Ultrasound-Guided Percutaneous A1 Pulley Release: Needle Technique
1 Rehabilitation Medicine Division, and Academic Affairs Division, Nopparat Rajathanee Hospital, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
Affiliation : Norarit Luanchumroen MD1
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 (cid:976)inger [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 post-
operation. Surgical complications were followed-up for six months.
Results : Thirty-nine (cid:976)ingers 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 (cid:976)inger, A1 pulley
