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Sonographically Assisted Percutaneous Release of the A1 Pulley: A New Surgical Technique for Treating Trigger Digit

From the Department of Orthopaedics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, and the Department of Orthopaedic Surgery, Ping-Tong Christian Hospital, Ping-Tong, Taiwan

Correspondence: Corresponding author. Dr I. M. Jou, MD, PhD, Department of Orthopaedics, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan. Tel.: +886 6 276 6689; fax: +886 6 276 6189. E-mail: jming{at}mail.ncku.edu.tw

This study introduces a sonographically assisted percutaneous technique for releasing trigger digits which provides direct visualization of the release and avoids the risks of incomplete release and injury to adjacent neurovascular structures associated with other percutaneous release techniques. The "safe zone" and an estimate of the size of the A1 pulley were determined in a separate cadaver study. We then used these landmarks in a prospective clinical study of 107 digits in 83 consecutive patients treated by this technique. During the follow-ups of between 9 and 15 months, we evaluated 104 digits in 80 patients. Pain was absent in 101 digits (97%) and considerably improved in the other three (3%). All mechanical problems had been resolved and none recurred during follow-up. This technique allows the surgeon to see and monitor, precisely, the percutaneous division of the A1 pulley without open surgery and, therefore, to avoid the inherent risks of percutaneous and open surgical release.

Key Words: percutaneous release • trigger digit • sonography

Journal of Hand Surgery (British and European Volume), Vol. 31, No. 2, 191-199 (2006)
DOI: 10.1016/J.JHSB.2005.11.003


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