Percutaneous ultrasound-guided A1 pulley release utilizing a modified 20-gauge spinal needle

Abstract

Background: Trigger finger is a common cause of hand pain. Though multiple techniques for percutaneous A1 pulley release have been described in the literature, there is a continued need for safe and effective techniques using inexpensive, familiar, and commonly found instruments. This study evaluated outcomes of percutaneous A1 pulley release performed using a novel technique with a modified 20-gauge spinal needle and ultrasound guidance, with follow-up outcomes at least 6 months after the procedure.

Objective: To evaluate the efficacy and safety of a novel percutaneous A1-pulley release technique in individuals with trigger finger.

Design: Retrospective observational study.

Setting: Private practice outpatient orthopedics clinic.

Participants: Forty digits from 30 unique patients with trigger finger who underwent percutaneous A1 pulley release.

Interventions: Percutaneous ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle.

Main outcome measures: The primary outcome measure was cessation of triggering. Secondary measures examined intraoperative and postoperative pain, postprocedural duration of activity limiting pain, and time to perform the procedure.

Results: Immediate cessation of triggering was achieved in all 40 digits following the procedure, with no recurrence reported at any time at an average follow-up of 11 months (range 6-32). Patients reported returning to normal activity in 2.75 days. Only one minor complication was reported, tenosynovitis, which resolved with a corticosteroid injection.

Conclusions: Percutaneous, ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle can be safely performed with good outcomes and a rapid return to normal activity.