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Moungondo F, Van Ovestraeten L, Boushnak MO, Schuind F. Retrograde Percutaneous Release of Trigger Finger or Thumb Using Sono-Instruments®: Detailed Technique, Pearls, and Pitfalls. Cureus 2024; 16:e52911. [PMID: 38274628 PMCID: PMC10809902 DOI: 10.7759/cureus.52911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 01/27/2024] Open
Abstract
Percutaneous release is a common treatment option for trigger finger stenosing tenosynovitis. While surgical and conservative treatments are available, percutaneous techniques offer several advantages, including faster recovery time, reduced complications, and simultaneous treatment of multiple trigger fingers. The sono-instrument is a minimally invasive device designed for surgical release of the A1 pulley in adults. The device is efficient and safe, and in addition, several design features enhance the visibility of the instrument under ultrasound imaging. The technique is truly percutaneous, as the whole operation is done through a single needle puncture. This minimizes postoperative discomfort and allows an immediate return to daily living and professional activities. The technique can be performed in an outpatient clinic under local anesthesia. The learning curve is quick; however, surgeons must acquire experience in hand sonography to master this new form of surgery. The aim of this article is to provide an in-depth exposition of the technical nuances, pearls, and pitfalls of this novel retrograde percutaneous release method. To our knowledge, this is the first retrograde truly percutaneous release technique yet described, facilitated by the novel Sono-Instruments®.
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Affiliation(s)
- Fabian Moungondo
- Department of Orthopedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, BEL
| | - Luc Van Ovestraeten
- Department of Orthopaedics and Traumatology, Hand and Wrist Center, Hand and Foot Surgery Unit (HFSU), AO Foundation, Erasme University Hospital, Tournai, BEL
| | - Mohammad O Boushnak
- Department of Orthopedics and Sports Medicine, North Sydney Orthopaedic and Sports Medicine Centre, Mater Hospital, Sydney, AUS
| | - Frédéric Schuind
- Department of Orthopedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, BEL
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Pages L, Cambon A. Ultrasound-guided percutaneous opening of the A1 pulley with surgical knife on anterograde versus retrograde approach: A comparative cadaver study (40 fingers). HAND SURGERY & REHABILITATION 2023; 42:512-516. [PMID: 37544505 DOI: 10.1016/j.hansur.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Trigger finger is one of the most common pathologies of the finger flexor mechanism. Previous studies have shown the value of ultrasound-guided percutaneous tenolysis. The aim of this study was to compare the efficacy and safety of anterograde versus retrograde percutaneous ultrasound-guided tenolysis. MATERIALS AND METHODS This was a comparative cadaver study performed between December 2021 and April 2022 in France, with 40 fresh cadaver fingers. Thumbs were excluded. A single surgeon performed 20 ultrasound-guided anterograde releases and 20 ultrasound-guided retrograde releases, using a second-generation minimally invasive surgical knife, and a multipurpose linear ultrasound transducer. The primary endpoint was the success of ultrasound-guided release, defined as complete opening of the A1 pulley along its entire length. RESULTS The success rate was 90% in the retrograde group and 95% in the anterograde group (non-significant difference: p = 0.56). There was no significant difference in superficial flexor tendon slip injuries or partial A2 pulley injuries. There were no neurovascular pedicle lesions. CONCLUSION The choice of anterograde or retrograde ultrasound-guided tenolysis should be left to the surgeon's discretion.
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Affiliation(s)
- Laure Pages
- Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Clinique Drouot Laffitte Sport & Arthrose, 20 Rue Laffitte 75009, Paris, France.
| | - Adeline Cambon
- Sorbonne University, Orthopaedic, Trauma and Hand Surgery, Saint-Antoine Hospital, Paris, France
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Sun J, Zou X, Fu Q, Wu J, Yuan S, Alhaskawi A, Dong Y, Zhou H, Abdalbary SA, Lu H. Case report: Ultrasound-guided needle knife technique for carpal ligament release in carpal tunnel syndrome treatment. Front Neurol 2023; 14:1291702. [PMID: 38020668 PMCID: PMC10665483 DOI: 10.3389/fneur.2023.1291702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common peripheral neuropathy of the hand, mainly manifesting as sensory disturbances, motor dysfunctions, and pain in the fingers and hand. The pathogenesis of the disease is associated with fibrosis of the transverse carpal ligament in the carpal tunnel, which compresses median nerve. In our case, we demonstrate an ultrasound-guided needle knife technique to treat CTS. We guided the patient to a supine position on the examination table. The skin of the wrist area was sterilized for the procedure. After the skin was dry, we positioned sterile drapes, located the median nerve and compression, and marked the compression point. Local anesthesia was administered. An ultrasound-guided needle knife was inserted. The needle knife was advanced under ultrasound guidance. The carpal ligament was incised. A gradual release of pressure on the median nerve was observed on the ultrasound monitor. After treatment, the patient's finger sensation and motor function can significantly improve, and pain symptoms are markedly reduced, this case demonstrates that small needle-knife treatment can serve as a safe and effective minimally invasive therapeutic method.
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Affiliation(s)
- Jianjun Sun
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Xiaodi Zou
- Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qinyun Fu
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Jianhua Wu
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Shuaishuai Yuan
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Ahmad Alhaskawi
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanzhao Dong
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Hui Lu
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Nakagawa H, Redmond T, Colberg R, Latzka E, White MS, Bowers RL, Sussman WI. Ultrasound-Guided A1 Pulley Release: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2491-2499. [PMID: 37401544 DOI: 10.1002/jum.16294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/21/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023]
Abstract
The purpose of this review was to summarize the current literature pertaining to ultrasound-guided percutaneous A1 pulley release procedures. We searched PubMed, Cochrane Library, Embase, and Web of Science for clinical studies examining ultrasound-guided percutaneous A1 pulley release. A total of 17 studies involving 749 procedures were included in this review. The overall success rate was 97%. There were 23 minor complications (4 cases of hematomas, 15 cases of persistent pain, and 4 cases of transient numbness) and no major complications reported. Ultrasound-guided A1 pulley release is an effective and safe procedure for the treatment of trigger fingers and thumb.
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Affiliation(s)
- Hirotaka Nakagawa
- Department of Orthopedics and Rehabilitation, Tufts Medical Center, Boston, Massachusetts, USA
| | - Travis Redmond
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ricardo Colberg
- Andrews Sports Medicine and Orthopeadic Center, Birmingham, Alabama, USA
| | - Erek Latzka
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mia S White
- Emory University Woodruff Health Science Center Library, Atlanta, Georgia, USA
| | - Robert L Bowers
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Walter I Sussman
- Department of Orthopedics and Rehabilitation, Tufts Medical Center, Boston, Massachusetts, USA
- Boston Sports & Biologics, Wellesley Hills, Massachusetts, USA
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Yavari M, Modaresi SM, Hassanpour SE, Moosavizadeh SM, Tabrizi A. Clinical Study Between Percutaneous Ultrasound-Guided Release and Open Classic Surgery in Treating Multiple Trigger Fingers. Adv Biomed Res 2023; 12:88. [PMID: 37288036 PMCID: PMC10241637 DOI: 10.4103/abr.abr_392_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/26/2022] [Accepted: 04/03/2022] [Indexed: 06/09/2023] Open
Abstract
Background A trigger finger is recognized as the most common hand tendinopathies that reduce functional ability. The present study compares the clinical outcomes of open classic release surgery with ultrasound-guided percutaneous surgery in cases of multiple finger involvement. Materials and Methods A cohort study has been performed from March 2019 to December 2020 by participating 34 trigger finger patients with multiple involvements. These patients were treated using classical open release and ultrasound-guided percutaneous release methods and both methods were compared in patients. The pain severity and functional ability obtained from the quick disabilities of the arm, shoulder, and hand (Quick-DASH) test scores were compared. Results The pain intensity in the classical open surgery patients was not significantly different from the ultrasound-guided group, and a one-month follow-up showed that the pain intensity in the ultrasound-guided patients was significantly less than in the other group (P = 0.02). Besides, no significant difference was observed between the functional abilities before and after the one-month follow-up. Indeed, the two groups had the same situations. Also, the recovery time in the ultrasound-guided percutaneous release group was significantly faster than in the other group. These cases had statistical differences as P = 0.001 and P < 0.001, respectively. The surgical release was 100% successful in both groups. The patients' satisfaction rates in the ultrasound-guided and open classic surgery treatment methods were 94.1 and 76.4%, respectively. Conclusions Classical open release and ultrasound-guided percutaneous surgery could successfully treat multiple trigger fingers. However, ultrasound-guided percutaneous surgery provided faster recovery and less pain intensity than the other method.
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Affiliation(s)
- Masoud Yavari
- Department of Hand and Microsurgery, Panzdahe Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Masoud Modaresi
- Department of Hand and Microsurgery, Panzdahe Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Esmail Hassanpour
- Department of Plastic Surgery, Panzdahe Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Moosavizadeh
- Department of Plastic Surgery, Panzdahe Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Tabrizi
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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