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DOI: 10.1055/s-0036-1594283
Percutaneous Release Procedures: Trigger Finger and Carpal Tunnel
Publication History
Publication Date:
21 December 2016 (online)
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Abstract
Trigger digit and carpal tunnel syndrome are both conditions traditionally treated with open surgery but are potentially amenable to curative treatment using percutaneous techniques. The advantages of minimally invasive techniques are lower risk of wound breakdown and infection, quicker healing, reduced postprocedural pain, reduced complications, and a quicker return to normal activity. The advent of high-resolution ultrasound has allowed percutaneous release procedures for these conditions to be developed and performed with a potential for a reduced risk of complications and an increased likelihood of success. This article reviews the literature as well as our institutional experience in performing ultrasound-guided percutaneous release for trigger digit and carpal tunnel syndrome.
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References
- 1 Rajeswaran G, Lee JC, Eckersley R, Katsarma E, Healy JC. Ultrasound-guided percutaneous release of the annular pulley in trigger digit. Eur Radiol 2009; 19 (9) 2232-2237
- 2 Notta A. Recherches sur une affection particulière des gaines tendineuses de la main, caractérisée par le développement d'une nodosité sur la trajet des tendons fléchisseurs des doigts et par l'empechement de leurs mouvements. Arch Gen Med 1850; 4: 142-161
- 3 Lecoq B, Hanouz N, Morello R , et al. Ultrasound-assisted surgical release of carpal tunnel syndrome: results of a pilot open-label uncontrolled trial conducted outside the operating theatre. Joint Bone Spine 2015; 82 (6) 442-445
- 4 Patel MR, Bassini L. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am 1992; 17 (1) 110-113
- 5 Turowski GA, Zdankiewicz PD, Thomson JG. The results of surgical treatment of trigger finger. J Hand Surg Am 1997; 22 (1) 145-149
- 6 Gilberts EC, Beekman WH, Stevens HJ, Wereldsma JC. Prospective randomized trial of open versus percutaneous surgery for trigger digits. J Hand Surg Am 2001; 26 (3) 497-500
- 7 Saldana MJ. Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 (4) 246-252
- 8 Panayotopoulos E, Fortis AP, Armoni A, Dimakopoulos P, Lambiris E. Trigger digit: the needle or the knife?. J Hand Surg [Br] 1992; 17 (2) 239-240
- 9 Lee JC, Healy JC. Normal sonographic anatomy of the wrist and hand. Radiographics 2005; 25 (6) 1577-1590
- 10 Lorthioir Jr J. Surgical treatment of trigger-finger by a subcutaneous method. J Bone Joint Surg Am 1958; 40-A (4) 793-795
- 11 Bain GI, Wallwork NA. Percutaneous A1 pulley release a clinical study. Hand Surg 1999; 4 (1) 45-50
- 12 Bamroongshawgasame T. A comparison of open and percutaneous pulley release in trigger digits. J Med Assoc Thai 2010; 93 (2) 199-204
- 13 Blumberg N, Arbel R, Dekel S. Percutaneous release of trigger digits. J Hand Surg [Br] 2001; 26 (3) 256-257
- 14 Cebesoy O, Kose KC, Baltaci ET, Isik M. Percutaneous release of the trigger thumb: is it safe, cheap and effective?. Int Orthop 2007; 31 (3) 345-349
- 15 Chao M, Wu S, Yan T. The effect of miniscalpel-needle versus steroid injection for trigger thumb release. J Hand Surg Eur Vol 2009; 34 (4) 522-525
- 16 Cihantimur B, Akin S, Ozcan M. Percutaneous treatment of trigger finger. 34 fingers followed 0.5-2 years. Acta Orthop Scand 1998; 69 (2) 167-168
- 17 Dahabra IA, Sawaqed IS. Percutaneous trigger finger release with 18-gauge needle. Saudi Med J 2007; 28 (7) 1065-1067
- 18 Dierks U, Hoffmann R, Meek MF. Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial. Tech Hand Up Extrem Surg 2008; 12 (3) 183-187
- 19 Eastwood DM, Gupta KJ, Johnson DP. Percutaneous release of the trigger finger: an office procedure. J Hand Surg Am 1992; 17 (1) 114-117
- 20 Elsayed MM. Percutaneous release of trigger finger. Egypt Orthop J 2013; 48 (3) 277-281
- 21 Guler F, Kose O, Ercan EC, Turan A, Canbora K. Open versus percutaneous release for the treatment of trigger thumb. Orthopedics 2013; 36 (10) e1290-e1294
- 22 Ha KI, Park MJ, Ha CW. Percutaneous release of trigger digits. J Bone Joint Surg Br 2001; 83 (1) 75-77
- 23 Jou IM, Chern TC. Sonographically assisted percutaneous release of the a1 pulley: a new surgical technique for treating trigger digit. J Hand Surg Br 2006; 31 (2) 191-199
- 24 Joy ABK, Wangjam K, Singh I, Bimol N, Nilachandra L. Percutaneous release of trigger fingers: is it reserved for a few surgeons?. Int J Phys Med Rehabil 2002; 13: 1-4
- 25 Kuo LC, Su FC, Tung WL, Lai KY, Jou IM. Kinematical and functional improvements of trigger digits after sonographically assisted percutaneous release of the A1 pulley. J Orthop Res 2009; 27 (7) 891-896
- 26 Lyu SR. Closed division of the flexor tendon sheath for trigger finger. J Bone Joint Surg Br 1992; 74 (3) 418-420
- 27 Maneerit J, Sriworakun C, Budhraja N, Nagavajara P. Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone. J Hand Surg Br 2003; 28 (6) 586-589
- 28 Mishra SR, Gaur AK, Choudhary MM, Ramesh J. Percutaneous A1 pulley release by the tip of a 20-g hypodermic needle before open surgical procedure in trigger finger management. Tech Hand Up Extrem Surg 2013; 17 (2) 112-115
- 29 Nagoshi M, Hashizume H, Nishida K, Takagoshi H, Pu J, Inoue H. Percutaneous release for trigger finger in idiopathic and hemodialysis patients. Acta Med Okayama 1997; 51 (3) 155-158
- 30 Park MJ, Oh I, Ha KI. A1 pulley release of locked trigger digit by percutaneous technique. J Hand Surg [Br] 2004; 29 (5) 502-505
- 31 Patel MR, Moradia VJ. Percutaneous release of trigger digit with and without cortisone injection. J Hand Surg Am 1997; 22 (1) 150-155
- 32 Ragoowansi R, Acornley A, Khoo CT. Percutaneous trigger finger release: the ‘lift-cut’ technique. Br J Plast Surg 2005; 58 (6) 817-821
- 33 Rojo-Manaute JM, Rodríguez-Maruri G, Capa-Grasa A, Chana-Rodríguez F, Soto MdelV, Martín JV. Sonographically guided intrasheath percutaneous release of the first annular pulley for trigger digits, part 1: clinical efficacy and safety. J Ultrasound Med 2012; 31 (3) 417-424
- 34 Ryu HK, Lee SK, Min BW, Ban JS, Lee JH, Kim EJ. Clinical experience of the percutaneous release for trigger fingers. Korean J Anesthesiol 2009; 56 (1) 60-65
- 35 Sato ES, Gomes Dos Santos JB, Belloti JC, Albertoni WM, Faloppa F. Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release and open surgery. Rheumatology (Oxford) 2012; 51 (1) 93-99
- 36 Torudom Y. Percutaneous trigger thumb release with 18 gauge needle. J Med Assoc Thai 2012; 95 (Suppl. 12) S90-S92
- 37 Uçar BY. Percutaneous surgery: a safe procedure for trigger finger?. N Am J Med Sci 2012; 4 (9) 401-403
- 38 Uruc V, Cingu AK, Sayit E, Kucukdurmaz F, Aytekin MN. Percutaneous trigger finger release with microvitreoretinal 19 gauge ophthalmologic knife. Acta Ortop Bras 2011; 19: 309-311
- 39 Yiannakopoulos CK, Ignatiadis IA. Transdermal anaesthesia for percutaneous trigger finger release. Hand Surg 2006; 11 (3) 159-162
- 40 Zyluk A, Jagielski G. Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial. J Hand Surg Eur Vol 2011; 36 (1) 53-56
- 41 Zhao JG, Kan SL, Zhao L , et al. Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence. J Hand Surg Am 2014; 39 (11) 2192-2202
- 42 Peterson WW, Manske PR, Bollinger BA, Lesker PA, McCarthy JA. Effect of pulley excision on flexor tendon biomechanics. J Orthop Res 1986; 4 (1) 96-101
- 43 Bain GI, Turnbull J, Charles MN, Roth JH, Richards RS. Percutaneous A1 pulley release: a cadaveric study. J Hand Surg Am 1995; 20 (5) 781-784 ; discussion 785–786
- 44 Carrozzella J, Stern PJ, Von Kuster LC. Transection of radial digital nerve of the thumb during trigger release. J Hand Surg Am 1989; 14 (2 Pt 1): 198-200
- 45 Dunn MJ, Pess GM. Percutaneous trigger finger release: a comparison of a new push knife and a 19-gauge needle in a cadaveric model. J Hand Surg Am 1999; 24 (4) 860-865
- 46 Heithoff SJ, Millender LH, Helman J. Bowstringing as a complication of trigger finger release. J Hand Surg Am 1988; 13 (4) 567-570
- 47 Pope DF, Wolfe SW. Safety and efficacy of percutaneous trigger finger release. J Hand Surg Am 1995; 20 (2) 280-283
- 48 Stothard J, Kumar A. A safe percutaneous procedure for trigger finger release. J R Coll Surg Edinb 1994; 39 (2) 116-117
- 49 Wang J, Zhao JG, Liang CC. Percutaneous release, open surgery, or corticosteroid injection, which is the best treatment method for trigger digits?. Clin Orthop Relat Res 2013; 471 (6) 1879-1886
- 50 Tanaka J, Muraji M, Negoro H, Yamashita H, Nakano T, Nakano K. Subcutaneous release of trigger thumb and fingers in 210 fingers. J Hand Surg [Br] 1990; 15 (4) 463-465
- 51 Wilhelmi BJ, Mowlavi A, Neumeister MW, Bueno R, Ketchum J, Lee WP. Surface landmarks to locate the thenar branch of the median nerve: an anatomical study. Plast Reconstr Surg 2003; 111 (5) 1612-1615
- 52 Lane LB. Percutaneous release of the first annular pulley. J Hand Surg Am 1995; 20: 785-786
- 53 Chern TC, Jou IM, Yen SH, Lai KA, Shao CJ. Cadaveric study of sonographically assisted percutaneous release of the A1 pulley. Plast Reconstr Surg 2005; 115 (3) 811-822
- 54 Rojo-Manaute JM, Soto VL, De las Heras Sánchez-Heredero J, Del Valle Soto M, Del Cerro-Gutiérez M, Martín JV. Percutaneous intrasheath ultrasonographically guided first annular pulley release: anatomic study of a new technique. J Ultrasound Med 2010; 29 (11) 1517-1529
- 55 Lapègue F, André A, Meyrignac O , et al. US-guided percutaneous release of the trigger finger by using a 21-gauge needle: a prospective study of 60 cases. Radiology 2016; 280 (2) 493-499
- 56 Rojo-Manaute JM, Capa-Grasa A, Rodríguez-Maruri GE, Moran LM, Martínez MV, Martín JV. Ultra-minimally invasive sonographically guided carpal tunnel release: anatomic study of a new technique. J Ultrasound Med 2013; 32 (1) 131-142
- 57 Keith MW, Masear V, Amadio PC , et al. Treatment of carpal tunnel syndrome. J Am Acad Orthop Surg 2009; 17 (6) 397-405
- 58 Nakamichi K, Tachibana S, Yamamoto S, Ida M. Percutaneous carpal tunnel release compared with mini-open release using ultrasonographic guidance for both techniques. J Hand Surg Am 2010; 35 (3) 437-445
- 59 Chern TC, Jou IM, Chen WC, Wu KC, Shao CJ, Shen PC. An ultrasonographic and anatomical study of carpal tunnel, with special emphasis on the safe zones in percutaneous release. J Hand Surg Eur Vol 2009; 34 (1) 66-71
- 60 Nakamichi K, Tachibana S. Ultrasonographically assisted carpal tunnel release. J Hand Surg Am 1997; 22 (5) 853-862
- 61 Rowe NM, Michaels V J, Soltanian H, Dobryansky M, Peimer CA, Gurtner GC. Sonographically guided percutaneous carpal tunnel release: an anatomic and cadaveric study. Ann Plast Surg 2005; 55 (1) 52-56 ; discussion 56
- 62 Lecoq B, Hanouz N, Vielpeau C, Marcelli C. Ultrasound-guided percutaneous surgery for carpal tunnel syndrome: a cadaver study. Joint Bone Spine 2011; 78 (5) 516-518
- 63 Stecco C, Macchi V, Lancerotto L, Tiengo C, Porzionato A, De Caro R. Comparison of transverse carpal ligament and flexor retinaculum terminology for the wrist. J Hand Surg Am 2010; 35 (5) 746-753
- 64 Romeo P, d'Agostino MC, Lazzerini A, Sansone VC. Extracorporeal shock wave therapy in pillar pain after carpal tunnel release: a preliminary study. Ultrasound Med Biol 2011; 37 (10) 1603-1608
- 65 Wilson KM. Double incision open technique for carpal tunnel release: an alternative to endoscopic release. J Hand Surg Am 1994; 19 (6) 907-912
- 66 Morioka M, Whitehouse DJ, Griffin MJ. Vibrotactile thresholds at the fingertip, volar forearm, large toe, and heel. Somatosens Mot Res 2008; 25 (2) 101-112
- 67 Klein RD, Kotsis SV, Chung KC. Open carpal tunnel release using a 1-centimeter incision: technique and outcomes for 104 patients. Plast Reconstr Surg 2003; 111 (5) 1616-1622
- 68 Cellocco P, Rossi C, Bizzarri F, Patrizio L, Costanzo G. Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study. J Hand Surg Am 2005; 30 (3) 493-499
- 69 Scholten RJ, Mink van der Molen A, Uitdehaag BM, Bouter LM, de Vet HC. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; CD003905 (4) CD003905
- 70 Trumble TE, Diao E, Abrams RA, Gilbert-Anderson MM. Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial. J Bone Joint Surg Am 2002; 84-A (7) 1107-1115
- 71 Nakamichi K, Tachibana S. Distance between the median nerve and ulnar neurovascular bundle: clinical significance with ultrasonographically assisted carpal tunnel release. J Hand Surg Am 1998; 23 (5) 870-874
- 72 Markison RE. Percutaneous ultrasound-guided MANOS carpal tunnel release technique. Hand (NY) 2013; 8 (4) 445-449
- 73 Rojo-Manaute JM, Capa-Grasa A, Chana-Rodríguez F , et al. Ultra-minimally invasive ultrasound-guided carpal tunnel release: a randomized clinical trial. J Ultrasound Med 2016; 35 (6) 1149-1157