Percutaneous release of trigger finger without local anaesthesia as an outpatient procedure
Keywords:
Percutaneous release, Trigger Finger, Stenosing tenosynovitis, Without local anaesthesia
Abstract
Background: Stenosing tenosynovitis or trigger finger frequently involves the thumb and ring fingers of the dominant hand and more commonly seen in adult female population, in their 5th and 6th decades of life.
Method: In this study, 18-gauge needle was used for the percutaneous release of trigger finger without any local anaesthesia in 12 patients with prior consent.
Results: Highest numbers of patients were in 41-60 years age group (66.7%). 3 patients (25%) belong to 20-41 years age group. Only 1 patient (8.3%) of age group 61-80 was affected by trigger finger. 7 Patients (58.3%) were females and 5 patients (41.6%) were males. The most commonly affected finger was the ring (58.3%) followed by the middle (33.3%) and index (8.3%). Right hand and left hand was affected side in 8 (66.6%) and 4 (33.3%) patients respectively. According to greens classification, Grade II patients were 50%, grade III 41.6% and grade IV 8.3%. Average duration of the procedure was 5-7 minutes. There was no evidence of complications. 4 patients experienced mild postoperative pain. In one patient the procedure has to be abandoned as patient could not tolerate the pain.
Conclusion: As we do not use local anaesthesia localization of A 1 pulley in trigger finger is much easier for percutaneous release. Therefore, the procedure is more effective and time saving as well.
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References
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7. Salim N, Abdullah S, Sapuan J, Haflah NH. Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers. J Hand Surg Eur Vol.2012;37(1):27-34.doi:10.1177/1753193411415343. Epub 2011 Aug 4.
8. Kazuki K, Egi T, Okada M, Takaoka K. Clinical outcome of extrasynovial steroid injection for trigger finger. Hand Surg. 2006;11(1-2):1-4. doi:10.1142/S021 8810406003115
9. Pataradool K, Buranapuntaruk T. Proximal phalanx injection for trigger finger: randomized controlled trial. Hand Surg. 2011;16(3):313-317. doi:10.1142/S0218810 411005606
10. Tarbhai K, Hannah S, von Schroeder HP. Trigger finger treatment: a comparison of 2 splint designs. J Hand Surg Am. 2012;37(2):243-9, 249.e1. doi: 10. 1016/j. jhsa.2011.10.038. Epub 2011 Dec 20.
11. Chao M, Wu S, Yan T. The effect of miniscalpel-needle versus steroid injection for trigger thumb release. J Hand Surg Eur Vol. 2009;34(4):522-525. doi: 10. 1177/1753193409100961.
12. Ha KI, Park MJ, Ha CW. Percutaneous release of trigger digits: a technique and results using a specially designed knife. J Bone Joint Surg. 2001;83(1):75-77
13. Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg Am. 2006;31(1):135-146. doi:10.1016/j.jhsa.2005.10.013
14. Gilberts EC, Wereldsma JC. Long-term results of percutaneous and open surgery for trigger fingers and thumbs. Int Surg. 2002; 87(1):48-52.
15. Lorthioir J Jr. Surgical treatment of trigger-finger by a subcutaneous method. J Bone Joint Surg Am. 1958; 40-A(4): 793-795
16. Dierks U, Hoffmann R, Meek MF. Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial. Tech Hand Up Extrem Surg. 2008; 12 (3): 183-187. doi: 10. 1097/ BTH.0b013e31817f289a.
17. Pavlicný R. [Percutaneous release in the treatment of trigger digits]. Acta Chir Orthop Traumatol Cech. 2010;77(1):46-51.
18. Schramm JM, Nguyen M, Wongworawat MD. The safety of percutaneous trigger finger release. Hand (N Y). 2008; 3(1):44-6. doi: 10.1007/s11552-007-9069-8. Epub 2007 Sep 14.
19. Cebesoy O, Kose KC, Baltaci ET, Isik M. Percutaneous release of the trigger thumb: is it safe, cheap and effective? Int Orthop. 2007; 31(3): 345-349. Epub 2006 Jul 18. DOI: 10.1007/ s00264-006- 0180-1
20. Tanaka J. Percutaneous trigger finger release. Techniques in hand & upper extremity surgery. 1999;3 (1): 52-57.
21. Kiliç BA, Kiter AE, Selçuk Y. [The effect of percutaneous trigger finger release on normal anatomic structures and long-term results of the procedure]. Acta Orthop Traumatol Turc. 2002;36(3):256-258.
22. Saldana MJ. Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(4):246-252.
23. Marcus AM, Culver JE Jr, Hunt TR 3rd. Treating trigger finger in diabetics using excision of the ulnar slip of the flexor digitorum superficialis with or without A1 pulley release. Hand (N Y). 2007;2(4):227-231. doi: 10.1007/s11552-007-9065-z. Epub 2007 Jul 26.
24. Ballantyne J, Hooper G. The hand and diabetes. CurrOrthop. 2004;18(2):118–125.doi: https://doi.org /10. 1016/j.cuor.2004.02.007
25. Fitzgerald BT, Setty A, Mudgal CS. Gout affecting the hand and wrist. J Am Acad Orthop Surg. 2007;15 (10) : 625-635.
26. Fahey JJ, Bollinger JA. Trigger-finger in adults and children. JBJS. 1954;36(6):1200-1218.
27. Newport ML, Lane LB, Stuchin SA. Treatment of trigger finger by steroid injection. J Hand Surg. 1990; 15 (5):748-750. doi: https://doi.org/10.1016/0363-5023 (90) 90149-L
28. Patel MR, Bassini L. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am. 1992; 17 (1):110-113. doi:10.1016/0363-5023 (92) 90124-8
29. Weilby A. Trigger finger. Incidence in children and adults and the possibility of a predisposition in certain age groups. Acta Orthop Scand. 1970;41(4):419-427. doi:10.3109/17453677008991529
30.Freiberg A, Mulholland RS, Levine R. Nonoperative treatment of trigger fingers and thumbs. The Journal of hand surgery. 1989; 14(3): 553-538. doi:10.1016/s0363-5023 (89)80024-3
31. Manske PR, Lesker PA. Flexor tendon nutrition. Hand Clinics. 1985;1(1):13-24.
32. Pope DF, Wolfe SW. Safety and efficacy of percutaneous trigger finger release. J Hand Surg Am. 1995; 20 (2): 280-283. doi: 10. 1016/S0363-5023 (05) 80026-7
33. Carrozzella J, Stern PJ, Von Kuster LC. Transection of radial digital nerve of the thumb during trigger release. J Hand Surg Am. 1989; 14(2 Pt 1):198-200. doi: 10.1016/0363-5023(89)90006-3.
34. Ranjeet N, Sapkota K, Thapa P, Onta PR, Wahegoankar K, Thapa UJ, et al. Trigger Finger: A Prospective Randomised Control Trial Comparing Percutaneous Release versus Open Release. J Clinic Diagnostic Res. 2018;12(7): RC05-RC08. doi: 10.7860/ JCDR/2018/34100.11771
35. Bain GI, Turnbull J, Charles MN, Roth JH, Richards RS. Percutaneous A1 pulley release: a cadaveric study. J Hand Surg Am. 1995;20(5):781-784; discussion 785-6. doi:10.1016/S0363-5023(05)80430-7
36. Eastwood DM, Gupta KJ, Johnson DP. ercutaneous release of the trigger finger: an office procedure. J Hand Surg Am. 1992;17(1):114-117. doi:10.1016/0363-5023 (92) 90125-9
37. Lange-Riess D, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of trigger finger and trigger thumb in adults. Arch Orthop Trauma Surg. 2009; 129 (12): 1617-1619. doi: 10.1007/s00402-008-0802-8. Epub 2009 Jan 6.
2. Green DP, Hotchkiss RN, Pederson WC. Green’s Operative Hand Surgery. Elsevier Health Sciences; 4th Edition; 1999. p. 2029
3. Wojahn RD, Foeger NC, Gelberman RH, Calfee RP. Long-term outcomes following a single corticosteroid injection for trigger finger. J Bone Joint Surg Am. 2014;96 (22):1849-1854. doi: 10.2106/JBJS.N.00004.
4. Sampson SP, Badalamente MA, Hurst LC, Seidman J. Pathobiology of the human A1 pulley in trigger finger. J Hand Surg Am. 1991;16(4):714-721. doi:10. 1016/ 0363-5023(91)90200-u
5. Wolfe, S.W. Tenosynovitis. in: D.P. Green, R.N. Hotchkiss, W.C. Pederson, S.W. Wolfe (Eds.) Green's operative hand surgery. 5th ed. Churchill Livingstone, New York; 2005:2137-2158.
6. Yamada K, Masuko T, Iwasaki N. Rupture of the flexor digitorum profundus tendon after injections of insoluble steroid for a trigger finger. J Hand Surg Eur Vol. 2011; 36 (1):77-78. doi: 10.1177/175319341038 2377.
7. Salim N, Abdullah S, Sapuan J, Haflah NH. Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers. J Hand Surg Eur Vol.2012;37(1):27-34.doi:10.1177/1753193411415343. Epub 2011 Aug 4.
8. Kazuki K, Egi T, Okada M, Takaoka K. Clinical outcome of extrasynovial steroid injection for trigger finger. Hand Surg. 2006;11(1-2):1-4. doi:10.1142/S021 8810406003115
9. Pataradool K, Buranapuntaruk T. Proximal phalanx injection for trigger finger: randomized controlled trial. Hand Surg. 2011;16(3):313-317. doi:10.1142/S0218810 411005606
10. Tarbhai K, Hannah S, von Schroeder HP. Trigger finger treatment: a comparison of 2 splint designs. J Hand Surg Am. 2012;37(2):243-9, 249.e1. doi: 10. 1016/j. jhsa.2011.10.038. Epub 2011 Dec 20.
11. Chao M, Wu S, Yan T. The effect of miniscalpel-needle versus steroid injection for trigger thumb release. J Hand Surg Eur Vol. 2009;34(4):522-525. doi: 10. 1177/1753193409100961.
12. Ha KI, Park MJ, Ha CW. Percutaneous release of trigger digits: a technique and results using a specially designed knife. J Bone Joint Surg. 2001;83(1):75-77
13. Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg Am. 2006;31(1):135-146. doi:10.1016/j.jhsa.2005.10.013
14. Gilberts EC, Wereldsma JC. Long-term results of percutaneous and open surgery for trigger fingers and thumbs. Int Surg. 2002; 87(1):48-52.
15. Lorthioir J Jr. Surgical treatment of trigger-finger by a subcutaneous method. J Bone Joint Surg Am. 1958; 40-A(4): 793-795
16. Dierks U, Hoffmann R, Meek MF. Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial. Tech Hand Up Extrem Surg. 2008; 12 (3): 183-187. doi: 10. 1097/ BTH.0b013e31817f289a.
17. Pavlicný R. [Percutaneous release in the treatment of trigger digits]. Acta Chir Orthop Traumatol Cech. 2010;77(1):46-51.
18. Schramm JM, Nguyen M, Wongworawat MD. The safety of percutaneous trigger finger release. Hand (N Y). 2008; 3(1):44-6. doi: 10.1007/s11552-007-9069-8. Epub 2007 Sep 14.
19. Cebesoy O, Kose KC, Baltaci ET, Isik M. Percutaneous release of the trigger thumb: is it safe, cheap and effective? Int Orthop. 2007; 31(3): 345-349. Epub 2006 Jul 18. DOI: 10.1007/ s00264-006- 0180-1
20. Tanaka J. Percutaneous trigger finger release. Techniques in hand & upper extremity surgery. 1999;3 (1): 52-57.
21. Kiliç BA, Kiter AE, Selçuk Y. [The effect of percutaneous trigger finger release on normal anatomic structures and long-term results of the procedure]. Acta Orthop Traumatol Turc. 2002;36(3):256-258.
22. Saldana MJ. Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(4):246-252.
23. Marcus AM, Culver JE Jr, Hunt TR 3rd. Treating trigger finger in diabetics using excision of the ulnar slip of the flexor digitorum superficialis with or without A1 pulley release. Hand (N Y). 2007;2(4):227-231. doi: 10.1007/s11552-007-9065-z. Epub 2007 Jul 26.
24. Ballantyne J, Hooper G. The hand and diabetes. CurrOrthop. 2004;18(2):118–125.doi: https://doi.org /10. 1016/j.cuor.2004.02.007
25. Fitzgerald BT, Setty A, Mudgal CS. Gout affecting the hand and wrist. J Am Acad Orthop Surg. 2007;15 (10) : 625-635.
26. Fahey JJ, Bollinger JA. Trigger-finger in adults and children. JBJS. 1954;36(6):1200-1218.
27. Newport ML, Lane LB, Stuchin SA. Treatment of trigger finger by steroid injection. J Hand Surg. 1990; 15 (5):748-750. doi: https://doi.org/10.1016/0363-5023 (90) 90149-L
28. Patel MR, Bassini L. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am. 1992; 17 (1):110-113. doi:10.1016/0363-5023 (92) 90124-8
29. Weilby A. Trigger finger. Incidence in children and adults and the possibility of a predisposition in certain age groups. Acta Orthop Scand. 1970;41(4):419-427. doi:10.3109/17453677008991529
30.Freiberg A, Mulholland RS, Levine R. Nonoperative treatment of trigger fingers and thumbs. The Journal of hand surgery. 1989; 14(3): 553-538. doi:10.1016/s0363-5023 (89)80024-3
31. Manske PR, Lesker PA. Flexor tendon nutrition. Hand Clinics. 1985;1(1):13-24.
32. Pope DF, Wolfe SW. Safety and efficacy of percutaneous trigger finger release. J Hand Surg Am. 1995; 20 (2): 280-283. doi: 10. 1016/S0363-5023 (05) 80026-7
33. Carrozzella J, Stern PJ, Von Kuster LC. Transection of radial digital nerve of the thumb during trigger release. J Hand Surg Am. 1989; 14(2 Pt 1):198-200. doi: 10.1016/0363-5023(89)90006-3.
34. Ranjeet N, Sapkota K, Thapa P, Onta PR, Wahegoankar K, Thapa UJ, et al. Trigger Finger: A Prospective Randomised Control Trial Comparing Percutaneous Release versus Open Release. J Clinic Diagnostic Res. 2018;12(7): RC05-RC08. doi: 10.7860/ JCDR/2018/34100.11771
35. Bain GI, Turnbull J, Charles MN, Roth JH, Richards RS. Percutaneous A1 pulley release: a cadaveric study. J Hand Surg Am. 1995;20(5):781-784; discussion 785-6. doi:10.1016/S0363-5023(05)80430-7
36. Eastwood DM, Gupta KJ, Johnson DP. ercutaneous release of the trigger finger: an office procedure. J Hand Surg Am. 1992;17(1):114-117. doi:10.1016/0363-5023 (92) 90125-9
37. Lange-Riess D, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of trigger finger and trigger thumb in adults. Arch Orthop Trauma Surg. 2009; 129 (12): 1617-1619. doi: 10.1007/s00402-008-0802-8. Epub 2009 Jan 6.
CITATION
DOI: 10.17511/ijoso.2019.i04.05
Published: 2019-10-31
How to Cite
Kumar Malviya, V., & Kripal Soni, R. (2019). Percutaneous release of trigger finger without local anaesthesia as an outpatient procedure. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 5(4), 259-265. https://doi.org/10.17511/ijoso.2019.i04.05
Section
Original Article
OAI - Open Archives Initiative
Therapoid
