J Med Assoc Thai 2018; 101 (11):1543-9

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Ultrasound-Guided Percutaneous A1 Pulley Release: Needle Technique
Luanchumroen N Mail

Background: Ultrasound [US]-guided percutaneous annular [A1] pulley release using needle is a minimal invasive surgery that enables early functional recovery with low complication rates for trigger finger [TF] treatment.

Objective: To evaluate the results of such surgical technique for TF treatment in Thais.

Materials and Methods: The present study was a single center, prospective cohort study. Patients age 20 years and older diagnosed as grade II TF or higher for at least four months and unresponsive to conservative treatment were included in the study. The patients having chronic diseases or rheumatoid arthritis, previous TF surgery, pregnant, or bleeding risks were excluded. US-guided percutaneous A1 pulley release using needle were performed for TF treatment. TF recovery, pain, use of analgesic medications, return time to normal activity, cosmetic, and overall satisfaction using 10-cm visual analog scale were assessed one week postoperation. Surgical complications were followed-up for six months.

Results: Thirty-nine fingers from 33 patients received US-guided percutaneous A1 pulley release using needle were included in analysis. Mean operative time (± SD) was 6.17±1.70 minutes. Median (IQR) of post-operative pain durations, use of analgesic medications, and recovering time to normal activity were 1 (0, 2), 0.5 (0.5, 1), and 2 (1, 2) days, respectively. Means of patient satisfaction scores for wound appearance and overall treatment were 9.87 and 9.61, respectively. Only one patient had incomplete release. No severe complication was observed.

Conclusion: US-guided percutaneous A1 pulley release with needle technique was an effective treatment for TF without severe complication and high levels of overall satisfaction.

Keywords: Ultrasound-guided, Percutaneous release, Trigger finger, A1 pulley

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