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Jengojan S, Sorgo P, Streicher J, Snoj Ž, Kasprian G, Gruber G, Bodner G. Ultrasound-guided thread versus ultrasound-guided needle release of the A1 pulley: a cadaveric study. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01875-y. [PMID: 39192166 DOI: 10.1007/s11547-024-01875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/09/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To assess and compare two ultrasound-guided, minimally invasive procedures to release the A1-pulley (needle release and thread release) regarding efficacy and safety in an anatomical specimen model. MATERIALS AND METHODS Twenty-one ultrasound-guided needle releases and 20 ultrasound-guided thread releases were performed on digits of Thiel-embalmed anatomical specimens. A scoring system was developed to assess ultrasound visibility, intervention outcome (incomplete, almost complete, or full transection of the A1 pulley), and injury to adjacent structures (neurovascular structures, tendons, A2 pulley). Statistical analysis was performed to compare the score of the two groups (group 1: needle release,group 2: thread release). A P-value of ≤ 0.05 was considered significant. RESULTS Needle release was completely successful in 15 cases (71.5%), almost complete release was achieved in four cases (19%), and incomplete transection occurred in two cases (9.5%). Thread release was completely successful in 17 cases (85%), and almost complete transection was observed in the remaining three cases (15%). In both procedures no neurovascular structures were harmed. Slight injury of flexor tendons occurred in two cases (9.5%) in needle release and in five cases (25%) in thread release. There were no significant statistical differences between the groups regarding ultrasound visibility, intervention safety and outcome, (P > 0.05). CONCLUSION Ultrasound-guided needle release and ultrasound-guided thread release have similar success of release, both being effective and safe techniques for the release of the A1 pulley.
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Affiliation(s)
- Suren Jengojan
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Philipp Sorgo
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems an der Donau, Austria
| | - Johannes Streicher
- Department of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems an der Donau, Austria
| | - Žiga Snoj
- Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerlinde Gruber
- Department of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems an der Donau, Austria
| | - Gerd Bodner
- Neuromuscular Imaging Ordinationszentrum Döbling, Heiligenstädter Straße 46-48, 1190, Vienna, Austria
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Jengojan S, Sorgo P, Kasprian G, Streicher J, Gruber G, Moser V, Bodner G. Ultrasound-guided minimally invasive thread release of Guyon's canal: initial experience in cadaveric specimens. Eur Radiol Exp 2024; 8:56. [PMID: 38714623 PMCID: PMC11076429 DOI: 10.1186/s41747-024-00456-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/11/2024] [Indexed: 05/10/2024] Open
Abstract
OBJECTIVE Guyon's canal syndrome is caused by compression of the ulnar nerve at the wrist, occasionally requiring decompression surgery. In recent times, minimally invasive approaches have gained popularity. The aim of this study was to assess the efficacy and safety of ultrasound-guided thread release for transecting the palmar ligament in Guyon's canal without harming surrounding structures, in a cadaveric specimen model. METHODS After ethical approval, thirteen ultrasound-guided thread releases of Guyon's canal were performed on the wrists of softly embalmed anatomic specimens. Cadavers showing injuries or prior operations at the hand were excluded. Subsequently, the specimens were dissected, and the outcome of the interventions and potential damage to adjacent anatomical structures as well as ultrasound visibility were evaluated with a score from one to three. RESULTS Out of 13 interventions, a complete transection was achieved in ten cases (76.9%), and a partial transection was documented in three cases (23.1%). Irrelevant lesions on the flexor tendons were observed in two cases (15.4%), and an arterial branch was damaged in one (7.7%). Ultrasound visibility varied among specimens, but essential structures were delineated in all cases. CONCLUSION Ultrasound-guided thread release of Guyon's canal has shown promising first results in anatomic specimens. However, further studies are required to ensure the safety of the procedure. RELEVANCE STATEMENT Our study showed that minimally invasive ultrasound-guided thread release of Guyon's canal is a feasible approach in the anatomical model. The results may provide a basis for further research and refinement of this technique. KEY POINTS • In Guyon's canal syndrome, the ulnar nerve is compressed at the wrist, often requiring surgical release. • We adapted and tested a minimally invasive ultrasound-guided thread release technique in anatomic specimens. • The technique was effective; however, in one specimen, a small anatomic branch was damaged.
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Affiliation(s)
- Suren Jengojan
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria.
| | - Philipp Sorgo
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria
- Department of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria
| | - Johannes Streicher
- Department of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Gerlinde Gruber
- Department of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Veith Moser
- Department of Trauma Surgery, Lorenz Boehler Hospital, Donaueschingenstraße 13, 1200, Vienna, Austria
| | - Gerd Bodner
- Neuromuscular Imaging Ordinationszentrum Döbling, Heiligenstaedter Straße 55-63, 1190, Vienna, Austria
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Orozco Lopez D, Mochal-King C, Fontenot R, O'Shea CM. Ex-vivo evaluation of a percutaneous looped thread desmotomy of the accessory ligament of the deep digital flexor tendon in horses. Vet Surg 2024; 53:503-512. [PMID: 38140785 DOI: 10.1111/vsu.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/11/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To determine the ability to completely transect the equine accessory ligament of the deep digital flexor tendon (AL-DDFT) via an ultrasonographically-guided, percutaneous looped thread desmotomy using FiberWire suture as a cutting device. STUDY DESIGN Ex-vivo study. SAMPLE POPULATION A total of 24 normal equine distal forelimb specimens. METHODS Under ultrasonographic guidance, a Jamshidi needle was placed between the suspensory ligament and the AL-DDFT, and between the AL-DDFT and the deep digital flexor tendon, through two stab incisions. FiberWire suture was fed through the needle and looped around the AL-DDFT. Using a sawing motion, the ligament was transected, and the suture exited through the lateral incision. Surgical sites were dissected and assessed for completeness of transection, iatrogenic injuries, and suture remnants. Descriptive statistics were reported. RESULTS The procedure met the successful criteria in 18/24 (75%) of the limbs. The median surgical time was 11 min (range 7-25). No suture failure or suture remnants were noted in any of the specimens. Complications included iatrogenic injury to the medial and lateral neurovascular bundles in 4/24 and 1/24 specimens, respectively. CONCLUSION Complete transection of the AL-DDFT was achieved in 22/24 (92%) of the specimens; however, the neurovascular bundles were injured in 5/24 (21%) of the specimens. CLINICAL SIGNIFICANCE A percutaneous looped thread desmotomy of the AL-DDFT can be studied as an alternative technique for use in equine models prior to its clinical use in patients. Additional studies are required to evaluate efficacy and safety in anesthetized or standing horses.
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Affiliation(s)
- David Orozco Lopez
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Cathleen Mochal-King
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Robin Fontenot
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Caitlin M O'Shea
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
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Margenfeld F, Zendehdel A, Tamborrini G, Müller-Gerbl M. The advantages of utilizing different ultrasound imaging techniques on joints of human cadavers in the teaching of anatomy - A scoping review. Ann Anat 2024; 251:152179. [PMID: 37879500 DOI: 10.1016/j.aanat.2023.152179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/05/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND A common approach to define sonoanatomy is a reciprocal exchange of macroscopic and microscopic information in ultrasound imaging. High-resolution ultrasound has been long established and is crucial as an inexpensive and adaptable tool, not just in clinical settings but also while teaching anatomy. Early application of ultrasonography provides medical students with a couple of benefits: they acquire an improved understanding of anatomy and learn how to use it. METHODS A comprehensive literature review has been carried out, with relevant studies discovered in the following databases: MEDLINE, EMBASE, CENTRAL, BIOSIS Previews and Web of Science Core Collection. Gray literature was also considered in two different ways: (1) Regarding grey literature databases: National Gray Literature Collection. (2) For PhD theses and dissertations, the databases EThOS and Open Access Theses and Dissertations were screened for relevant studies by combining the keywords used in the search string. The reference lists of all relevant papers were scanned. Search process was performed on January 3rd, 2023. The search string was developed with the aid of and finally checked by a professional librarian. Only ultrasound studies on human cadavers were included, not animals or phantoms. If the studied subject was a joint, the article was included. Only B-Mode ultrasound was included, whereas Elastosonography, Doppler sonography and quantitative approaches including among others sound speed, backscatter attenuation were excluded. Intravascular, intraosseous, intraarticular, and three-dimensional or four-dimensional ultrasonography were also eliminated from the analysis. All appropriate information comprising articles, PhD theses, dissertations and chapters in textbooks were considered. There were solely English and German studies covered. There was no additional restriction on the publishing year. The included studies' general characteristics and ultrasound techniques were taken from them and examined. Using VOS viewer, a keyword analysis was also carried out. RESULTS 142 of the 8899 results that were returned by the search satisfied the requirements. With a quarter of the included studies, the knee joint was the most extensively studied joint, followed by the elbow joint (10.6%) and the shoulder joint (9.2%). The methodological analysis includes 125 studies. Both the sample size and the ultrasonographer's qualifications were diverse. The probe position and the ultrasound method were precisely documented so that a reader could duplicate them in about three-quarters of the included studies (72.8%). CONCLUSION The current study, in our perspective, is the first scoping review to screen ultrasound studies on human cadaver joints. A heterogeneous field was shown by the methodological investigation. We suggest using a uniform method for conducting and presenting ultrasound examinations in future studies.
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Affiliation(s)
- Felix Margenfeld
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland.
| | - Adib Zendehdel
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland
| | - Giorgio Tamborrini
- Swiss Ultrasound Center UZR and Institute for Rheumatology, Aeschenvorstadt 68, Basel 4051, Switzerland; Rheumatology Clinic, University Hospital of Basel, Basel 4001 Switzerland
| | - Magdalena Müller-Gerbl
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland
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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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Sutter D, Treier A, Vögelin E. Sonographically controlled minimally-invasive A1 pulley release using a new guide instrument - a case series of 106 procedures in 64 patients. BMC Musculoskelet Disord 2023; 24:875. [PMID: 37950217 PMCID: PMC10636860 DOI: 10.1186/s12891-023-06982-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
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.
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Affiliation(s)
- Damian Sutter
- Department of Hand Surgery, University Hospital Berne, Inselspital Bern, Freiburgstrasse 10, CH-3010, Berne, Switzerland.
| | - Aline Treier
- Department of Hand Surgery, University Hospital Berne, Inselspital Bern, Freiburgstrasse 10, CH-3010, Berne, Switzerland
| | - Esther Vögelin
- Department of Hand Surgery, University Hospital Berne, Inselspital Bern, Freiburgstrasse 10, CH-3010, Berne, Switzerland
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De Gasperi D, Guo D, Guo D, Lu Y, Brounts SH. Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses. Vet Surg 2023; 52:388-394. [PMID: 36625237 DOI: 10.1111/vsu.13932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 11/23/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To develop and describe a minimally invasive, ultrasound-guided, percutaneous technique for the desmotomy of equine palmar/plantar annular ligaments (PALs) using a transecting thread. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Twenty-one normal equine distal limb specimens. METHODS Under ultrasonographic guidance, a surgical thread was percutaneously placed around the PAL through 2 skin punctures (proximal and distal) using a 18 gauge spinal needle in equine limbs (11 forelimbs, 10 hindlimbs) with normal PALs. The ligament was transected by a back-and-forth motion of the thread until the loop emerged from the proximal skin puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported. RESULTS The PAL was completely transected in 17/21 limbs. The mean duration of the procedure was 16 minutes. Superficial needle puncture or subtle abrasion of the superficial digital flexor tendon was noticed in 4 limbs. No iatrogenic injury to other intrathecal structures was identified. After PAL division, the needle entry and exit points had a mean diameter of 1.2 and 1 mm, respectively. CONCLUSION Desmotomy of normal PALs in equine limb specimens was performed effectively using the percutaneous thread-transecting technique with minimal iatrogenic damage to adjacent structures. CLINICAL SIGNIFICANCE Information from this study will allow refinement of the technique for use in equine clinical cases either in standing or anesthetized horses.
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Affiliation(s)
- Diego De Gasperi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Danzhu Guo
- BayCare Clinic, Green Bay, Wisconsin, USA
| | - Yan Lu
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Sabrina H Brounts
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
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McCool L, Tonkin B, Guo D, Guo D, Senk A. Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis. Hand (N Y) 2021; 16:644-649. [PMID: 31540554 PMCID: PMC8461189 DOI: 10.1177/1558944719873435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.
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Affiliation(s)
| | - Brionn Tonkin
- Minneapolis Veterans Affairs Medical Center, MN, USA
| | | | | | - Alexander Senk
- Minneapolis Veterans Affairs Medical Center, MN, USA,Alexander Senk, Department of Physical Medicine & Rehabilitation, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
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Projection of the A1-Pulley of the Thumb onto Superficial Anatomical Landmarks: An Anatomical Study and a Useful Guide to Surgeons. Indian J Orthop 2021; 55:330-335. [PMID: 34306545 PMCID: PMC8275720 DOI: 10.1007/s43465-021-00397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of our study was to project the A1-pulley of the thumb onto the total thumb length to enable its complete division with and without direct sight. MATERIALS AND METHODS The study involved 50 hands from adult human cadavers. The proximal and distal borders of the A1-pulley were measured with reference to the first metacarpophalangeal joint (MCPJ). The length of the thumb was defined as the interval between the first carpometacarpal joint (CMCJ) and the apex of the thumb. The length of the pulley is calculated proportionally with reference to the line between the first CMCJ and apex of the thumb. RESULTS Approximated by computing 95% confidence intervals, the pulley can be expected to lie in an area between 34.0% (proximal border) and 57.8% (distal border) alongside this line. CONCLUSION Percutaneous and minimally-invasive division of the A1-pulley needs to be performed between 34.0 and 57.8% of the length between the first CMCJ and apex of the thumb.
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Boettcher BJ, Hollman JH, Stuart MJ, Finnoff JT. Ultrasound‐Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study. PM R 2020; 12:1113-1119. [DOI: 10.1002/pmrj.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | - John H. Hollman
- Department of Physical Medicine and Rehabilitation Mayo Clinic College of Medicine and Science Rochester MN
| | - Michael J. Stuart
- Department of Orthopedic Surgery Mayo Clinic College of Medicine and Science Rochester MN
| | - Jonathan T. Finnoff
- Department of Physical Medicine and Rehabilitation Mayo Clinic College of Medicine and Science Rochester MN
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Wu YY, He FD, Chen K, Quan JR, Guo XY. Comparison of the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:573-581. [PMID: 32116288 DOI: 10.3233/xst-190620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger. METHODS A total of 60 patients with trigger finger were enrolled in this retrospective study. Among them, 30 patients were treated with ultrasound-guided needle release of the A1 pulley with corticosteroid injection (group A) and 30 patients were treated with single ultrasound-guided corticosteroids injection (group B). The following parameters were evaluated including clinical parameters (pain degree, function of joint, finger tendon function, postoperative satisfaction), and ultrasound parameter (thickness of A1 pulley). RESULTS The postoperative visual analogue scale (VAS) and Quinnell scores in two groups were significantly lower than that before operation (p < 0.05). The postoperative Quinnell score of group A was significantly lower than that in group B (p < 0.05). The TAM results showed that the postoperative overall excellent and good rate of group A was significantly higher than that in group B (p < 0.05). The postoperative survey showed that more than 80% patients reported satisfaction in the two groups. The ultrasound imaging results showed that the postoperative thickness of A1 pulley in two groups were thinner than that before operation (p < 0.05). There were no adverse effects and complications in the two groups. CONCLUSIONS Both approaches had treatment benefit in trigger finger. Ultrasound-guided needle release of the A1 pulley with corticosteroid injection had better treatment benefits than single ultrasound-guided corticosteroids injection in improving finger tendon function and joint function.
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Affiliation(s)
- Yan-Yan Wu
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fan-Ding He
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kai Chen
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie-Rong Quan
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuan-Yan Guo
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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A cadaveric study using the ultra-minimally invasive thread transection technique to decompress the superficial peroneal nerve in the lower leg. Acta Neurochir (Wien) 2019; 161:2133-2139. [PMID: 31123834 DOI: 10.1007/s00701-019-03944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND After successful applications of the ultra-minimally invasive thread transecting technique (Guo Technique) for both thread carpal tunnel release and thread trigger finger release, we hypothesized that this technique could be used for superficial peroneal nerve release in the lower leg by selective crural fasciectomy. This study is aimed at testing the operative feasibility of performing the thread superficial peroneal nerve release (TSPNR) procedure in cadavers. METHODS The TSPNR procedure was performed on 15 fresh frozen cadaveric lower-extremity specimens under ultrasound guidance. All cadaveric specimens were dissected and visually assessed immediately after the procedures. RESULTS All 15 legs demonstrated a complete transection of the crural fasciae along the course of the superficial peroneal nerve (SPN) including where it penetrated and traversed the crural fascia. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 20 min. CONCLUSION This cadaveric study demonstrated that the technique of TSPNR was accurate, reliable, and feasible while causing no injury to adjacent neurovascular structures and avoiding having to make a skin incision. Further studies are warranted to verify the results of this study before implementing this new technique in the clinical setting.
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Thread common peroneal nerve release-a cadaveric validation study. Acta Neurochir (Wien) 2019; 161:1931-1936. [PMID: 31270613 DOI: 10.1007/s00701-019-03998-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine if the thread release technique can be applied to common peroneal nerve entrapment at the fibular neck. METHODS The thread common peroneal nerve release was performed on 15 fresh frozen cadaveric lower extremity specimens. All procedures were performed under ultrasound guidance and immediately underwent post-procedural gross anatomic inspection for completeness of decompression and presence or absence of iatrogenic neurovascular injury. RESULTS All 15 specimens demonstrated complete transection of the deep fascia of the peroneus longus overlying the common peroneal nerve. The transections extended to the bifurcation of the superficial peroneal and deep peroneal nerves. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 30 min. CONCLUSION This cadaveric validation study demonstrates the accuracy of the thread common peroneal nerve release. Future pilot studies are warranted to ensure the safety of this procedure in the clinical setting.
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Pan M, Sheng S, Fan Z, Lu H, Yang H, Yan F, E Z. Ultrasound-Guided Percutaneous Release of A1 Pulley by Using a Needle Knife: A Prospective Study of 41 Cases. Front Pharmacol 2019; 10:267. [PMID: 30971922 PMCID: PMC6444079 DOI: 10.3389/fphar.2019.00267] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the efficacy of ultrasonography-guided percutaneous A1 pulley release with the needle knife for trigger finger. Methods: The prospective study included 21 patients (21 fingers) who underwent blind release with the needle knife and 20 patients (20 fingers) who underwent ultrasonography-guided release with the needle knife. The thickness and width of A1 pulley, clinical grade before and after release, complications, and operation time were compared between the groups. Results: The results showed that the ultrasonography-guided group had significantly better grade postoperatively and reached to 100% complete release in one time compared to the blind group (p < 0.05). Moreover, no any complications had been happened in the ultrasonography-guided group. A relatively longer operation time of the ultrasonography-guided group was observed compared to the time of the blind group. Conclusions: The needle knife is a very good tool for release of triggering fingers. Ultrasound provides a direct and precise visualization of the thickness, width and location of A1 pulley lesion. The combined use of ultrasound and the needle knife can achieve the best result for trigger finger. Moreover, the combination changes the traditional opinion and operator-dependent mode that were once widely adopted in the hospital of Chinese Medicine.
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Affiliation(s)
- Min Pan
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Shuya Sheng
- Shenzhen Middle School, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen, China
| | - Zhiqi Fan
- College of Optoelectronic Engineering of Shenzhen University, SPACEnter Space Science and Technology Institute, Shenzhen, China
| | - Hao Lu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Hong Yang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Fei Yan
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Zhansen E
- Longgang Central Hospital, Shenzhen, China
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Davies J, Fallon V, Kyaw Tun J. Ultrasound-guided percutaneous compartment release: a novel technique, proof of concept, and clinical relevance. Skeletal Radiol 2019; 48:959-963. [PMID: 30570711 PMCID: PMC6476821 DOI: 10.1007/s00256-018-3134-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ultrasound-guided thread release (USGTR) is a minimally invasive technique with excellent clinical outcomes currently used in clinical practice to divide the transverse carpal ligament in carpal tunnel syndrome. The purpose of this study is to determine whether this technique can be modified for use in large anatomical compartments in soft embalmed cadaveric models. MATERIALS AND METHODS Two operators adapted the USGTR technique for use in muscular compartments of the forearms and legs in a single soft embalmed cadaver. An iterative approach was used to adapt and improve the technique for use in large compartments, using equipment readily available in most radiology departments. RESULTS The USGTR technique was successfully modified and both operators were able to accurately divide fascial layers over distances of up to 30 cm using the modified technique. Fascial division was confirmed with ultrasound and dissection. CONCLUSIONS This adapted technique can successfully be used to divide fascial planes over longer distances than is currently achieved in clinical practice. The improved outcomes associated with USGTR at the carpal tunnel may therefore also be achievable in fasciotomy procedures in larger anatomical compartments. Further study is required to investigate the effects of this modified USGTR technique on intracompartmental pressure.
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Affiliation(s)
- Joseph Davies
- Royal London Hospital, Bart’s Health NHS Trust, London, E1 1BB UK
| | | | - Jimmy Kyaw Tun
- Royal London Hospital, Bart’s Health NHS Trust, London, E1 1BB UK
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Guo D, McCool L, Senk A, Tonkin B, Guo J, Lytie RM, Guo D. Minimally invasive thread trigger digit release: a preliminary report on 34 digits of the adult hands. J Hand Surg Eur Vol 2018; 43:942-947. [PMID: 29764283 DOI: 10.1177/1753193418774497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The trigger finger release was performed in 34 digits (11 thumbs and 23 fingers) of 24 patients through the thread transecting technique with the tip-to-tip approach, in which a 22-gauge needle inserts into a 18-gauge needle when both needles are inside the hand, guiding the 22-gauge needle to exit the hand at the same access point of 18-gauge needle. We prospectively evaluated the effectiveness and functional recovery of these patients. In all 34 digits, triggering and locking were resolved, and complete extension and flexion occurred immediately following the release. There were no complications, such as incomplete release, neurovascular or flexor tendon or A2 pulley injury, infection, or tendon bow-stringing. Patients did not require prescription pain medications. Most patients used their hands to meet their basic living needs the same day of the procedure. The hand function evaluated with the Quick Disabilities of the Arm, Shoulder and Hand questionnaire, and scored 4 within 3 months. Level of evidence: II.
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Affiliation(s)
| | | | | | | | - Joseph Guo
- 3 Ridge & Crest Company, Monterey Park, CA, USA
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Gnanasekaran D, Veeramani R, Karuppusamy A. Morphometric study of pulleys of the thumb. Anat Cell Biol 2018; 51:71-78. [PMID: 29984050 PMCID: PMC6026824 DOI: 10.5115/acb.2018.51.2.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/20/2018] [Accepted: 03/19/2018] [Indexed: 11/27/2022] Open
Abstract
Pulleys are thickened regions in flexor tendons sheaths of the digits. They are essential and act as fulcrum for the flexion and extension of the digits. The arrangement and number of pulley system differs greatly between the thumb and other digits. There is paucity of literature regarding the pulley system of thumb. We aimed to study the morphometry of the pulley system of the thumb in Indian cadavers. Dissection was carried out in 55 adult human cadaveric thumbs. The most common morphologic pattern of pulley observed in the thumb is type III (30 thumbs). The least observed is type I (4 thumbs). The mean width and standard deviation of A1, Av, oblique, and A2 pulleys are 5.06±0.87, 5.38±1.22, 4.68±1.13, and 6.04±1.41 mm, respectively. The gap distances between the pulleys were also measured. The results obtained from the present study may be helpful in surgical treatment of trigger thumb with less complication and also in reconstruction of the closed rupture of the pulley of the thumb.
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Affiliation(s)
- Dhivyalakshmi Gnanasekaran
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Raveendranath Veeramani
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Aravindhan Karuppusamy
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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