A Comparison of Blinded versus Ultrasound-Guided Limited-Open Trigger Finger Release Using the Yasunaga Knife

Efficacy of Ultrasound-Guided Tendon Release for Trigger Finger Compared With Open Surgery: A Systematic Review and Meta-Analysis

BACKGROUND

Trigger finger (also known as stenosing tenosynovitis) is a chronic inflammatory disorder that affects the fingers and causes discomfort and functional impairment. It is estimated to affect 2-3.6% of the population and is more common in manual laborers and individuals engaged in repetitive hand activities. This study comprehensively compares the efficacy of ultrasound-guided release versus traditional open surgery in treating trigger fingers.

MATERIALS

We systematically searched PubMed, Scopus, EMBASE, and the Cochrane Library to identify relevant studies. Inclusion criteria were studies evaluating ultrasound-guided release of trigger finger (grade 2 and higher) compared with open surgical release. A meta-analysis was performed by Revman software 5.4.1 to assess efficacy, utilizing appropriate statistical methods to address heterogeneity. Primary outcome measures included "Quick Disability of Arm, Shoulder, and Hand" (QDASH) scores, Grip strength, and the Visual Analogue Scale (VAS). Secondary outcome measures included Days of stopping analgesia, full-digit flexion and extension, days to return to normal activities, pinch strength, Quinnell grading score, and bow strengthening.

RESULTS

Out of the initial pool of 820 studies, five met the inclusion criteria, including 275 patients with 283 trigger digits. The analysis revealed significant differences favoring the ultrasound-guided release group over the surgical group for improvement in Quick Disability of Arm, Shoulder, and Hand score in the first month (MD -0.48, 95% CI: 0.75 to -0.2, P = .0007, I2  = 20%). The difference was not statistically significant in the 3-month follow-up period (MD -2.25, 95% CI: -0.54 to 0.05, P = .1, I2  = 0%). Additionally, there is a significant difference in the days required for return to normal activities in favor of the ultrasound release approach (MD -13.78, 95% CI: -16.68 to 10.89, P = .00001, I2  = 68%). The data displayed heterogeneity, which was resolved through sensitivity analysis that also favored the ultrasound-guided group. In terms of grip strength, full-digit flexion and extension, VAS, and days of stopping analgesia no significant differences were observed.

CONCLUSIONS

Ultrasound-guided release showed advantages over open surgical release, resulting in improved QDASH score and quicker return to normal activities. This offers a minimally invasive, successful alternative to open surgery, reducing associated risks. Further studies with long-term follow-up are recommended.

From teaching to practice: Evaluating the impact of an upper-limb ultrasound surgery diploma on surgical practice

OBJECTIVES

This study evaluates the impact of an upper-limb ultrasound surgery diploma on surgical practices, specifically assessing how this specialized training influences the adoption and application of ultrasound techniques in upper limb surgeries.

MATERIAL AND METHODS

A comprehensive survey was conducted from August to November 2023, targeting individuals who completed the upper-limb ultrasound surgery diploma program between 2013 and 2023. The survey, distributed online, comprised 31 questions spanning demographic information, professional background, specifics about the diploma program, motivations for pursuing the diploma, post-diploma practices, challenges faced, and financing of ultrasound equipment.

RESULTS

Out of the 181 actually receiving the questionnaire. 94 (52%) completed the survey. The results showed an increase in ultrasound-guided interventions from 14.9% to 47.9% post-diploma. The diploma significantly influenced diagnostic ultrasound usage, though not statistically significant (35.3%-74.5%). The primary motivation for pursuing the diploma was the desire to embrace innovation (76.6%). Post-diploma, over half of the graduates observed a positive impact on patient recruitment. Challenges included lack of confidence and time constraints. Over 56% of graduates planned to increase their ultrasound-guided surgery practice. Net Promoter Score of the ultrasound interventions practices was 54.8.

CONCLUSION

The study demonstrates the considerable impact of the upper-limb ultrasound surgery diploma on surgical practices, notably in increasing the adoption and application of ultrasound-guided techniques. It highlights the importance of specialized training in adapting to technological advancements and enhancing patient care, suggesting directions for future surgical education and clinical practice integration.

Sonographically controlled minimally-invasive A1 pulley release using a new guide instrument - a case series of 106 procedures in 64 patients

BACKGROUND

With percutaneous and minimally-invasive pulley release becoming more popular, safety and reliability of such minimally-invasive procedures remain a concern. Visualization of the technical steps by ultrasound suggests increased safety but shows the potential for harm to tendons, nerves and vessels without proper instrumentation. We present the results of implementing a sonographically guided minimally-invasive procedure in 106 trigger digits of 64 patients between 2018-2021.

METHODS

A guide instrument for use with a commercially available hook knife was developed and tested in 16 cadaver hands. Due to complication early in our clinical series this guide was modified in due course. A revised design of the guide has been in use since November 2019 with improved performance and safety.

RESULTS

One hundred six procedures in 64 patients were performed. After guide revision, we report a success rate of 97.3%. Complications after instrument revision include two cases of incomplete pulley release and one case of inadvertent skin laceration. The majority of patients report returning to all strenuous activities within two weeks at most apart from four individuals with prolonged postoperative discomfort.

CONCLUSION

We present the results of the development and implementation of a novel guide instrument for use with a hook knife to treat trigger finger. Despite several limitations of this study, we show that sonographically controlled, minimally-invasive A1 pulley release can be performed safely and effectively with appropriate surgical instruments and practice.

Ultrasound-Guided A1 Pulley Release: A Systematic Review

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.