Percutaneous Release of Trigger Fingers

Open versus percutaneous release for trigger digits: Reversal between short-term and long-term outcomes

Introduction. Trigger finger is one of the most common causes of hand pain and disability. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Many authors have noted that percutaneous release is convenient and cost-effective with a low complication rate. Only few studies have published results on combination of percutaneous release and steroid injection.
 Objective. To compare the differences of outcomes in adults with trigger finger treated with combination of percutaneous release and corticosteroid injection to those treated with percutaneous release alone
 Methods. We included all patients older than 18 years old in the UP-PGH Department of Orthopedics with a diagnosis of trigger finger who have consented to participate in this study. They were randomized into two treatment groups. One group was treated with percutaneous release only and the other group was treated with combined percutaneous release and corticosteroid injection. Outcomes measured were total active motion (TAM), postoperative pain, time to return-to-work, patient satisfaction, and complications.
 Results. Post-procedure, both groups showed significant improvement in motion of the fingers (p = 0.034) and pain relief (p = 0.001). TAM scores of the combination group were better compared to the control at all time intervals (p = 0.03, 0.008, 0.004, 0.019) and better pain VAS scores in the 1st week (p = 0.009). Patients who received the combination treatment showed a trend toward better patient satisfaction, shorter duration of post-release pain and earlier return-to-work.
 Conclusion. The addition of corticosteroid injections to percutaneous release of trigger finger significantly improves TAM and pain VAS scores.

IntroductionTrigger finger is a common cause of pain and disability of the hand. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a rapid and cost-effective method which saves a surgical procedure and results in better functional outcome.Materials and MethodsThis is a prospective observational study conducted on fifty-two fingers and thumbs in 52 patients treated from 1st July 2014 till 31st December 2014, in the Orthopaedic Section, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. All the baseline characteristics of the patients, like demographics, symptoms, Quinell's criteria and functional outcome were recorded. The patients were treated at our hospital with trigger finger, managed with percutaneous release using an 18 gauge needle and followed up for a minimum period of three months. The follow-up information included range of motion scoring, patient satisfaction and overall outcome of the procedure in terms of patient acceptance. The data was analyzed to determine the functional outcome at three months.ResultsThere was complete release of A1 pulleys in 52 out of 52 digits (100%) in the patients undergoing percutaneous release and significant patient satisfaction. No recurrence was observed.ConclusionPercutaneous release of trigger finger with needle was not only associated with excellent functional outcome and recovery in terms of patient satisfaction and range of finger motion three months post-procedure but also was found to be cost effective.

ObjectivesPediatric trigger thumb (PTT) is characterized by flexion deformity and interphalangeal joint locking caused by A1 pulley constriction. Open A1 pulley release is the standard surgical method, whereas percutaneous release under local anesthesia offers a minimally invasive outpatient alternative. This study compared the outcomes of these two techniques.MethodsA retrospective cohort of children aged 2–10 years undergoing A1 pulley release between 2012 and 2024 was analyzed. Patients were assigned to open release under general anesthesia or percutaneous release under local anesthesia. Demographics, operative details, complications, and outcomes were compared using appropriate statistical tests, with significance set at p<0.05.ResultsNinety-nine patients (107 thumbs) were included: 53 (58 thumbs) in the open group and 46 (49 thumbs) in the percutaneous group. Mean age at surgery was similar (4.33 ± 1.53 vs. 4.29 ± 1.70 years; p=0.781). Satisfactory results were achieved in 100 % of open and 85.7 % of percutaneous cases (p=0.003). Recurrence was 3.4 % and 8.2 %, respectively (p=0.409). No neurovascular or tendon injuries occurred; superficial infections were minor and limited to the open group.ConclusionsBoth techniques are effective and safe. Open release remains the gold standard, while percutaneous release is a practical minimally invasive option in selected patients.Level of evidenceIII, retrospective comparative study.

Outcome of percutaneous trigger finger release technique using a 20-gauge hypodermic needle

Trigger finger and thumb are amongst the most common hand disabilities seen by orthopaedic surgeons. Surgical release of the first annular pulley (A1) is generally indicated when non-operative treatment fails. We present the long-term results of open operative treatment of trigger finger or trigger thumb in adults performed by a single surgeon. From July 1988 to 1998, 305 trigger fingers or thumbs in 276 consecutive patients were treated operatively, including 179 women and 97 men. The average age at operation time was 46.2 years. Two hundred and ten (76%) of the operations were performed for a single trigger digit release, 76 (24%) for multiple trigger digits in individual patients. All operations were done under tourniquet control with local infiltration anaesthesia under outpatient conditions using a transverse incision just distal to the distal palmar crease or on the flexor crease of the thumb at the metacarpophalangeal joint. At latest follow-up after an average of 14.3 years (min: 10, max: 20) 234 patients could be evaluated and were out of complaints, there were no serious complications such as nerve transection or bowstringing or recurrencies. We recommend open surgery of trigger finger and trigger thumb.

Trigger Finger Treatment: A Comparison of 2 Splint Designs

Open trigger finger release is an elective surgical procedure that serves as the gold standard treatment for trigger digits. The aim of this procedure is to release the A1 pulley in a setting in which the pulley is completely visible, ultimately allowing the flexor tendons that were previously impinged on to glide more easily through the tendon sheath. Although A1-or the first annular pulley-is the site of triggering in nearly all cases, alternative sites include A2, A3, and the palmar aponeurosis1. Typically, the surgical procedure can be conducted in an outpatient setting and can vary in duration from a few minutes to half an hour. The surgical procedure involves the patient lying in the supine position with the operative hand positioned to the side. A small incision, ranging from 1 to 1.5 cm, is made on the volar side of the hand, just proximal to the A1 pulley in the skin crease in order to minimize scarring. Once the underlying neurovascular structures are exposed, the A1 pulley is released longitudinally at least to the level of the A2 pulley, followed by decompression of the flexor tendons that were previously impinged on. In order to confirm the release, the patient is asked to flex and extend the affected finger. The wound is irrigated and closed once the release is confirmed by both the patient and surgeon. Aside from an open release, trigger finger can be treated nonoperatively with use of splinting and corticosteroid injection. Alternative operative treatments include a percutaneous release, which involves the use of a needle to release the A1 pulley2. Trigger finger can initially be treated nonoperatively. If unsuccessful, surgical intervention is considered the ultimate remedy2. Because of their efficacious nature, corticosteroid injections are indicated preoperatively, particularly in non-diabetic patients3. Splinting is often an appropriate treatment option in patients who wish to avoid a corticosteroid injection1. However, if nonoperative treatment modalities fail to resolve pain and symptoms, surgical intervention is indicated2. In comparison with a percutaneous trigger finger release, an open release provides enhanced exposure and may be safer with respect to avoiding iatrogenic neurovascular injury2. However, in a randomized controlled trial, Gilberts et al. found no difference in the rates of recurrence when comparing open versus percutaneous trigger finger release4. With reported success rates ranging from 90% to 100%, the open release of the A1 pulley is considered a common procedure associated with minimal complications2. Complications of the procedure were assessed in a retrospective analysis of 43 patients who underwent 78 open trigger releases performed by 1 surgeon. In that study, the authors reported a minor complication rate of 28% and a major complication rate of 3%5. Specifically, the 2 major complications noted by the authors were a synovial fistula and a proximal interphalangeal joint arthrofibrosis. In a larger study that included 543 patients who underwent 795 open trigger releases, the authors reported a minor complication rate of 9.6% and major complication rate of 2.4%6. Furthermore, the most common complications involved persistent stiffness, swelling, or pain. In that analysis, the authors suggested that sedation, male gender, and general anesthesia may be associated with greater risk6. At the discretion of the surgeon, a longitudinal, transverse, or oblique incision is made directly on top of the tendon at the level of the metacarpophalangeal joint, which is the preferred incision site because it provides maximal accessibility to the A1 pulley.Local anesthesia is preferred because it allows the patient and surgeon to confirm the release immediately.If conducting an open trigger release on the thumb, the surgeon should identify and protect the radial digital nerve, which courses directly over the A1 pulley. MCP = metacarpophalangeal.

Objective: To compare percutaneous A1 pulley release and steroid injection in terms of mean pain score in trigger digit. Study Design: Comparative cross- sectional study. Place and Duration of Study: Orthopedic Department Combined Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2018. Methodology: Patients with trigger finger diagnosed clinically in Out Patient Department meeting inclusion and exclusion criteria were included in the study. Patients were randomly allocated to Group A &amp; B by lottery method. Group A had percutaneous release of A1 pulley using a surgical blade 11, after preparation of the skin and injection of 1ml 2% plain Lidocaine. Group B had injection with corticosteroid. Both procedures were carried out in Out Patient Department under strict aseptic measures. Visual analogue score at start and end of the study was recorded. Results: A total of 185 patients were included in this study, 122(66%) were males and females were 63(34%). The mean age of patient was 37.80±11.80 years with range from 15-60 years. Mean score of Group A was 39.16±12.22 years and the mean age Group B was 38.93±10.98 years. 56(30.3%) patient had mild visual analogue score, 96 (51.9%) had moderate visual analogue, 33(17.8%) had severe visual analogue. Conclusion: Percutaneous release was found better option for the treatment of the trigger digit with a high success rate. Surgery should be reserved only for cases refractory to steroid injection technique.

BackgroundAlthough percutaneous trigger digit release is common, controversy exists regarding its safety. The purpose of this study was to evaluate the feasibility and safety of the neurovascular displacement by local hydraulic dilatation (LHD) during percutaneous trigger digit release.Material/MethodsTen cadaver hands with 50 digits were dissected in this anatomical study. The distance between bilateral neurovascular bundles in each digit was measured before LHD and after LHD. The difference between the measured data before LHD and those after LHD in the same digit was compared to assess the feasibility of the neurovascular displacement by LHD. A further 81 patients with 106 trigger digits were treated by percutaneous release with neurovascular displacement by LHD in our clinical series. All patients were followed for 12 months. During the follow-up period, the presence of any postoperative complication and patient satisfaction were recorded.ResultsIn our anatomical study, there was a statistically significant difference (p<0.05) comparing the average distance of bilateral neurovascular bundles before LHD with that after LHD. In the current series, no complications, such as digital neurovascular injury or recurrence of trigger, were encountered. On subjective assessment, 80/81 patients (98.8%) with 105/106 digits (99.1%) were graded as satisfactory with complete resolution of symptoms by percutaneous release under LHD.ConclusionsBased on our study anatomical and clinical results, the neurovascular displacement by LHD may be a feasible adjunctive technique that may play a role in increasing the safety of percutaneous trigger digit release.

Trigger finger is a common yet vastly understudied fibroproliferative hand pathology, severely affecting patients’ quality of life. Consistent trauma due to inadequate positioning within the afflicted finger’s tendon/pulley system leads to cellular dysregulation and eventual fibrosis. While the genetic characteristics of the fibrotic tissue in the trigger finger have been studied, the pathways that govern the initiation and propagation of fibrosis are still unknown. The complete gene expression profile of the trigger finger has never been explored. Our study has used the Nanostring nCounter gene expression assay to investigate the molecular signaling involved in trigger finger pathogenesis. We collected samples from patients undergoing trigger finger (n = 4) release surgery and compared the gene expression to carpal tunnel tissue (n = 4). Nanostring nCounter analysis identified 165 genes that were differentially regulated; 145 of these genes were upregulated, whereas 20 genes were downregulated. We found that several collagen genes were significantly upregulated, and a regulatory matrix metalloproteinase (MMP), MMP-3, was downregulated. Bioinformatic analysis revealed that several known signaling pathways were dysregulated, such as the TGF-β1 and Wnt signaling pathways. We also found several novel signaling pathways (e.g., PI3K, MAPK, JAK-STAT, and Notch) differentially regulated in trigger finger. The outcome of our study helps in understanding the molecular signaling pathway involved in the pathogenesis of the trigger finger.

Cost and compliance are 2 factors that can significantly affect the outcomes of non-operative and operative treatment of trigger finger (TF) and both may be influenced by social factors. The purpose of this study was to investigate socioeconomic disparities in the surgical treatment for TF. Adult patients (≥18 years old) were identified using International Classification of Diseases 9 and 10 Clinical Modification diagnostic codes for TF and Current Procedural Terminology (CPT) procedural codes (CPT: 26055) in the New York Statewide Planning and Research Cooperative System database. Each diagnosis was linked to procedure data to determine which patients went on to have TF release. A multivariable logistic regression was performed to assess the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation index (SDI), Charlson Comorbidity Index, and primary insurance type. A P-value < .05 was considered significant. Of the 31 411 TF patients analyzed, 8941 (28.5%) underwent surgery. Logistic regression analysis showed higher odds of receiving surgery in females (odds ratio [OR]: 1.108) and those with workers compensation (OR: 1.7). Hispanic (OR: 0.541), Asian (OR: 0.419), African American (OR: 0.455), and Other race (OR: 0.45) had decreased odds of surgery. Medicaid (OR: 0.773), Medicare (OR: 0.841), and self-pay (OR: 0.515) reimbursement methods had reduced odds of receiving surgery. Higher social deprivation was associated with decreased odds of surgery (OR: 0.988). There are disparities in demographic characteristics among those who receive TF release for trigger finger related to race, primary insurance, and social deprivation.

Background: The trigger finger, also known as stenosing tenosynovitis of the flexor tendon, is a common cause of hand disability; This can result in significant limitations in certain daily living activities. It is possible to treat this condition with conservative or surgical methods. Methods: This is a retrospective, observational, cross-sectional and descriptive study. The source population consisted of all patients with a diagnosis of trigger finger who had been treated in the department of plastic and reconstructive surgery of our institution between 2020 and 2023. The primary objective of this study is to determine the prevalence and characterize the clinical and surgical characteristics of the population affected by trigger finger in our hospital. Results: The total population was 237 patients, of which 165 were women (70%) and 72 men (30%). The most affected hand was the right hand, with a total of 158 patients (67%). In the right hand, the middle finger was the most affected (45%). Of the 237 patients, 80 of them had obesity (34%), 86 had type 2 diabetes mellitus (36%), 95 had systemic arterial hypertension (40%). Open technique was performed in 190 (80%) patients, while percutaneous technique was performed in 47 (20%) of them. Conclusion: The female sex was twice as frequent, and the middle finger and thumb were the most affected. Most of the patients received surgical treatment with open approach and percutaneous approach in 20% of them.

Master’s Surgical Technique: Surgical Treatment of Trigger Thumb and Trigger Finger

The purpose of this study was to evaluate the effectiveness of conventional open surgery and percutaneous release with aspecially designed needle for treating stenosing tenosynovitis in terms of cure, relapse and complication rates. In this study 89fingers from 76patients were randomly assigned and allocated to one of the treatment groups. Atotal of 37patients were treated with open surgery in group1 and 39patients with percutaneous release using a specially designed needle in group2. Apatient-based 4-inch visual analogue scale (VAS), Quinnell grading (QG), disability of arm shoulder and hand (DASH) score and finger total joint range of motion (FTROM) score were evaluated before treatment and after 7, 30 and 180days. When finger QG scores were equal or greater than 2points at follow-up at 180days this was defined as recurrence.. There were no significant differences between the two groups (P > 0.05) in terms of VAS, DASH and QG scores and the degree of FTROM. At 7days all the data were significantly different (p < 0.05) compared with preoperative data, 30 days was significantly different (p < 0.05) compared with 7 days while at 180 days no significant differences could be found (p > 0.05) compared with 30 days. The recurrence rate in group1 was 4.65% and 6.55% in group2. The percutaneous release and open surgery methods displayed similar effectiveness regarding the cure and recurrence of trigger finger disorder. The use of a specially designed needle for release is asafe and reliable method.