Randomized Controlled Trial on Combined Percutaneous Release and Steroid Injection Versus Percutaneous Release Alone for Trigger Finger in Adults

@#INTRODUCTION: Trigger finger is one of the most common causes of hand pain and disability. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Many authors have noted that percutaneous release is convenient and cost-effective with a low complication rate. Only few studies have published results on combination of percutaneous release and steroid injection. OBJECTIVE: To compare the differences of outcomes in adults with trigger finger treated with combination of percutaneous release and corticosteroid injection to those treated with percutaneous release alone METHODS: We included all patients older than 18 years old in the UP-PGH Department of Orthopedics with a diagnosis of trigger finger who have consented to participate in this study. They were randomized into two treatment groups. One group was treated with percutaneous release only and the other group was treated with combined percutaneous release and corticosteroid injection. Outcomes measured were total active motion (TAM), postoperative pain, time to return-to-work, patient satisfaction, and complications. RESULTS: Post-procedure, both groups showed significant improvement in motion of the fingers (p = 0.034) and pain relief (p = 0.001). TAM scores of the combination group were better compared to the control at all time intervals (p = 0.03, 0.008, 0.004, 0.019) and better pain VAS scores in the 1st week (p = 0.009). Patients who received the combination treatment showed a trend toward better patient satisfaction, shorter duration of post-release pain and earlier return-to-work. CONCLUSION: significantly improves TAM and pain VAS scores.

Factors influencing the outcomes of the traditional Chinese medicine percutaneous release treatment for the stenosal tendosynovitis / 国际中医中药杂志

Objective The aim of this study is to analyze the factors influencing the outcomes of the traditional Chinese medicine (TCM) percutaneous release treatment for the stenosal tendosynovitis. Methods A total of 119 eligible participants, from outpatient of Dongzhimen Hospital during June, 2014 to April, 2017, were included into the study. The participants received TCM percutaneous release treatment, and were followed-up and assessed outcomes at 27 w. Responders were defined as participants with normal movement in week 27 compared with the baseline period. The NRS assessment in both groups was described, and the baseline characteristics of participants potentially related to cure response were mainly analyzed using Logistic regression analysis. Results Cure group and non-cure group were determined according to the cure response. And the outcomes of pain relief along the timeframe showed the feasibility of criteria of cure response. The uni-factor Logistic regression analysis showed that the factors age,course of disease,interventions and pain severity were significantly different between the cure and non-cure groups,and the multi-factor Logistic regression confirmed the four factors influenced the cure response of the TCM percutaneous release treatment for the stenosal tendosynovitis. The cutting knife was 5.85 fold than the traditional needling knife at increasing the cure response (OR=5.853,95% CI 1.853-18.485;P=0.003).All the factors that age equal to or older than 60 years(OR=6.170, 95% CI 1.890-20.141; P=0.003), course of disease more than six months (OR=4.696, 95% CI 1.371-16.085;P=0.014)and pain severity from 6 to 7(OR=5.184,95% CI 1.416-18.975;P=0.013)were negatively associated with clinical response. Conclusions The patients with increasing age, long course of disease and distinct pain severity may be less likely to respond to the TCM percutaneous release treatment. These findings contribute to guiding clinical practice in terms of pretreatment patient selection. Further research is needed to confirm the association.

Percutaneous planter fasciitis release under local anesthesia: A prospective study / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Plantar fasciitis is the most common cause of pain on the bottom of the heel. It occurs when the strong band of the tissue supporting the arch of foot becomes irritated and inflamed. The majority of patients can be treated conservatively but some resistant cases need surgery eventually. This study aims to evaluate the outcome results of percutaneous planter fascia release under local anesthesia for chronic planter fasciitis.</p><p><b>METHODS</b>This prospective study was conducted in the Department of Orthopaedic Surgery in the School of Medical Science and Research, Sharda University, India from December 2010 to December 2013. Totally 78 patients with planter fasciitis for more than 6-12 months were recruited from the outpatient department. All patients were operated on under local anesthesia and followed up for a year.</p><p><b>RESULTS</b>The clinical results were evaluated in terms of pain, activity level and patient satisfaction. Pain relief was achieved averagely at eight weeks after surgery. The results were excellent in 88.46% (69/78) patients and good in 6.41% (9/78) patients. Neither complications of lateral column instability, sinus tarsitis and metatarsalgia nor wound-related complications were encountered. On subjective evaluations, 88.46% (69/78) patients reported full satisfaction and 6.41% (9/78) reported partial satisfaction after treatment.</p><p><b>CONCLUSION</b>Percutaneous planter fasciitis release under local anesthesia is a minimally invasive procedure that can be performed in the outpatient setting. It is easy, quick, effective and moreover with few complications.</p>

Ultrasound-Guided Percutaneous Release of the Trigger Thumb

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.

Percutaneous A1 Pulley Release of Locked Trigger Thumb in Children

PURPOSE: To report the clinical outcomes of percutaneous A1 pulley release for the surgical treatment of locked trigger thumb in children. MATERIALS AND METHODS: Twenty-six trigger thumbs in 24 patients with a average of 14.2 months follow-up after percutaneous release were enrolled. There were 15 females and 9 males with an average age of 39 months. The mean time from first presentation to surgery was 16 months. Procedures were performed under local anesthesia. Postoperative examinations at immediate, 3 months and 1-year recorded pain, triggering and range of motion and presence of complications. RESULTS: All thumbs had a satisfactory result without digital nerve injury. Eleven patients(46%) had a mean 14.3degrees extension loss of the interphalangeal joint and 12.0degrees hyperextension of the metacarpophalangeal joint of the thumb, compared to the contralateral thumb. At final follow-up, all but 1 patient were completely resolved. The duration of symptoms and age were higher in the group with thumb deformity (p<0.05). CONCLUSION: Temporary thumb deformity is possible after surgical treatment of trigger thumb in children with a long duration of symptoms. Percutaneous release can be a safe and satisfactory treatment option in pediatric trigger thumb.

Clinical experience of the percutaneous release for trigger fingers / 대한마취과학회지

BACKGROUND: Conservative management for the trigger fingers includes splinting, steroid injection and other adjuvant methods. If conservative treatment fails, a surgical release of the A1 pulley is offered. Although the success rate of the surgical intervention is high, the complications, for example, a digital nerve injury, bowstringing, infection and continued triggering, have been reported. Percutaneous release with an 18 guage needle has been reported as a safe and effective procedure for the trigger fingers. This study evaluates the safety and efficacy of the percutaneous release. METHODS: 33 patients received the percutaneous release of the A1 pulley with an 18 guage needle and steroid injection (Group A) and 36 patients did the only administration of steroid as a control group (Group B). Patients were examined with a clinical staging for the Watanabe stage (W stage) and 0-10 points verbal numerical rating scale (VNRS) score at 1 week, 3 months, 1 year after the initial treatment. RESULTS: After 1 year of the follow-up, 93.5% in the group A and 57.6% in the group B had complete release of the trigger fingers in the W stage. VNRS after the initial treatment demonstrated that the decrement of the pain score was more significant in the group A. CONCLUSIONS: We need to consider the percutaneous release with steroid injection at an early stage of the trigger fingers because of the more effective resolution of the symptoms and the better long-term prognosis than a steroid injection alone.

Percutaneous Release of the Trigger Finger using Newly Designed Scalpel / 대한정형외과학회잡지

Percutaneous method of Al pulley release for the trigger fingers using hypodermic needle or small sharp scalpel has been described by some authors. In our experience, however, these methods had some difficulties in handling the instruments and not easy to utilize proper technique. Therefore we designed a special scalpel for easy and safe percutaneous release of the Al pulley. The scalpel has a hook shaped end with a blade on the inner side. Insertion site through the skin should be 0.5cm distal to the Al pulley, and the hooked end is located at the proximal margin of the Al pulley followed by longitudinal cut of the pulley distally. We performed this procedure in 44 trigger fingers of 41 patients in our out-patient clinic. There were 9 males and 32 females with a mean age of 54.4 years (range, 24 to 83 years). Affected digits were 23 thumbs, 1 index, 13 middle, 5 ring and 2 little fingers. 9 of them were locked in flexion or extension. The duration of symptom was an average of 7.9 months. After a mean follow up of 11.3 months, 42 fingers (95.4%) were completely free of symptoms including triggering. One had mild residual triggering due to incomplete release of the pulley and another had re-release of the pulley for remaining flexion limitation. One finger showed mild bowstringing after release, which subsided in 3 months. One patient complained of persistent pain and tenderness over the release site. There were no injuries of nerves or vessels and no infections. The duration of discomfort after release ranged from 3 to 70 days (av. 18.5 days). All patients, except one, were satisfied with the treatment method and their results. We think that percutaneous release of trigger fingers using our special scalpel is a very effective and convenient procedure both to surgeons and patients. It can be easily and safely performed in out-patient clinic with successful results.

Comparison of Percutaneous and Open Decompression in the Treatment of Carpal Tunnel Syndrome / 대한정형외과학회잡지

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome that characterized by pain, especially in night, sensory disturbance in median nerve dermatome of the hand, and thenar muscle atrophy. Open decompression was a treatment of choice, when operative intervention is necessary. But, endoscopic or percutaneous decompression is introduced recently. Authors analyzed 21 cases of open decompression and 22 cases of percutaneous decompression and they could be follow up over 6 months at Dept. of Orthopedics, Chonnam University Hospital from June 1990 to January 1995. The results are as follows. 1. There were no difference in age, sex, lesion side, symptoms duration until operation, etiology and occupation between percutaneous and open decompression. 2. There were excellent or good results in clinical symptom in 19 cases(90%) of open procedures and 19 cases(86%) of percutaneous procedure and more rapid relief of the pain, and grip power in percutaneous procedure than open procedure. 3. The EMG, recorded at 1 week, 4 weeks, 3 months and 6 months after operation, revealed improvement in sensory than motor function. There was more rapid recovery in percutaneous procedure than open procedure especially latency and amplitude of sensory nerve. There were 2 cases in open procedure and 3 cases in percutaneous procedure who did not respond to treatment. As a result, percutaneous procedure was more simple and rapid recovery than open procedure in clinical progressions and EMG reports, but recovery rate of symptomatic relief was similar. Therefore percutaneous procedure is thought to be more reasonable method in the treatment of carpal tunnel syndrome if surgical intervention is indicated.

Percutaneous Release of Trigger Gingers / 대한정형외과학회잡지

A simple out-patient's procedure with the use of a simple 17 or 18G hypodermic needle for the percutaneous release of trigger finger is described. The authors are reporting the satisfactory result obtained by means of percutaneous release of tendon sheath without skin incision in 21 trigger fingers of 17 patients treated at the out-patient-basis.