J Korean Soc Surg Hand.  2016 Dec;21(4):218-224. 10.12790/jkssh.2016.21.4.218.

Ultrasound-Guided Percutaneous Release of the Trigger Thumb

• Park KH
• Shin WJ
• Lee DH
• Kim JP

• KMID: 2364213
• DOI: http://doi.org/10.12790/jkssh.2016.21.4.218

Abstract

PURPOSE
Trigger thumb is a common condition with a prevalence rate up to 3% among the adults. The main pathophysiology is locking of the flexor tendon at the A1 pulley. Treatments include nonsteroidal anti-inflammatory drug, steroid injection, and surgical A1 pulley release. The purpose of this study was to evaluate the safety and effectiveness of ultrasound-guided percutaneous release of trigger thumb.
METHODS
The author prospectively reviewed 37 patients who had undergone ultrasound-guided percutaneous release by the same surgeon from January 2012 to June 2014. The effect of ultrasound-guided A1 pulley release was evaluated by using visual analogue scale (VAS) score, disabilities of arm, shoulder, and hand (DASH) score, and grip and pinch strengths preoperatively and at 12weeks after the surgery. In addition, complications related with the procedure were evaluated.
RESULTS
Triggering and locking were resolved in all patients after surgery. VAS and DASH improved from 5.0±1.8 and 45.8±16.9 preoperatively to 0.3±0.6 and 16.2±6.3 at 12 weeks, respectively (p=0.019 and p=0.021). Grip and pinch strengths statistically improved from33.5±8.6 kg and 36.7±8.1 kg, preoperatively 46.2±6.1 kg and 47.1±7.4 kg, respectively (p=0.026 and p=0.041). Complications such as incomplete resection, neurologic symptoms or wound infection were not found throughout the period of the study.
CONCLUSION
Ultrasound-guided percutaneous A1 pulley release provides complete relief of symptoms with no major complication in trigger thumb.

Keyword

Trigger thumb; A1 pulley; Percutaneous release; Ultrasound

MeSH Terms

Adult
Arm
Hand
Hand Strength
Humans
Neurologic Manifestations
Pinch Strength
Prevalence
Prospective Studies
Shoulder
Tendons
Trigger Finger Disorder*
Ultrasonography
Wound Infection

Figure

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  Fig. 1. A specially designed knife (HAKI knife, BK Meditech Inc., Seoul, Korea)8.

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  Fig. 2. A photograph of percutaneous release assisted ultrasound (ACUSON S1000, Siemens Medical Solutions Inc.). Holding the thumb at 30° abduction and 15° flexion, a HAKI knife was inserted distally to the metacarphophalangeal flexion crease.

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  Fig. 3. (A) A axial view of the A1 pulley in the right thumb. Arrow indicates tip of HAKI knife which was located in A1 pulley layer, not tendon; yellow territory, radial digital nerve; red territory, radial digital artery. (B) A axial view of the A1 pulley in the right thumb using Doppler. MCP, metacarpophalangeal; FPL, flexor pollicis longus.

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  Fig. 4. A sagittal view of the A1 pulley in the right thumb. Yellow arrow indicate A1 pulley at MCP joint. MCP, metacarpophalangeal; FPL, flexor pollicis longus.

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  Fig. 5. A sagittal view of the A1 pulley in the right thumb. Arrow indicates tip of HAKI knife which was located in proximal A1 pulley margin, not tendon; yellow arrow, A1 pulley. MCP, metacarpophalangeal; FPL, flexor pollicis longus.

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