges were significantly lower (P<0.001).

CONCLUSIONS

Gartland type II SCH fractures can be safely treated in a freestanding ASC with excellent clinical and radiographic outcomes equal to those obtained in the HOSP and HOPD; treatment in the ASC also is more efficient and cost-effective.

LEVEL OF EVIDENCE

Level III-retrospective comparative study.