Ultrasound-Guided Percutaneous Release of A1 Pulley by Using a Needle Knife: A Prospective Study of 41 Cases

Min Pan, Shuya Sheng, Zhiqi Fan, Hao Lu, Hong Yang, Fei Yan, Zhansen E, Min Pan, Shuya Sheng, Zhiqi Fan, Hao Lu, Hong Yang, Fei Yan, Zhansen E

Abstract

Objective: The purpose of this study was to evaluate the efficacy of ultrasonography-guided percutaneous A1 pulley release with the needle knife for trigger finger. Methods: The prospective study included 21 patients (21 fingers) who underwent blind release with the needle knife and 20 patients (20 fingers) who underwent ultrasonography-guided release with the needle knife. The thickness and width of A1 pulley, clinical grade before and after release, complications, and operation time were compared between the groups. Results: The results showed that the ultrasonography-guided group had significantly better grade postoperatively and reached to 100% complete release in one time compared to the blind group (p < 0.05). Moreover, no any complications had been happened in the ultrasonography-guided group. A relatively longer operation time of the ultrasonography-guided group was observed compared to the time of the blind group. Conclusions: The needle knife is a very good tool for release of triggering fingers. Ultrasound provides a direct and precise visualization of the thickness, width and location of A1 pulley lesion. The combined use of ultrasound and the needle knife can achieve the best result for trigger finger. Moreover, the combination changes the traditional opinion and operator-dependent mode that were once widely adopted in the hospital of Chinese Medicine.

Keywords: A1 pulley; needle knife; release; trigger finger; ultrasonography-guided.

Figures

Figure 1
Figure 1
Patients' flowchart.
Figure 2
Figure 2
The scheme of Hanzhang needle knife. The needle knife consists of three parts: tip, body and handle, with a 0.8 mm blade on the tip, and 40 mm length of the body. The tip can serve as a scalpel during release.
Figure 3
Figure 3
(A) The anatomical landmark of entry point. (B) The marking method of the entry point (Triggering thumb: A straight line paralleling to the thumb from the midpoint A1 of the distal thumb crease is drawn. The line C is the transverse line of proximal thumb crease. B1 is the intersection point of A1 parallel line and C line. The entry point is +0.5 mm of B1 proximally. Triggering finger: A connection line is drawn between the midpoint of the proximal finger crease (A2~A5) and D (the midpoint of wrist rasceta). Line B is drawn between the distal and proximal palmar creases. B2~B5 are the intersection points of lines B and line AD. The entry point is −0.5 mm of B2~B5 distally).
Figure 4
Figure 4
The scheme (A) and spot (B) of the blind release.
Figure 5
Figure 5
The ultrasound images before (A) and after (B,C) release in the blind group. (A) The yellow arrow showed the thickness of A1 pulley in the right thumb before release. (B) The yellow arrow showed the fluid of the surrounding tissue immediately after release. (C) The red arrow was the wrong cutting direction after piercing into the skin from the marked entry point. The yellow arrow was the thickening location of A1 pulley. They were not at the same point. PP, proximal phalange, MC, metacarpal bone.
Figure 6
Figure 6
The scheme (A) and spot (B) of the ultrasonography-guided release. The body of the needle knife paralleled to the tendon. With the help of ultrasound, it was easy and safe to complete the whole procedure.
Figure 7
Figure 7
The ultrasound images before (A), during (B) and after (C) release with ultrasonography-guided. (A) The yellow arrow showed the thickening of A1 pulley in the right index finger before operation. (B) The red arrow showed the needle knife was cutting the A1 pulley (yellow arrow). (C) The A1 pulley (the yellow arrow) became normal thickness immediately after ultrasonography-guided release. PP, proximal phalange; MC, metacarpal bone.

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