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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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Brodeur PG, Raducha JE, Kim KW, Johnson C, Rebello E, Cruz AI, Gil JA. Social Disparities in the Management of Trigger Finger: An Analysis of 31 411 Cases. Hand (N Y) 2023; 18:1342-1348. [PMID: 35658639 PMCID: PMC10617479 DOI: 10.1177/15589447221094040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cost and compliance are 2 factors that can significantly affect the outcomes of non-operative and operative treatment of trigger finger (TF) and both may be influenced by social factors. The purpose of this study was to investigate socioeconomic disparities in the surgical treatment for TF. METHODS Adult patients (≥18 years old) were identified using International Classification of Diseases 9 and 10 Clinical Modification diagnostic codes for TF and Current Procedural Terminology (CPT) procedural codes (CPT: 26055) in the New York Statewide Planning and Research Cooperative System database. Each diagnosis was linked to procedure data to determine which patients went on to have TF release. A multivariable logistic regression was performed to assess the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation index (SDI), Charlson Comorbidity Index, and primary insurance type. A P-value < .05 was considered significant. RESULTS Of the 31 411 TF patients analyzed, 8941 (28.5%) underwent surgery. Logistic regression analysis showed higher odds of receiving surgery in females (odds ratio [OR]: 1.108) and those with workers compensation (OR: 1.7). Hispanic (OR: 0.541), Asian (OR: 0.419), African American (OR: 0.455), and Other race (OR: 0.45) had decreased odds of surgery. Medicaid (OR: 0.773), Medicare (OR: 0.841), and self-pay (OR: 0.515) reimbursement methods had reduced odds of receiving surgery. Higher social deprivation was associated with decreased odds of surgery (OR: 0.988). CONCLUSIONS There are disparities in demographic characteristics among those who receive TF release for trigger finger related to race, primary insurance, and social deprivation.
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Affiliation(s)
- Peter G. Brodeur
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jeremy E. Raducha
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kang Woo Kim
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Cameron Johnson
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Elliott Rebello
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Aristides I. Cruz
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph A. Gil
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Çimen O, Nami Ş. Does Surgical Experience Affect the Outcomes During Percutaneous Release of the Trigger Finger? Cureus 2023; 15:e46049. [PMID: 37771935 PMCID: PMC10523415 DOI: 10.7759/cureus.46049] [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: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
Background Trigger finger is a condition characterized by clicking or locking during finger movement, sometimes resulting in the freezing of a finger in flexion or extension. The aim of our retrospective study was to determine the effect of the surgeon's learning curve on clinical outcomes in percutaneous release of the trigger finger. In addition, we evaluated the effects of diabetes and local steroid injections on clinical outcomes. Methodology A total of 954 trigger fingers in 678 patients were reviewed from 2012 to 2022. All percutaneous release procedures were performed by a single surgeon in our institute under local anesthesia. The main outcome measures were recurrence and patient satisfaction. In addition, all patients were evaluated in terms of re-operation and complications. The mean follow-up period was 54.87 months. Results There was complete relief of symptoms in 636 (93.81%) patients, and 22 (3.24%) patients had mild pain but were satisfied. We found that the success rate increased over time. The success rate was 91.4% in the first three years and increased to 98.25% in the next seven years (p = 0.001). There was no statistically significant difference between the diabetic and non-diabetic groups in terms of recurrence, satisfaction rate, and complications (p > 0.05). There was no statistically significant difference in terms of recurrence, satisfaction rate, and complications between the groups that received and did not receive steroid injections (p > 0.05). Conclusions Percutaneous release is a safe and reliable procedure in the treatment of trigger fingers, and the success rate increases as the experience increases. Moreover, diabetes mellitus and steroid injections did not affect the clinical results.
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Affiliation(s)
- Oğuzhan Çimen
- Department of Orthopaedics and Traumatology, Medistanbul Hospital, Istanbul, TUR
| | - Şahin Nami
- Department of Orthopaedics and Traumatology, Avicenna Hospital, Istanbul, TUR
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Li SM, Chen P, Yan MZ, Du WS, Guo R, Luo T. Modified Acupotomy versus Percutaneous Release for Trigger Thumb: A Retrospective Study. J Pain Res 2022; 15:1141-1148. [PMID: 35469251 PMCID: PMC9034873 DOI: 10.2147/jpr.s339710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Acupotomy is now increasingly used for trigger thumb, while recent evidence showed it increased the risk of nerve injury. Based on the close proximity of the neurovascular bundles and the A1 pulley, we designed a modified acupotomy. Given that percutaneous release is the common surgical treatment, this retrospective study aimed to compare the effect and safety of modified acupotomy versus percutaneous release for trigger thumb. Methods This is a retrospective study. All patients with trigger thumb were retrieved in the electronic records of the Department of Pain Medicine at the Beijing Hospital of Traditional Chinese Medicine from January 2016 to September 2018. Both short-term (3 months) and long-term (2 years) outcomes were evaluated using the criteria established through Gilberts et al.’s questionnaire, including triggering, residual pain, stiffness, digital nerve injury, scar, infection and satisfaction. Chi-square test or Fisher’s exact test was used to compare differences between two groups. Results A total of 305 patients with 334 trigger thumbs treated with either modified acupotomy (n = 194 thumbs) or percutaneous release (n = 140 thumbs) were included. Of them, 221 (72.5%) were female, and the mean age was 56.2 ± 10.0 years. The mean duration of trigger thumb lasted for 7.5 ± 3.6 months. At 3 months, all triggering were alleviated by both therapies. Although more digital nerve injury occurred in the percutaneous release (0 [0%] thumbs vs 5 [3.6%] thumbs, P = 0.012), more residual pain (30 [15.5%] thumbs vs 6 [4.3%] thumbs; rate ratio, 3.61; 95% confidence interval [CI]: 1.54–8.43; P = 0.001) and less satisfaction occurred in the modified acupotomy group. At 2 years, more recurrent triggering, residual pain and digital nerve injury occurred in the percutaneous release group (2 [1.0%] thumbs vs 12 [8.6%] thumbs; rate ratio, 0.12; 95% CI: 0.03–0.53; P = 0.001; 9 [4.6%] thumbs vs 22 [15.7%] thumbs; rate ratio, 0.30; 95% CI: 0.14–0.62 P < 0.001; 0 [0%] thumbs vs 4 [2.9%] thumbs, P = 0.030, respectively). Moreover, satisfaction was significantly better in the modified acupotomy group. Conclusion The modified acupotomy had better long-term outcomes and satisfaction than the percutaneous release for trigger thumb, although percutaneous release has less residual pain and better satisfaction in the short term. The modified acupotomy is a treatment option for trigger thumb.
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Affiliation(s)
- Shu-Ming Li
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People’s Republic of China
| | - Ping Chen
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People’s Republic of China
| | - Ming-Zhe Yan
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People’s Republic of China
| | - Wei-Shuai Du
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People’s Republic of China
| | - Ren Guo
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People’s Republic of China
- Correspondence: Ren Guo; Tao Luo, Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Backstreet Gallery, Dongcheng District, Beijing, 100010, People’s Republic of China, Email ;
| | - Tao Luo
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People’s Republic of China
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Endoscopic Retrograde Approach for Trigger Finger Release: A Cadaver Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3294. [PMID: 33425606 PMCID: PMC7787330 DOI: 10.1097/gox.0000000000003294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
Trigger finger is one of the most common causes of disability and pain in the hand. Current surgical techniques for trigger finger release fall short in that they are performed blindly with trauma to, or require incision of, the palmar fascia, which can be a source of significant and long-lasting morbidity. Retrograde endoscopic release of the A1 pulley was performed through a single incision at the proximal digital crease in cadaveric specimens. The fingers were then dissected to assess for completeness of release and inspected for injury to nearby structures. Complete release of the A1 pulley was noted in 16 of 16 fingers. No significant injuries to the A2 pulley and flexor tendon were found, and no injuries to the digital nerves or vasculature occurred. The described technique, as demonstrated in cadaveric specimens, is a feasible alternative approach in the treatment of trigger finger. The technique allows complete visualization of A1 pulley release through a single palmar fascia sparing incision.
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Herrera JM, Herrera L, Rotella P, Cantero Téllez R, Castellanos J, Vázquez F. Percutaneous Reconstruction of the Ulnar Collateral Ligament of the Metacarpophalangeal Joint of the Thumb: Technique and Results. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2020. [DOI: 10.1055/s-0040-1719014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objectives The present study aims to describe a new percutaneous technique for the reconstruction of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb with a tendon graft, and to evaluate the functional outcomes and stability six months postoperatively.
Material and methods The percutaneous ligamentoplasty technique was performed with a palmaris longus tendon graft and tenodesis screws in 6 patients with ulnar instability of the thumb (> 30° degrees of radial deviation) for more than 6 weeks. Range of motion, grip strength, and pinch strength (lateral/key pinch, tip pinch, and palmar pinch) were assessed in comparison to the contralateral limb, as well as the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score.
Results At 6 months, the joint movement was of 100%, the grip strength was of 94.8%, the key pinch was of 95%, the palmar pinch was of 85.7%, and the tip pinch was of 93.5% compared to the contralateral limb. The internal tilt was of 14° compared to 9° at the contralateral limb. The Quick DASH score decreased from 24.2 to 2.6 points.
Conclusion We devised this versatile surgical procedure to obtain early mobility with the advantages related to the percutaneous techniques.
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Affiliation(s)
- Juan Manuel Herrera
- Hand Surgery Unit, Centro Privado de Cirugía del Pie y la Mano (CEPYM), Tucumán, Argentina
- Hand Surgery Unit, Centro Integral de Ortopedia y Traumatología (CIOT), Tucumán, Argentina
| | - Lucas Herrera
- Hand Surgery Unit, Centro Integral de Ortopedia y Traumatología (CIOT), Tucumán, Argentina
| | - Pablo Rotella
- Hand Surgery Unit, Instituto Rotella, Tucumán, Argentina
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Abstract
BACKGROUND Trigger finger is a common clinical disorder, characterised by pain and catching as the patient flexes and extends digits because of disproportion between the diameter of flexor tendons and the A1 pulley. The treatment approach may include non-surgical or surgical treatments. Currently there is no consensus about the best surgical treatment approach (open, percutaneous or endoscopic approaches). OBJECTIVES To evaluate the effectiveness and safety of different methods of surgical treatment for trigger finger (open, percutaneous or endoscopic approaches) in adults at any stage of the disease. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and LILACS up to August 2017. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials that assessed adults with trigger finger and compared any type of surgical treatment with each other or with any other non-surgical intervention. The major outcomes were the resolution of trigger finger, pain, hand function, participant-reported treatment success or satisfaction, recurrence of triggering, adverse events and neurovascular injury. DATA COLLECTION AND ANALYSIS Two review authors independently selected the trial reports, extracted the data and assessed the risk of bias. Measures of treatment effect for dichotomous outcomes calculated risk ratios (RRs), and mean differences (MDs) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). When possible, the data were pooled into meta-analysis using the random-effects model. GRADE was used to assess the quality of evidence for each outcome. MAIN RESULTS Fourteen trials were included, totalling 1260 participants, with 1361 trigger fingers. The age of participants included in the studies ranged from 16 to 88 years; and the majority of participants were women (approximately 70%). The average duration of symptoms ranged from three to 15 months, and the follow-up after the procedure ranged from eight weeks to 23 months.The studies reported nine types of comparisons: open surgery versus steroid injections (two studies); percutaneous surgery versus steroid injection (five studies); open surgery versus steroid injection plus ultrasound-guided hyaluronic acid injection (one study); percutaneous surgery plus steroid injection versus steroid injection (one study); percutaneous surgery versus open surgery (five studies); endoscopic surgery versus open surgery (one study); and three comparisons of types of incision for open surgery (transverse incision of the skin in the distal palmar crease, transverse incision of the skin about 2-3 mm distally from distal palmar crease, and longitudinal incision of the skin) (one study).Most studies had significant methodological flaws and were considered at high or unclear risk of selection bias, performance bias, detection bias and reporting bias. The primary comparison was open surgery versus steroid injections, because open surgery is the oldest and the most widely used treatment method and considered as standard surgery, whereas steroid injection is the least invasive control treatment method as reported in the studies in this review and is often used as first-line treatment in clinical practice.Compared with steroid injection, there was low-quality evidence that open surgery provides benefits with respect to less triggering recurrence, although it has the disadvantage of being more painful. Evidence was downgraded due to study design flaws and imprecision.Based on two trials (270 participants) from six up to 12 months, 50/130 (or 385 per 1000) individuals had recurrence of trigger finger in the steroid injection group compared with 8/140 (or 65 per 1000; range 35 to 127) in the open surgery group, RR 0.17 (95% CI 0.09 to 0.33), for an absolute risk difference that 29% fewer people had recurrence of symptoms with open surgery (60% fewer to 3% more individuals); relative change translates to improvement of 83% in the open surgery group (67% to 91% better).At one week, 9/49 (184 per 1000) people had pain on the palm of the hand in the steroid injection group compared with 38/56 (or 678 per 1000; ranging from 366 to 1000) in the open surgery group, RR 3.69 (95% CI 1.99 to 6.85), for an absolute risk difference that 49% more had pain with open surgery (33% to 66% more); relative change translates to worsening of 269% (585% to 99% worse) (one trial, 105 participants).Because of very low quality evidence from two trials we are uncertain whether open surgery improve resolution of trigger finger in the follow-up at six to 12 months, when compared with steroid injection (131/140 observed in the open surgery group compared with 80/130 in the control group; RR 1.48, 95% CI 0.79 to 2.76); evidence was downgraded due to study design flaws, inconsistency and imprecision. Low-quality evidence from two trials and few event rates (270 participants) from six up to 12 months of follow-up, we are uncertain whether open surgery increased the risk of adverse events (incidence of infection, tendon injury, flare, cutaneous discomfort and fat necrosis) (18/140 observed in the open surgery group compared with 17/130 in the control group; RR 1.02, 95% CI 0.57 to 1.84) and neurovascular injury (9/140 observed in the open surgery group compared with 4/130 in the control group; RR 2.17, 95% CI 0.7 to 6.77). Twelve participants (8 versus 4) did not complete the follow-up, and it was considered that they did not have a positive outcome in the data analysis. We are uncertain whether open surgery was more effective than steroid injection in improving hand function or participant satisfaction as studies did not report these outcomes. AUTHORS' CONCLUSIONS Low-quality evidence indicates that, compared with steroid injection, open surgical treatment in people with trigger finger, may result in a less recurrence rate from six up to 12 months following the treatment, although it increases the incidence of pain during the first follow-up week. We are uncertain about the effect of open surgery with regard to the resolution rate in follow-up at six to 12 months, compared with steroid injections, due high heterogeneity and few events occurred in the trials; we are uncertain too about the risk of adverse events and neurovascular injury because of a few events occurred in the studies. Hand function or participant satisfaction were not reported.
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Affiliation(s)
- Haroldo Junior Fiorini
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, n 783, 5° andarSão PauloBrazil04038‐032
| | - Marcel Jun Tamaoki
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, n 783, 5° andarSão PauloBrazil04038‐032
| | - Mário Lenza
- Faculdade Israelita de Ciencias da Saude Albert Einstein and Hospital Israelita Albert EinsteinOrthopaedic Department and School of MedicineAv. Albert Einstein, 627/701São PauloSão PauloBrazilCEP 05651‐901
| | - Joao Baptista Gomes dos Santos
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, n 783, 5° andarSão PauloBrazil04038‐032
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, n 783, 5° andarSão PauloBrazil04038‐032
| | - Joao carlos Belloti
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, n 783, 5° andarSão PauloBrazil04038‐032
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Wang H, Wang P, Amajoyi O, Chen CJ, Chen GY. The Safety of Percutaneous Trigger Digit Release Increased by Neurovascular Displacement with Local Hydraulic Dilatation: An Anatomical and Clinical Study. Med Sci Monit 2017; 23:5034-5040. [PMID: 29055964 PMCID: PMC5665611 DOI: 10.12659/msm.904676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Although percutaneous trigger digit release is common, controversy exists regarding its safety. The purpose of this study was to evaluate the feasibility and safety of the neurovascular displacement by local hydraulic dilatation (LHD) during percutaneous trigger digit release. Material/Methods Ten cadaver hands with 50 digits were dissected in this anatomical study. The distance between bilateral neurovascular bundles in each digit was measured before LHD and after LHD. The difference between the measured data before LHD and those after LHD in the same digit was compared to assess the feasibility of the neurovascular displacement by LHD. A further 81 patients with 106 trigger digits were treated by percutaneous release with neurovascular displacement by LHD in our clinical series. All patients were followed for 12 months. During the follow-up period, the presence of any postoperative complication and patient satisfaction were recorded. Results In our anatomical study, there was a statistically significant difference (p<0.05) comparing the average distance of bilateral neurovascular bundles before LHD with that after LHD. In the current series, no complications, such as digital neurovascular injury or recurrence of trigger, were encountered. On subjective assessment, 80/81 patients (98.8%) with 105/106 digits (99.1%) were graded as satisfactory with complete resolution of symptoms by percutaneous release under LHD. Conclusions Based on our study anatomical and clinical results, the neurovascular displacement by LHD may be a feasible adjunctive technique that may play a role in increasing the safety of percutaneous trigger digit release.
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Affiliation(s)
- Honggang Wang
- Department of Orthopedics, California Hospital Medical Center, Los Angeles, CA, USA.,Department of Orthopaedic and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Ping Wang
- Department of Medical Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Obioma Amajoyi
- Department of Orthopaedics, California Hospital Medical Center, Los Angeles, CA, USA
| | - Clark J Chen
- University of California Los Angeles, Los Angeles, CA, USA
| | - Gary Y Chen
- Department of Orthopedics, California Hospital Medical Center, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
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Nikolaou VS, Malahias MA, Kaseta MK, Sourlas I, Babis GC. Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger. World J Orthop 2017; 8:163-169. [PMID: 28251067 PMCID: PMC5314146 DOI: 10.5312/wjo.v8.i2.163] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/06/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique.
METHODS In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade II-IV according to Green classification system, were recruited. Two groups were formed; Group A (16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B (16 patients) underwent an open surgical release of the A1 pulley, through a 10-15 mm incision. Patients were assessed pre- and postoperatively (follow-up: 2, 4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering (primary variable of interest) was expressed as the “success rate” per digit. The time for taking postoperative pain killers, range of motion recovery, QuickDASH test scores (Greek version), return to normal activities (including work), complications and cosmetic results were assessed.
RESULTS The success rate in group A was 93.75% (15/16) and in group B 100% (16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean QuickDASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickDASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5% (14/16) of group A patients, while in 56.25% (9/16) of group B patients were evaluated as fair or poor.
CONCLUSION Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger’s disease.
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Abstract
INTRODUCTION Percutaneous trigger finger releases (TFRs) performed in the office setting are becoming more prevalent. This study compares the costs of in-hospital open TFRs, open TFRs performed in ambulatory surgical centers (ASCs), and in-office percutaneous releases. METHODS An expected-value decision-analysis model was constructed from the payer perspective to estimate total costs of the three competing treatment strategies for TFR. Model parameters were estimated based on the best available literature and were tested using multiway sensitivity analysis. RESULTS Percutaneous TFR performed in the office and then, if needed, revised open TFR performed in the ASC, was the most cost-effective strategy, with an attributed cost of $603. The cost associated with an initial open TFR performed in the ASC was approximately 7% higher. Initial open TFR performed in the hospital was the least cost-effective, with an attributed cost nearly twice that of primary percutaneous TFR. DISCUSSION An initial attempt at percutaneous TFR is more cost-effective than an open TFR. Currently, only about 5% of TFRs are performed in the office; therefore, a substantial opportunity exists for cost savings in the future. LEVEL OF EVIDENCE Decision model level II.
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Xiong L, Chng CB, Chui CK, Yu P, Li Y. Shared control of a medical robot with haptic guidance. Int J Comput Assist Radiol Surg 2016; 12:137-147. [PMID: 27314590 DOI: 10.1007/s11548-016-1425-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 05/21/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Tele-operation of robotic surgery reduces the radiation exposure during the interventional radiological operations. However, endoscope vision without force feedback on the surgical tool increases the difficulty for precise manipulation and the risk of tissue damage. The shared control of vision and force provides a novel approach of enhanced control with haptic guidance, which could lead to subtle dexterity and better maneuvrability during MIS surgery. METHODS The paper provides an innovative shared control method for robotic minimally invasive surgery system, in which vision and haptic feedback are incorporated to provide guidance cues to the clinician during surgery. The incremental potential field (IPF) method is utilized to generate a guidance path based on the anatomy of tissue and surgical tool interaction. Haptic guidance is provided at the master end to assist the clinician during tele-operative surgical robotic task. RESULTS The approach has been validated with path following and virtual tumor targeting experiments. The experiment results demonstrate that comparing with vision only guidance, the shared control with vision and haptics improved the accuracy and efficiency of surgical robotic manipulation, where the tool-position error distance and execution time are reduced. CONCLUSIONS The validation experiment demonstrates that the shared control approach could help the surgical robot system provide stable assistance and precise performance to execute the designated surgical task. The methodology could also be implemented with other surgical robot with different surgical tools and applications.
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Affiliation(s)
- Linfei Xiong
- Center of Robotics and Intelligent Machine, Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, No. 266 Fangzhen Road, Beibei District, Chongqing, 400714, China.
| | - Chin Boon Chng
- Mechanical Engineering, National University of Singapore, Singapore, Singapore
| | - Chee Kong Chui
- Mechanical Engineering, National University of Singapore, Singapore, Singapore. .,Control and Mechatronics Laboratory, National University of Singapore, EA-04-06, 9 Engineering Drive 1, 117575, Singapore, Singapore.
| | - Peiwu Yu
- Department of General Surgery, Southwest Hospital, Chongqing, China
| | - Yao Li
- Center of Robotics and Intelligent Machine, Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, No. 266 Fangzhen Road, Beibei District, Chongqing, 400714, China
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Lapègue F, André A, Meyrignac O, Pasquier-Bernachot E, Dupré P, Brun C, Bakouche S, Chiavassa-Gandois H, Sans N, Faruch M. US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases. Radiology 2016; 280:493-9. [PMID: 26919442 DOI: 10.1148/radiol.2016151886] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate the efficacy of ultrasonographically (US)-guided percutaneous treatment of the trigger finger by releasing the A1 pulley with a 21-gauge needle. Materials and Methods This two-part study was approved by the ethics committee, and written consent was obtained from all patients. The first part consisted of 10 procedures on cadaver digits followed by dissection to analyze the effectiveness of the A1 pulley release and detect any collateral damage to the A2 pulley, interdigital nerves, or underlying flexor tendons. The second part was performed during an 18-month period starting in March 2013. It was a prospective clinical study of 60 procedures performed in 48 patients. Outcomes were evaluated through a clinical examination at day 0 and during a 6-month follow-up visit, where the trigger digit was evaluated clinically and the Quick Disabilities of the Arm, Shoulder and Hand outcome measure, or QuickDASH, and patient satisfaction questionnaires were administered. Results No complications were found during the cadaver study. However, the release was considered "partial" in all fingers. In the clinical study, the trigger finger was completely resolved in 81.7% (49 of 60) of cases immediately after the procedure. Moderate trigger finger persisted in 10 cases, and one thumb pulley could not be released. A US-guided corticosteroid injection was subsequently performed in these 11 cases. At 6-month follow-up, only two cases still had moderate trigger finger and there were no late complications. The mean QuickDASH questionnaire score was 4; all patients said they were satisfied. Conclusion US-guided treatment of the trigger finger by using a 21-gauge needle is feasible in current practice, with minimal complications. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Franck Lapègue
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Aymeric André
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Olivier Meyrignac
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Etienne Pasquier-Bernachot
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Pierre Dupré
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Céline Brun
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Sarah Bakouche
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Hélène Chiavassa-Gandois
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Nicolas Sans
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Marie Faruch
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
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Orbach H, Wolovelsky A, Rinott M, Rubin G, Rozen N. Synovial Fistula as a Complication of Release of A1 Pulley for Trigger Finger. J Hand Microsurg 2015; 7:136-9. [PMID: 26078526 DOI: 10.1007/s12593-014-0121-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/07/2014] [Indexed: 01/08/2023] Open
Affiliation(s)
- Hagay Orbach
- Orthopaedic Department, Ha'Emek Medical Center, Afula, Israel ; Kibuts Shluhot, Beit Shean Valley 10910 Israel
| | | | - Micha Rinott
- Orthopaedic Department, Ha'Emek Medical Center, Afula, Israel ; Faculty of Medicine, Technion, Haifa, Israel
| | - Guy Rubin
- Orthopaedic Department, Ha'Emek Medical Center, Afula, Israel ; Faculty of Medicine, Technion, Haifa, Israel
| | - Nimrod Rozen
- Orthopaedic Department, Ha'Emek Medical Center, Afula, Israel ; Faculty of Medicine, Technion, Haifa, Israel
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Zhao JG, Kan SL, Zhao L, Wang ZL, Long L, Wang J, Liang CC. Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence. J Hand Surg Am 2014; 39:2192-202. [PMID: 25227600 DOI: 10.1016/j.jhsa.2014.07.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the overall success rate and potential influencing factors within the current evidence for percutaneous first annular pulley release. METHODS We searched PubMed, EMBASE, and the Cochrane Library for all clinical studies of percutaneous release. The rates of successful procedure and complication were extracted and analyzed. We charted the overall success rate on a forest plot with 95% confidence intervals. Data of success rates were analyzed in 5- and 10-year intervals to determine whether the rate of success had increased chronologically. We then performed 3 subgroup analyses according to instrument type (needles vs knife blades), cortisone use (cortisone vs noncortisone), and sonography guidance (sonography vs non-sonography guidance). Pooled success rates were calculated in the subgroups and compared using chi-square test. RESULTS A total of 34 studies involving 2,114 percutaneous procedures were included in this systematic review and meta-analysis. The total success rate was 94%. There was a trend toward increasing number of publications in the past 20 years. We found a statistically significant trend showing that overall success rates had increased over time. Chi-square test revealed that percutaneous release with sonography guidance had a significantly higher success rate than non-sonography guidance. There were no significant differences in other subgroup analyses including instrument type and cortisone use. CONCLUSIONS Percutaneous release is an effective and safe procedure for the treatment of trigger digit. It has become progressively popular in recent years, with a trend toward increased overall success. Sonography might be a helpful tool for maximizing success. The success rates were not affected by instruments and cortisone use. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jia-Guo Zhao
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China.
| | - Shi-Lian Kan
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Li Zhao
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Zeng-Liang Wang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Lei Long
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Jia Wang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Cong-Cong Liang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
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