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Li Z, Guo Y, Chen L, Xue W. Ultrasound-guided needle knife release for stenosing tenosynovitis of the flexor pollicis longus: a prospective randomized controlled trial. HAND SURGERY & REHABILITATION 2024; 43:101786. [PMID: 39370042 DOI: 10.1016/j.hansur.2024.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/26/2024] [Accepted: 10/01/2024] [Indexed: 10/08/2024]
Abstract
PURPOSE This study aimed to evaluate the efficacy and safety of ultrasound-guided needle knife release in the treatment of stenosing tenosynovitis of the flexor pollicis longus. METHODS In this prospective trial, 60 patients with clinically and ultrasonographically confirmed stenosing tenosynovitis of the flexor pollicis longus were randomly allocated to 1 of 3 groups: ultrasound-guided needle knife release (n = 20), traditional conservative treatment (n = 20), and open surgery (n = 20). The primary outcome measure was the Quinnell grade of triggering severity. Secondary outcomes comprised pain intensity (on visual analog scale), satisfaction (5-point Likert scale), and complications. Outcomes were evaluated at baseline, 1 week, 1 month and 3 months post-intervention by blinded assessors. RESULTS At all follow-up time points, the needle knife release group demonstrated significantly lower Quinnell grades (p < 0.05) and pain scores (p < 0.001) than the conservative treatment group; satisfaction was greater in the needle knife release group compared to the conservative treatment group at 1 month (p = 0.002) and 3 months (p < 0.001). There were no significant differences in outcomes between the needle knife release group and the open surgery group. The overall complications rate was 5% in the needle knife release group, 10% in the conservative treatment group, and 15% in the open surgery group (p = 0.574). CONCLUSION Ultrasound-guided needle knife release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus, with outcomes that are better than with traditional conservative treatment and similar to those of open surgery.
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Affiliation(s)
- Zhengliang Li
- Department of Ultrasound, People's Hospital of Luliang City, Shanxi, China
| | - Yahong Guo
- Department of Ultrasound, People's Hospital of Luliang City, Shanxi, China
| | - Linfeng Chen
- Department of Ultrasound, People's Hospital of Luliang City, Shanxi, China
| | - Wenyan Xue
- Department of Ultrasound, People's Hospital of Luliang City, Shanxi, China.
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Rohilla R, Kaur H, Tiwari P. Comparison of efficacy and safety of USG-guided versus blind pulley release for trigger finger: A systematic review and meta-analysis. J Clin Orthop Trauma 2024; 58:102795. [PMID: 39554281 PMCID: PMC11566334 DOI: 10.1016/j.jcot.2024.102795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/18/2024] [Accepted: 10/28/2024] [Indexed: 11/19/2024] Open
Abstract
Background To compare the efficacy and safety of the USG-guided vs blind pulley release (PR) for Trigger Finger by performing a meta-analysis of all relevant studies in the published literature. Methods A thorough and methodical search of the PubMed, Embase, Scopus, and Cochrane Library databases was carried out. Review Manager Software (RevMan) 5.4.1 was used to analyze the extracted data, and the results were displayed as forest plots with matching 95 % confidence intervals. Results The primary efficacy outcome i.e. residual triggering was significantly lower in USG-guided PR as compared to blind PR with a risk ratio of 0.16 (95 % CI 0.03-0.87), p = 0.03. The primary safety outcome i.e., percentage of complications was lower in the USG-guided procedure group, although the result was not statistically significant with a risk ratio of 0.25 (95 % CI 0.05-1.16), p = 0.08 with I2 of 0 %. The operation time was longer in the USG-guided PR as compared to the blind procedure, although the difference was not statistically significant with a mean difference of 5.36 (95 % CI: -3.73, 14.46), p = 0.25. The postoperative visual analog scale (VAS) score at 4 weeks was significantly lower in USG-guided PR versus blind PR with a mean difference of -0.40 (95 % CI: -0.68, -0.33), p = 0.004. Conclusion When compared to blind PR, ultrasound-guided A1 PR for trigger finger was proven to be a safer and more economical method.
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Affiliation(s)
- Rachna Rohilla
- Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Harmeet Kaur
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Punit Tiwari
- Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India
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Moungondo F, Van Ovestraeten L, Boushnak MO, Schuind F. Retrograde Percutaneous Release of Trigger Finger or Thumb Using Sono-Instruments®: Detailed Technique, Pearls, and Pitfalls. Cureus 2024; 16:e52911. [PMID: 38274628 PMCID: PMC10809902 DOI: 10.7759/cureus.52911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 01/27/2024] Open
Abstract
Percutaneous release is a common treatment option for trigger finger stenosing tenosynovitis. While surgical and conservative treatments are available, percutaneous techniques offer several advantages, including faster recovery time, reduced complications, and simultaneous treatment of multiple trigger fingers. The sono-instrument is a minimally invasive device designed for surgical release of the A1 pulley in adults. The device is efficient and safe, and in addition, several design features enhance the visibility of the instrument under ultrasound imaging. The technique is truly percutaneous, as the whole operation is done through a single needle puncture. This minimizes postoperative discomfort and allows an immediate return to daily living and professional activities. The technique can be performed in an outpatient clinic under local anesthesia. The learning curve is quick; however, surgeons must acquire experience in hand sonography to master this new form of surgery. The aim of this article is to provide an in-depth exposition of the technical nuances, pearls, and pitfalls of this novel retrograde percutaneous release method. To our knowledge, this is the first retrograde truly percutaneous release technique yet described, facilitated by the novel Sono-Instruments®.
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Affiliation(s)
- Fabian Moungondo
- Department of Orthopedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, BEL
| | - Luc Van Ovestraeten
- Department of Orthopaedics and Traumatology, Hand and Wrist Center, Hand and Foot Surgery Unit (HFSU), AO Foundation, Erasme University Hospital, Tournai, BEL
| | - Mohammad O Boushnak
- Department of Orthopedics and Sports Medicine, North Sydney Orthopaedic and Sports Medicine Centre, Mater Hospital, Sydney, AUS
| | - Frédéric Schuind
- Department of Orthopedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, BEL
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Sutter D, Treier A, Vögelin E. Sonographically controlled minimally-invasive A1 pulley release using a new guide instrument - a case series of 106 procedures in 64 patients. BMC Musculoskelet Disord 2023; 24:875. [PMID: 37950217 PMCID: PMC10636860 DOI: 10.1186/s12891-023-06982-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND With percutaneous and minimally-invasive pulley release becoming more popular, safety and reliability of such minimally-invasive procedures remain a concern. Visualization of the technical steps by ultrasound suggests increased safety but shows the potential for harm to tendons, nerves and vessels without proper instrumentation. We present the results of implementing a sonographically guided minimally-invasive procedure in 106 trigger digits of 64 patients between 2018-2021. METHODS A guide instrument for use with a commercially available hook knife was developed and tested in 16 cadaver hands. Due to complication early in our clinical series this guide was modified in due course. A revised design of the guide has been in use since November 2019 with improved performance and safety. RESULTS One hundred six procedures in 64 patients were performed. After guide revision, we report a success rate of 97.3%. Complications after instrument revision include two cases of incomplete pulley release and one case of inadvertent skin laceration. The majority of patients report returning to all strenuous activities within two weeks at most apart from four individuals with prolonged postoperative discomfort. CONCLUSION We present the results of the development and implementation of a novel guide instrument for use with a hook knife to treat trigger finger. Despite several limitations of this study, we show that sonographically controlled, minimally-invasive A1 pulley release can be performed safely and effectively with appropriate surgical instruments and practice.
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Affiliation(s)
- Damian Sutter
- Department of Hand Surgery, University Hospital Berne, Inselspital Bern, Freiburgstrasse 10, CH-3010, Berne, Switzerland.
| | - Aline Treier
- Department of Hand Surgery, University Hospital Berne, Inselspital Bern, Freiburgstrasse 10, CH-3010, Berne, Switzerland
| | - Esther Vögelin
- Department of Hand Surgery, University Hospital Berne, Inselspital Bern, Freiburgstrasse 10, CH-3010, Berne, Switzerland
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Nakagawa H, Redmond T, Colberg R, Latzka E, White MS, Bowers RL, Sussman WI. Ultrasound-Guided A1 Pulley Release: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2491-2499. [PMID: 37401544 DOI: 10.1002/jum.16294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/21/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023]
Abstract
The purpose of this review was to summarize the current literature pertaining to ultrasound-guided percutaneous A1 pulley release procedures. We searched PubMed, Cochrane Library, Embase, and Web of Science for clinical studies examining ultrasound-guided percutaneous A1 pulley release. A total of 17 studies involving 749 procedures were included in this review. The overall success rate was 97%. There were 23 minor complications (4 cases of hematomas, 15 cases of persistent pain, and 4 cases of transient numbness) and no major complications reported. Ultrasound-guided A1 pulley release is an effective and safe procedure for the treatment of trigger fingers and thumb.
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Affiliation(s)
- Hirotaka Nakagawa
- Department of Orthopedics and Rehabilitation, Tufts Medical Center, Boston, Massachusetts, USA
| | - Travis Redmond
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ricardo Colberg
- Andrews Sports Medicine and Orthopeadic Center, Birmingham, Alabama, USA
| | - Erek Latzka
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mia S White
- Emory University Woodruff Health Science Center Library, Atlanta, Georgia, USA
| | - Robert L Bowers
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Walter I Sussman
- Department of Orthopedics and Rehabilitation, Tufts Medical Center, Boston, Massachusetts, USA
- Boston Sports & Biologics, Wellesley Hills, Massachusetts, USA
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6
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Rodríguez-Maruri G, Rojo-Manaute JM, Capa-Grasa A, Chana Rodríguez F, Cerezo López E, Vaquero Martín J. Ultrasound-Guided A1 Pulley Release Versus Classic Open Surgery for Trigger Digit: A Randomized Clinical Trial. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1267-1275. [PMID: 36478278 DOI: 10.1002/jum.16139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/28/2022] [Accepted: 11/14/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES We compared an ultra-minimally invasive ultrasound-guided percutaneous A1 pulley release and a classic open surgery for trigger digit. METHODS We designed a single-center randomized control trial. All cases had clinical signs of primary grade III trigger digit. Concealed allocation (1:1) was used for assigning patients to each group and data collectors were blinded. The Quick-Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire was our primary variable. Quick-DASH, two-point discrimination, grip strength, time until stopping analgesics, having full digital range of motion and restarting everyday activities were registered on the 1st, 3rd, and 6th weeks, 3rd and 6th months, and 1st year after the procedure. RESULTS We randomized 84 patients to ultrasound-guided release and classic open surgery. Quick-DASH scores significantly favored the percutaneous technique until the 3rd month: 7.6 ± 1.2 versus 15.3 ± 2.4 (mean ± standard error of the mean). The percutaneous group obtained significantly better results in all the variables studied: time until stopping analgesics, achieving full range of motion and restarting everyday activities. Grip strength was significantly better in the percutaneous group for the 1st week only. Five cases of moderate local pain were observed in the open technique. There was one case of transient nerve numbness per group. CONCLUSIONS The ultra-minimally invasive ultrasound-guided A1 pulley release was clinically superior to the classic open surgery in functional recovery with a lower complication rate.
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Affiliation(s)
- Guillermo Rodríguez-Maruri
- Primary Care Musculoskeletal Unit, Area V, Servicio de Salud del Principado de Asturias, SESPA, Gijón, Spain
| | - Jose Manuel Rojo-Manaute
- Unit of Hand Surgery, Department of Orthopedics, Medcare Orthopedics and Spine Hospital, Dubai, United Arab Emirates
| | - Alberto Capa-Grasa
- Department of Physical and Rehabilitation Medicine, University Hospital La Paz, Madrid, Spain
| | | | | | - Javier Vaquero Martín
- Department of Orthopaedic Surgery, University Hospital Gregorio Marañón, Madrid, Spain
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Muramatsu K, Rayel MF, Arcinue J, Tani Y, Kobayashi M, Seto T. A Comparison of Blinded versus Ultrasound-Guided Limited-Open Trigger Finger Release Using the Yasunaga Knife. J Hand Surg Asian Pac Vol 2022; 27:124-129. [PMID: 35037574 DOI: 10.1142/s2424835522500096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: An open approach is the gold standard for trigger finger (TF) release. However, this may be associated with infection and scar tenderness. Percutaneous trigger release is an alternative, but this can sometimes result in incomplete release and digital nerve injury, even with ultrasound (US) guidance. Limited-open TF release is an intermediate technique that uses a specially designed knife via a 2-3 mm incision. The aim of this study is to compare the outcomes of blinded versus US-guided limited-open TF release using the Yasunaga knife (Medical U&A, Inc., Japan). Methods: About 138 fingers in 111 patients underwent limited-open TF release using the Yasunaga knife. Green classification was used to grade the severity of TF. Thirty-one patients had grade 3 TF and 80 patients had grade 4 TF. The TF was released in a blinded fashion in 60 patients and using US guidance in 51 patients. Outcome measures included residual triggering, contracture of the proximal interphalangeal joint, visual analog scale (VAS) for assessment of pain, Quick Disability of the Arm, Shoulder, and Hand (DASH) score, and the Patel and Moradia grading of patient satisfaction. Complications were also recorded. Results: Six patients had residual triggering in the blinded group, whereas it resolved in all patients in the US-guided group. This difference was statistically significant (p = 0.03). Patients in both groups showed significant improvement in VAS and Quick DASH score postoperatively. There were no significant differences between the two groups for these two outcomes. Patient satisfaction was graded as excellent by 20 patients and good by 30 patients in the US-guided group compared to eight excellent and 45 good in the blinded group. Conclusion: The incidence of residual triggering was lower and overall satisfaction higher in patients who underwent US-guided limited-open TF release using the Yasunaga knife. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Keiichi Muramatsu
- Department of Hand Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan.,Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Ma Felma Rayel
- Department of Hand Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Jasson Arcinue
- Department of Hand Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Yasuhiro Tani
- Department of Hand Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Masato Kobayashi
- Department of Hand Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Tetsuya Seto
- Department of Hand Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan.,Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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8
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White R, Croft M, Bird S, Sampson M. Ultrasonography-Guided Common Musculoskeletal Interventions from Head to Toe: Procedural Tips for General Radiologists. Korean J Radiol 2021; 22:2006-2016. [PMID: 34564959 PMCID: PMC8628157 DOI: 10.3348/kjr.2021.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/28/2021] [Accepted: 05/22/2021] [Indexed: 11/21/2022] Open
Abstract
The expanding scope of interventional musculoskeletal procedures has resulted in increased pressure on general radiologists. The confidence of general radiologists in performing ultrasound-guided musculoskeletal procedures varies with their clinical exposure. This didactic review provides a methodologically and clinically oriented approach to enhancing user understanding and confidence in performing ultrasound-guided musculoskeletal procedures. The body of the text is accompanied by figures depicting the procedural approach, injection site, and labeled ultrasonography images. This paper aims to provide a teaching and bedside aid for education on and the execution of musculoskeletal procedures to ensure the provision of quality health care.
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Affiliation(s)
- Roland White
- Department of Radiology, Royal Adelaide Hospital, Adelaide, Australia.,Department of Radiology, The University of Adelaide, School of Medicine, Adelaide, Australia.
| | - Michael Croft
- Department of Radiology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Matthew Sampson
- Benson Radiology, Wayville, Australia.,Department of Radiology, Flinders University, School of Medicine Adelaide, Adelaide, Australia
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Singh JP, Kumar S, Kathiria AV, Harjai R, Jawed A, Gupta V. Thumb ultrasound: Technique and pathologies. Indian J Radiol Imaging 2021; 26:386-396. [PMID: 27857468 PMCID: PMC5036340 DOI: 10.4103/0971-3026.190408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ultrasound is ideally suited for the assessment of complex anatomy and pathologies of the thumb. Focused and dynamic thumb ultrasound can provide a rapid real-time diagnosis and can be used for guided treatment in certain clinical situations. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.
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Affiliation(s)
- Jatinder P Singh
- Department of Imaging and Nuclear Medicine, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Shwetam Kumar
- Department of Imaging and Nuclear Medicine, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Atman V Kathiria
- Department of Imaging and Nuclear Medicine, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Rachit Harjai
- Department of Imaging and Nuclear Medicine, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Akram Jawed
- Bone and Joint Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Vikas Gupta
- Bone and Joint Institute, Medanta, The Medicity, Gurgaon, Haryana, India
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Colberg RE, Jurado Vélez JA, Garrett WH, Hart K, Fleisig GS. Ultrasound-guided microinvasive trigger finger release technique using an 18-gauge needle with a blade at the tip: A prospective study. PM R 2021; 14:963-970. [PMID: 34213082 DOI: 10.1002/pmrj.12665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Open surgical trigger finger release has limited success and the risk of complications; however, percutaneous techniques offer a successful alternative. There is limited understanding of the success of percutaneous trigger finger release. OBJECTIVE To prospectively evaluate the functional outcomes of patients with Green classification Grade 2 to 4 trigger finger treated with an ultrasound-guided microinvasive trigger finger release using a special 18-gauge needle with a blade at the tip. DESIGN Prospective, case-series study. SETTING This study took place at an academic institution by one sports medicine physician (R.E.C.) with subspecialty training and certification in musculoskeletal ultrasound. PATIENTS Sixty patients (79 cases) met criteria and agreed to participate in this study; 19 patients had multiple fingers treated. Average patient age was 62.8 years (SD 10.2). Average trigger finger severity diagnosis was Grade 3. INTERVENTIONS Patients were treated with an ultrasound-guided microinvasive trigger finger release using a special 18-gauge needle with a blade at the tip. MAIN OUTCOME MEASUREMENTS Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), numerical rating scale (NRS), and Nirschl scores were captured preprocedure, at various time points, and at final follow-up. Changes between preprocedure and final follow-up were analyzed by paired t test (p < .05). Differences were also analyzed between finger, grade level, and gender by repeated measures analyses of variance (p < .05). RESULTS No adverse events were documented perioperatively or postoperatively. Average follow-up time was 18.4 months (SD 4.6). At final follow-up, 100% of patients reported no recurrence of catching/locking, 97% had complete resolution of symptoms and significant improvement in QuickDASH scores, and 99% required no further treatment. All measurements showed a decrease in pain and symptoms over time. The improvements in QuickDASH score, NRS, and Nirschl scale and the resolution of mechanical symptoms were all statistically significant. CONCLUSIONS Ultrasound-guided release using the 18-gauge needle with a blade provides significant functional improvement and full resolution of mechanical symptoms with minimal adverse events.
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Affiliation(s)
- Ricardo E Colberg
- Andrew's Sports Medicine and Orthopedic Center, Pelham, Alabama, USA
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | | | - William Hunter Garrett
- Andrew's Sports Medicine and Orthopedic Center, Pelham, Alabama, USA
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Karen Hart
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA
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White RZ, Sampson MJ. Assessment of short-term response and review of technique of ultrasound-guided percutaneous A1 pulley release for the treatment of trigger finger. J Med Imaging Radiat Oncol 2021; 65:672-677. [PMID: 33749135 DOI: 10.1111/1754-9485.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ultrasound-guided percutaneous first annular pulley (A1) release is a non-surgical management for the treatment of trigger finger, also known as stenosing tenosynovitis. Trigger finger occurs secondary to inflammation and retinacular sheath hypertrophy with subsequent restriction of the flexor tendons. Trigger finger can have a marked functional impact, with current conservative measures including steroids and/or splinting, and surgical therapy involving open release. METHODS A population of 20 adult patients with ultrasound proven trigger finger underwent percutaneous release with refined technique. Patients with additional ultrasound proven tenosynovitis received steroid injection. RESULTS Of the 20 cases, 18 cases involved the fingers, 2 cases involved the thumb and 14 cases had additional tenosynovitis. All procedures involving the fingers were well tolerated with initial symptomatic and functional relief. At 1-week post-intervention, 2 finger cases without concurrent steroid injection represented with pain but not triggering. Cases which did not receive concurrent steroid injection described post-procedural pain requiring oral analgesia. One case involving the thumb was complicated by no relief with a mild radial digital nerve neuropraxia, with near complete resolution at 6 weeks. The second thumb case reported only partial relief of triggering. CONCLUSION US-guided percutaneous release of the A1 pulley is an effective procedure in achieving at least short-term resolution of trigger finger. It is best reserved for fingers due to the challenging anatomy of the thumb.
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Affiliation(s)
- Roland Z White
- CALHN, Royal Adelaide Hospital, Adelaide, SA, Australia.,The University of Adelaide School of Medicine, Adelaide, SA, Australia
| | - Matthew J Sampson
- Radiology, Benson Radiology, Wayville, SA, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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12
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Colberg RE, Pantuosco J, Fleisig G, Drogosz M. Ultrasound-Guided Microinvasive Trigger Finger Release Technique Combined With Three Tests to Confirm a Complete Release. Am J Phys Med Rehabil 2020; 99:1150-1156. [PMID: 33214498 DOI: 10.1097/phm.0000000000001510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Trigger finger at the A1 pulley is a common cause of hand pain leading to functional limitations. This study evaluated the outcomes of patients treated with a microinvasive ultrasound-guided trigger finger release technique using an 18 blade and described three tests that confirm a complete release. DESIGN A retrospective chart review and cross-sectional study of 46 cases of A1 pulley trigger finger releases in 28 patients performed at a private, sports medicine clinic using this technique were completed, meeting power criteria. The primary outcome measure was the resolution of mechanical catching/locking; secondary outcome measures were reduction in visual analog scale for pain and improvement of function in the modified Nirschl scale. RESULTS Complete release was achieved in all patients, with no recurrence of catching/locking during the first year (P < 0.0001). Ninety-eight percent of patients had significant pain and functional improvement (P < 0.0001). There were no complications perioperatively and postoperatively. The three confirmatory tests ensured that all cases obtained a successful outcome. CONCLUSION This technique combined with confirmatory tests resulted in full resolution of the locking for all patients and statistically significant reduction in pain and improvement in function.
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Affiliation(s)
- Ricardo E Colberg
- From the Andrews Sports Medicine and Orthopedic Center, Birmingham, Alabama (REC); Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham, Alabama (JP); and American Sports Medicine Institute, Birmingham, Alabama (GF, MD)
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13
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Sconfienza LM, Adriaensen M, Albano D, Aparisi Gómez MP, Bazzocchi A, Beggs I, Bignotti B, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gielen J, Gitto S, Gupta H, Klauser AS, Lalam R, Martin S, Martinoli C, Mauri G, McCarthy C, McNally E, Melaki K, Messina C, Mirón Mombiela R, Neubauer B, Obradov M, Olchowy C, Orlandi D, Plagou A, Prada Gonzalez R, Rutkauskas S, Snoj Z, Tagliafico AS, Talaska A, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Allen G. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-Part II, elbow and wrist. Eur Radiol 2020; 30:2220-2230. [PMID: 31844963 DOI: 10.1007/s00330-019-06545-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/20/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although image-guided interventional procedures of the elbow and wrist are routinely performed, there is poor evidence in the literature concerning such treatments. Our aim was to perform a Delphi-based consensus on published evidence on image-guided interventional procedures around the elbow and wrist and provide clinical indications on this topic. METHODS A board of 45 experts in image-guided interventional musculoskeletal procedures from the European Society of Musculoskeletal Radiology were involved in this Delphi-based consensus study. All panelists reviewed and scored published papers on image-guided interventional procedures around the elbow and wrist updated to September 2018 according to the Oxford Centre for Evidence-based Medicine levels of evidence. Consensus on statements drafted by the panelists about clinical indications was considered as "strong" when more than 95% of panelists agreed and as "broad" if more than 80% agreed. RESULTS Eighteen statements were drafted, 12 about tendon procedures and 6 about intra-articular procedures. Only statement #15 reached the highest level of evidence (ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement). Seventeen statements received strong consensus (94%), while one received broad consensus (6%). CONCLUSIONS There is still poor evidence in published papers on image-guided interventional procedures around the elbow and wrist. A strong consensus has been achieved in 17/18 (94%) statements provided by the panel on clinical indications. Large prospective randomized trials are needed to better define the role of these procedures in clinical practice. KEY POINTS • The panel provided 18 evidence-based statements on clinical indications of image-guided interventional procedures around the elbow and wrist. • Only statement #15 reached the highest level of evidence: ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement. • Seventeen statements received strong consensus (94%), while broad consensus was obtained by 1 statement (6%).
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20100, Milan, Italy.
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand
- Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Ian Beggs
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Bianca Bignotti
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Vito Chianca
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Angelo Corazza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Danoob Dalili
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Miriam De Dea
- UOC Radiologia, Ospedale di Feltre, AULSS1 Dolomiti, Veneto, Italy
| | - Jose Luis Del Cura
- Department of Radiology, Donostia University Hospital, Begiristain Doktorea Pasealekua, 109, 20014, Donostia/San Sebastian, Spain
- University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, CE, Italy
| | - Eleni Drakonaki
- Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece
- Department of Anatomy, Medical School of the European University of Cyprus, Nicosia, Cyprus
| | - Fernando Facal de Castro
- IBERORAD 1895 S.L., 08021, Barcelona, Spain
- Department of Radiology, General University Hospital of Valencia, Valencia, Spain
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan Gielen
- University of Antwerp, Antwerp, Belgium
- University of Antwerp Hospital (UZA), Antwerp, Belgium
| | | | | | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Silvia Martin
- Hospital Son Llatzer, Palma de Mallorca, Spain
- Medicine, Universidad de las Islas Baleares, Palma de Mallorca, Spain
| | - Carlo Martinoli
- DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Catherine McCarthy
- The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
- Oxford Musculoskeletal Radiology, Oxford, UK
| | | | - Kalliopi Melaki
- Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20100, Milan, Italy
| | - Rebeca Mirón Mombiela
- Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain
- Radiologisk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark
| | - Benedikt Neubauer
- Radiology, Medical University of Vienna, Vienna, Austria
- Ordensklinkum Linz, Linz, Austria
| | | | - Cyprian Olchowy
- Department of Oral Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Davide Orlandi
- Department of Radiology, Ospedale Evangelico Internazionale Genova, Genova, Italy
| | - Athena Plagou
- Department of Radiology, Private Institution of Ultrasonography, Athens, Greece
| | | | - Saulius Rutkauskas
- Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania
| | - Ziga Snoj
- University Medical Centre Ljubljana, Zaloška ul. 7, 1000, Ljubljana, Slovenia
| | - Alberto Stefano Tagliafico
- DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | | | - Violeta Vasilevska-Nikodinovska
- Medical Faculty, University "Ss.Cyril and Methodius", University Surgical Clinic "St.Naum Ohridski", Skopje, North Macedonia
| | - Jelena Vucetic
- Department of Radiology, General University Hospital of Valencia, Valencia, Spain
- Radiologisk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark
| | - David Wilson
- St Luke's Radiology Oxford Ltd, Oxford, UK
- Oxford University, Oxford, UK
| | - Federico Zaottini
- DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- Varelli Institute, Naples, Italy
| | - Georgina Allen
- St Luke's Radiology Oxford Ltd, Oxford, UK
- Oxford University, Oxford, UK
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Wu YY, He FD, Chen K, Quan JR, Guo XY. Comparison of the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:573-581. [PMID: 32116288 DOI: 10.3233/xst-190620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger. METHODS A total of 60 patients with trigger finger were enrolled in this retrospective study. Among them, 30 patients were treated with ultrasound-guided needle release of the A1 pulley with corticosteroid injection (group A) and 30 patients were treated with single ultrasound-guided corticosteroids injection (group B). The following parameters were evaluated including clinical parameters (pain degree, function of joint, finger tendon function, postoperative satisfaction), and ultrasound parameter (thickness of A1 pulley). RESULTS The postoperative visual analogue scale (VAS) and Quinnell scores in two groups were significantly lower than that before operation (p < 0.05). The postoperative Quinnell score of group A was significantly lower than that in group B (p < 0.05). The TAM results showed that the postoperative overall excellent and good rate of group A was significantly higher than that in group B (p < 0.05). The postoperative survey showed that more than 80% patients reported satisfaction in the two groups. The ultrasound imaging results showed that the postoperative thickness of A1 pulley in two groups were thinner than that before operation (p < 0.05). There were no adverse effects and complications in the two groups. CONCLUSIONS Both approaches had treatment benefit in trigger finger. Ultrasound-guided needle release of the A1 pulley with corticosteroid injection had better treatment benefits than single ultrasound-guided corticosteroids injection in improving finger tendon function and joint function.
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Affiliation(s)
- Yan-Yan Wu
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fan-Ding He
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kai Chen
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie-Rong Quan
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuan-Yan Guo
- Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Croutzet P, Guinand R, Mares O, Apard T, Candelier G, David I. Ultrasound-Guided de Quervain's Tendon Release, Feasibility, and First Outcomes. J Wrist Surg 2019; 8:513-519. [PMID: 31815068 PMCID: PMC6892647 DOI: 10.1055/s-0039-1678688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 01/07/2019] [Indexed: 01/08/2023]
Abstract
Background de Quervain's syndrome is one of the main tendonitis of the wrist. The hypothesis of authors was that de Quervain's syndrome could be successfully treated with a specific ultrasound-guided percutaneous procedure, as it is for trigger finger. Surgical Technique Identification of the subcompartmentalization of the first extensor compartment was performed first, using the Hiranuma's classification, prior to the surgery. Then, we assessed precisely the positions of the sensory branches of the radial nerve and drew the landmarks. Through a continuous ultrasound in-plane control, we performed a percutaneous retrograde section of each part of the first compartment of the extensors, using a dedicated surgical blade. Methods In a cadaveric study, authors proposed to assess the feasibility and safety of a new and specific procedure and then assessed their first clinical cases. Fourteen specimen wrists were analyzed with ultrasound and the procedure was performed prior to an open control of the efficiency of the release, and safety for the superficial nerves. Then, we reported the results of the 22 first patients included in the clinical series. Results In a cadaver laboratory, authors were able to identify with ultrasound the type of first compartment septation (subcompartmentalization) in 13 cases ( n = 14). The misidentification induced one incomplete release. No damages of the superficial radial nerve were observed despite close relationship. In the small series ( n = 22), the duration of surgery was 8 minutes (range: 4-18 minutes). It was performed in office surgery and no morbidities were noticed. All patients improved, from quickDASH preoperative score of 59 (range: 28-71) to quichDASH postoperative score of 9 (range: 0-25). Conclusion Ultrasound-guided percutaneous release in the de Quervain's disease is a safe and reliable procedure without specific morbidity. Great care should be taken to avoid sensory nerve injuries and to identify the correct type of subcompartmentalization with a precise ultrasound evaluation.
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Affiliation(s)
| | | | - Olivier Mares
- European Hand Ultrasound Surgery Society, Toulouse, France
| | - Thomas Apard
- European Hand Ultrasound Surgery Society, Toulouse, France
| | | | - Isabelle David
- European Hand Ultrasound Surgery Society, Toulouse, France
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Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3141-3154. [PMID: 31106876 DOI: 10.1002/jum.15025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
Trigger finger is a common pathologic condition of the digital pulleys and flexor tendons in the hand. The key clinical finding is a transient blockage of the digit when it is flexed with subsequent painful snapping when it is extended. Imaging is a helpful guide for establishing the severity of the disease, identifying the underlying cause, and deciding the appropriate management. This narrative review aims to recall the anatomic and pathologic bases and describe the ultrasound features of trigger finger, also including common ultrasound findings and complications after therapy. Ultrasound enables an accurate static and dynamic evaluation of trigger finger as well as a comparison with the adjacent normal digits and thus should be considered the radiologic modality of first choice for its diagnosis.
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Affiliation(s)
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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17
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Lee SH, Choi YC, Kang HJ. Comparative study of ultrasonography-guided percutaneous A1 pulley release versus blinded percutaneous A1 pulley release. J Orthop Surg (Hong Kong) 2019; 26:2309499018772368. [PMID: 29852804 DOI: 10.1177/2309499018772368] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purpose of this study was to compare the results of blind versus ultrasonography-guided percutaneous A1 pulley release for treatment of trigger finger. METHODS This prospective study included 21 patients (25 fingers) who underwent blind release and 20 patients (23 fingers) who underwent ultrasonography-guided release. The visual analog scale (VAS) score, proximal interphalangeal joint contracture, complications, and patient satisfaction were compared between the groups. RESULTS At the final follow-up, triggering had disappeared in all patients who underwent ultrasonography-guided release, whereas three patients who underwent blind release required revision surgery for postoperative triggering. No complications were observed. VAS score was significantly different between groups at 2 and 4 weeks postoperatively. All patients who underwent ultrasonography-guided release were satisfied, whereas three patients who underwent blind release were not satisfied. CONCLUSION Ultrasonography-guided percutaneous A1 pulley release for treatment of trigger finger reduces postoperative pain and complications, such as incomplete release, compared with a blind procedure.
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Affiliation(s)
- Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Young Chae Choi
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Hong Je Kang
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
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18
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It is possible to release the plantaris tendon under ultrasound guidance: a technical description of ultrasound guided plantaris tendon release (UPTR) in the treatment of non-insertional Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 2019; 27:2858-2862. [PMID: 30847522 DOI: 10.1007/s00167-019-05451-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Open plantaris tendon excision and ventral paratendinous stripping is a recognised treatment option in selected patients with non-insertional Achilles tendinopathy. The aim of this study was to develop a minimally invasive outpatient technique of ultrasound guided plantaris tendon release (UPTR). METHODS A 19 gauge needle, 15 gauge scalpel blade, hook knife (Smith and Nephew, Boston, MA, USA) and a beaver blade (Arthrex, Naples, FL, USA), were used under ultrasound guidance to identify and divide the plantaris tendon in 12 cadaveric legs. Specimens were dissected to identify whether division of the plantaris tendon had been successful. UPTR was subsequently performed on patients. RESULTS The 15 gauge scalpel blade, hook knife (Smith and Nephew, Boston, MA, USA) and beaver blade (Arthrex, Naples, FL, USA) were all able to cut the plantaris tendon. However, on dissection the hook knife (Smith and Nephew, Boston MA) caused less damage to surrounding structures. Subsequently, the plantaris tendon was successfully divided in three patients using UPTR technique without complication. CONCLUSION UPTR is a viable technique for treating plantaris related non-insertional Achilles tendinopathy.
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Pan M, Sheng S, Fan Z, Lu H, Yang H, Yan F, E Z. Ultrasound-Guided Percutaneous Release of A1 Pulley by Using a Needle Knife: A Prospective Study of 41 Cases. Front Pharmacol 2019; 10:267. [PMID: 30971922 PMCID: PMC6444079 DOI: 10.3389/fphar.2019.00267] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Min Pan
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Shuya Sheng
- Shenzhen Middle School, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen, China
| | - Zhiqi Fan
- College of Optoelectronic Engineering of Shenzhen University, SPACEnter Space Science and Technology Institute, Shenzhen, China
| | - Hao Lu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Hong Yang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Fei Yan
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Zhansen E
- Longgang Central Hospital, Shenzhen, China
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US-guided percutaneous release of the first extensor tendon compartment using a 21-gauge needle in de Quervain's disease: a prospective study of 35 cases. Eur Radiol 2018; 28:3977-3985. [PMID: 29619521 DOI: 10.1007/s00330-018-5387-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/10/2018] [Accepted: 02/14/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the efficacy of ultrasonography-guided percutaneous treatment of de Quervain tenosynovitis with the combination of a corticosteroid injection and release of the retinaculum of the first extensor compartment tendons with a 21-gauge needle. MATERIALS AND METHODS The first part of our study consisted of ten procedures on cadaver wrists followed by dissection to analyse the effectiveness of the retinaculum release and detect any collateral damage. The second part was a prospective clinical study of 35 procedures. Outcomes were evaluated through a 6-month clinical follow-up and telephone interview at the end of the study. The following parameters were monitored over time: pain level on a visual analogue scale, the QuickDASH and the PRWE. Patient satisfaction questionnaires were also administered. RESULTS No complications were found during the cadaver study. However, the release was confirmed as 'partial' in all wrists. In the clinical portion of this study, significant improvement was observed in 91.4 % of cases (32/35) within 1 month and the results were stable until the end of the study; all of these patients avoided surgery. The release procedure failed in three patients who eventually required surgical treatment. CONCLUSION US-guided partial release and simultaneous corticosteroid injection for treatment of de Quervain's disease using a 21-gauge needle is feasible in current practice, with minimal complications. KEY POINTS • Ultrasound-guided treatment of de Quervain's disease is feasible with a 21G needle. • There was notable regression of clinical signs in 91.4 % of cases. • The procedure is very safe, no iatrogenic neurovascular or tendinous injuries occurred. • Our procedure requires only one session and 3 days away from work.
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Nikolaou VS, Malahias MA, Kaseta MK, Sourlas I, Babis GC. Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger. World J Orthop 2017; 8:163-169. [PMID: 28251067 PMCID: PMC5314146 DOI: 10.5312/wjo.v8.i2.163] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique. METHODS In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade II-IV according to Green classification system, were recruited. Two groups were formed; Group A (16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B (16 patients) underwent an open surgical release of the A1 pulley, through a 10-15 mm incision. Patients were assessed pre- and postoperatively (follow-up: 2, 4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering (primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, QuickDASH test scores (Greek version), return to normal activities (including work), complications and cosmetic results were assessed. RESULTS The success rate in group A was 93.75% (15/16) and in group B 100% (16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean QuickDASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickDASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5% (14/16) of group A patients, while in 56.25% (9/16) of group B patients were evaluated as fair or poor. CONCLUSION Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger's disease.
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23
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Hoang D, Lin AC, Essilfie A, Minneti M, Kuschner S, Carey J, Ghiassi A. Evaluation of Percutaneous First Annular Pulley Release: Efficacy and Complications in a Perfused Cadaveric Study. J Hand Surg Am 2016; 41:e165-73. [PMID: 27180952 DOI: 10.1016/j.jhsa.2016.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/29/2016] [Accepted: 04/13/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Trigger finger is the most common entrapment tendinopathy, with a lifetime risk of 2% to 3%. Open surgical release of the flexor tendon sheath is a commonly performed procedure associated with a high rate of success. Despite reported success rates of over 94%, percutaneous trigger finger release (PFTR) remains a controversial procedure because of the risk of iatrogenic digital neurovascular injury. This study aimed to evaluate the safety and efficacy of traditional percutaneous and ultrasound (US)-guided first annular (A1) pulley releases performed on a perfused cadaveric model. METHODS First annular pulley releases were performed percutaneously using an 18-gauge needle in 155 digits (124 fingers and 31 thumbs) of un-embalmed cadavers with restored perfusion. A total of 45 digits were completed with US guidance and 110 digits were completed without it. Each digit was dissected and assessed regarding the amount of release as well as neurovascular, flexor tendon, and A2 pulley injury. RESULTS Overall, 114 A1 pulleys were completely released (74%). There were 38 partial releases (24%) and 3 complete misses (2%). No significant flexor tendon injury was seen. Longitudinal scoring of the flexor tendon was found in 35 fingers (23%). There were no lacerations to digital nerves and one ulnar digital artery was partially lacerated (1%) in a middle finger with a partial flexion contracture that prevented appropriate hyperextension. The ultrasound-assisted and blind PTFR techniques had similar complete pulley release and injury rates. CONCLUSIONS Both traditional and US-assisted percutaneous release of the A1 pulley can be performed for all fingers. Perfusion of cadaver digits enhances surgical simulation and evaluation of PTFR beyond those of previous cadaveric studies. The addition of vascular flow to the digits during percutaneous release allows for Doppler flow assessment of the neurovascular bundle and evaluation of vascular injury. CLINICAL RELEVANCE Our cadaveric data align with those of published clinical investigations for percutaneous A1 pulley release.
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Affiliation(s)
- Don Hoang
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ann C Lin
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anthony Essilfie
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael Minneti
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stuart Kuschner
- Department of Hand Surgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Joseph Carey
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Finnoff JT. The Evolution of Diagnostic and Interventional Ultrasound in Sports Medicine. PM R 2016; 8:S133-8. [DOI: 10.1016/j.pmrj.2015.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Jonathan T. Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Medicine, 600 Hennepin Ave, #310, Rochester, MN 55403
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Lapègue F, André A, Meyrignac O, Pasquier-Bernachot E, Dupré P, Brun C, Bakouche S, Chiavassa-Gandois H, Sans N, Faruch M. US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases. Radiology 2016; 280:493-9. [PMID: 26919442 DOI: 10.1148/radiol.2016151886] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate the efficacy of ultrasonographically (US)-guided percutaneous treatment of the trigger finger by releasing the A1 pulley with a 21-gauge needle. Materials and Methods This two-part study was approved by the ethics committee, and written consent was obtained from all patients. The first part consisted of 10 procedures on cadaver digits followed by dissection to analyze the effectiveness of the A1 pulley release and detect any collateral damage to the A2 pulley, interdigital nerves, or underlying flexor tendons. The second part was performed during an 18-month period starting in March 2013. It was a prospective clinical study of 60 procedures performed in 48 patients. Outcomes were evaluated through a clinical examination at day 0 and during a 6-month follow-up visit, where the trigger digit was evaluated clinically and the Quick Disabilities of the Arm, Shoulder and Hand outcome measure, or QuickDASH, and patient satisfaction questionnaires were administered. Results No complications were found during the cadaver study. However, the release was considered "partial" in all fingers. In the clinical study, the trigger finger was completely resolved in 81.7% (49 of 60) of cases immediately after the procedure. Moderate trigger finger persisted in 10 cases, and one thumb pulley could not be released. A US-guided corticosteroid injection was subsequently performed in these 11 cases. At 6-month follow-up, only two cases still had moderate trigger finger and there were no late complications. The mean QuickDASH questionnaire score was 4; all patients said they were satisfied. Conclusion US-guided treatment of the trigger finger by using a 21-gauge needle is feasible in current practice, with minimal complications. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Franck Lapègue
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Aymeric André
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Olivier Meyrignac
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Etienne Pasquier-Bernachot
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Pierre Dupré
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Céline Brun
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Sarah Bakouche
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Hélène Chiavassa-Gandois
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Nicolas Sans
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Marie Faruch
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
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Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. PM R 2015; 7:151-68.e12. [PMID: 25708351 DOI: 10.1016/j.pmrj.2015.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 12/23/2022]
Abstract
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based upon the evidence, the official AMSSM position relevant to each subject is made.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, University of California, Davis School of Medicine, Sacramento, CA; Tahoe Orthopedics and Sports Medicine, 1139 Third St, South Lake Tahoe, CA 96150.(∗); Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, IA(†).
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, IA(†)
| | - Erik Adams
- Midwest Sports Medicine Institute, Middleton, WI(‡)
| | - David Berkoff
- Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC(§)
| | - Andrew L Concoff
- Outpatient Musculoskeletal Rehabilitation, St Jude Medical Center, Fullerton, CA(¶)
| | - William Dexter
- Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA(#)
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN; Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN(∗∗)
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Chopra A, Rowbotham EL, Grainger AJ. Radiological intervention of the hand and wrist. Br J Radiol 2015; 89:20150373. [PMID: 26313500 PMCID: PMC4985953 DOI: 10.1259/bjr.20150373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/18/2015] [Accepted: 08/26/2015] [Indexed: 11/05/2022] Open
Abstract
The role of radiological guided intervention is integral in the management of patients with musculoskeletal pathologies. The key to image-guided procedures is to achieve an accurately placed intervention with minimal invasion. This review article specifically concentrates on radiological procedures of the hand and wrist using ultrasound and fluoroscopic guidance. A systematic literature review of the most recent publications relevant to image-guided intervention of the hand and wrist was conducted. During this search, it became clear that there is little consensus regarding all aspects of image-guided intervention, from the technique adopted to the dosage of injectate and the specific drugs used. The aim of this article is to formulate an evidence-based reference point which can be utilized by radiologists and to describe the most commonly employed techniques.
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Affiliation(s)
- Annu Chopra
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - Emma L Rowbotham
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - Andrew J Grainger
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
- Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Chapel Allerton Hospital, Leeds, UK
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Aly AR, Rajasekaran S, Mohamed A, Beavis C, Obaid H. Feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon--A pilot cadaveric study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:361-366. [PMID: 24962183 DOI: 10.1002/jcu.22189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/10/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe an ultrasound-guided proximal percutaneous tenotomy technique of long head of the biceps tendon (LHBT). METHODS Three fresh cadavers with no prior shoulder surgery or LHBT tears were included in the study. A single experienced musculoskeletal radiologist completed six ultrasound-guided proximal percutaneous tenotomies of LHBT. A superficial to deep approach was performed on four shoulders using an arthroscopic banana blade or retractable blade. A deep to superficial approach was performed on two shoulders using an arthroscopic hook blade. A blinded anatomist dissected each specimen and graded the tenotomy, length of proximal LHBT stump, and evidence of iatrogenic injuries. RESULTS Four of the six cadaveric LHBTs were fully transected. The two partially transected tenotomies were performed using the arthroscopic banana and retractable serrated blades (63% and 80% transections, respectively). The proximal LHBT stump mean length was 2.6 cm (95% CI, 1.8-3.4). There was no evidence of iatrogenic lesions. CONCLUSIONS This cadaveric study showed that the ultrasound-guided percutaneous tenotomy of the LHBT is a feasible procedure. The deep to superficial approach using an arthroscopic hook blade resulted in complete transection. Further cadaveric studies with larger numbers are warranted to confirm this novel technique's applicability in clinical practice.
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Affiliation(s)
- Abdel-Rahman Aly
- Health Pointe, Pain, Spine, & Sports Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sathish Rajasekaran
- Health Pointe, Pain, Spine, & Sports Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Adel Mohamed
- Department Anatomy and Cell Biology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cole Beavis
- Division of Orthopaedic Surgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Haron Obaid
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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American Medical Society for Sports Medicine position statement: interventional musculoskeletal ultrasound in sports medicine. Clin J Sport Med 2015; 25:6-22. [PMID: 25536481 DOI: 10.1097/jsm.0000000000000175] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based on the evidence, the official AMSSM position relevant to each subject is made.
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Zhao JG, Kan SL, Zhao L, Wang ZL, Long L, Wang J, Liang CC. Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence. J Hand Surg Am 2014; 39:2192-202. [PMID: 25227600 DOI: 10.1016/j.jhsa.2014.07.044] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the overall success rate and potential influencing factors within the current evidence for percutaneous first annular pulley release. METHODS We searched PubMed, EMBASE, and the Cochrane Library for all clinical studies of percutaneous release. The rates of successful procedure and complication were extracted and analyzed. We charted the overall success rate on a forest plot with 95% confidence intervals. Data of success rates were analyzed in 5- and 10-year intervals to determine whether the rate of success had increased chronologically. We then performed 3 subgroup analyses according to instrument type (needles vs knife blades), cortisone use (cortisone vs noncortisone), and sonography guidance (sonography vs non-sonography guidance). Pooled success rates were calculated in the subgroups and compared using chi-square test. RESULTS A total of 34 studies involving 2,114 percutaneous procedures were included in this systematic review and meta-analysis. The total success rate was 94%. There was a trend toward increasing number of publications in the past 20 years. We found a statistically significant trend showing that overall success rates had increased over time. Chi-square test revealed that percutaneous release with sonography guidance had a significantly higher success rate than non-sonography guidance. There were no significant differences in other subgroup analyses including instrument type and cortisone use. CONCLUSIONS Percutaneous release is an effective and safe procedure for the treatment of trigger digit. It has become progressively popular in recent years, with a trend toward increased overall success. Sonography might be a helpful tool for maximizing success. The success rates were not affected by instruments and cortisone use. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jia-Guo Zhao
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China.
| | - Shi-Lian Kan
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Li Zhao
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Zeng-Liang Wang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Lei Long
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Jia Wang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Cong-Cong Liang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
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Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. Br J Sports Med 2014; 49:145-50. [PMID: 25330777 DOI: 10.1136/bjsports-2014-094219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. OBJECTIVE Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues. DESIGN Systematic review of the literature. RESULTS USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). CONCLUSIONS The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, California, USA Department of Physical Medicine and Rehabilitation, Mayo Clinic college of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, Iowa, USA
| | - Erik Adams
- Midwest Sports Medicine Institute, Middleton, Wisconsin, USA
| | - David Berkoff
- Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew L Concoff
- Outpatient Musculoskeletal Rehabilitation, St. Jude Medical Center, Fullerton, California, USA Department of Family Medicine, Division of Sports Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - William Dexter
- Maine Medical Center, Portland, Maine, USA Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Gulabi D, Cecen GS, Bekler HI, Saglam F, Tanju N. A study of 60 patients with percutaneous trigger finger releases: clinical and ultrasonographic findings. J Hand Surg Eur Vol 2014; 39:699-703. [PMID: 24401742 DOI: 10.1177/1753193413517992] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present the clinical results and ultrasonographic findings of 61 trigger digits treated with percutaneous A1 pulley release. An endoscopic carpal tunnel knife was used for the release in the outpatient department. The mean follow-up period was 3.5 months. A total of 55 digits (90%) had complete relief of their triggering postoperatively. Six digits (10%) had Grade 2 triggering clinically in the early postoperative period.The complications included six cases of insufficient release (10%), scar sensitivity in one patient, short-term hypoaesthesia in three digits (5%), and flexor tendon laceration noted on postoperative ultrasonography in eight digits (13%). No neurovascular damage was noted on the postoperative ultrasonography. Ultrasonograpy provides information about tendon laceration and changes in thickness of the pulleys and confirm A1 pulley release after surgery, but it does not alter clinical decision-making. We believe that pre- and postoperative ultrasonograpy does not need to be included as a routine examination.
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Affiliation(s)
- D Gulabi
- Dr Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul, Turkey
| | - G S Cecen
- Dr Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul, Turkey
| | - H I Bekler
- Dr Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul, Turkey
| | - F Saglam
- Dr Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul, Turkey
| | - N Tanju
- Dr Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul, Turkey
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Dębek A, Czyrny Z, Nowicki P. Sonography of pathological changes in the hand. J Ultrason 2014; 14:74-88. [PMID: 26675521 PMCID: PMC4579729 DOI: 10.15557/jou.2014.0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/15/2013] [Accepted: 07/29/2013] [Indexed: 11/22/2022] Open
Abstract
Everyday medical practice shows that most common problems within the hand result from overload, injuries and degeneration. Dorsal side pathologies such as de Quervain's and Wartenberg's disease, intersection syndrome or degenerative lesions of carpometa-carpal joint of the thumb discussed in the paper can be accurately diagnosed and differentiated by means of ultrasound examination. Ultrasound is similarly powerful in detection and grading of traumatic lesions involving extensor tendons and their sagittal bands or the flexor tendons and their pulleys. In the case of carpal tunnel syndrome one can not only visualize the median nerve but also other structures of the tunnel that may cause compression. Similarly ulnar nerve compression within the Guyon's canal can be well evaluated. In cases of nerve trauma one can precisely define the level, and in cases of nerve discontinuity, the distance between stumps can be measured which is important in surgery planning. Often nerve trauma is a sequelae of tendon reconstruction. In such cases scars and nerve entrapment can be depicted. Tumors within a hand are usually benign, of which the most common are ganglia. On ultrasound examination a connection between a ganglion and its source (usually a joint or sheath) can frequently be defined. The relationship of tumors to nerves, tendon sheaths or vessels may suggest their nature. Ultrasound with dynamic tissue assessment is a very valuable adjunct to clinical examination.
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Affiliation(s)
- Anna Dębek
- Indywidualna Specjalistyczna Praktyka Lekarska, Warszawa, Polska
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Hopkins J, Sampson M. Percutaneous tenotomy: Development of a novel, percutaneous, ultrasound-guided needle-cutting technique for division of tendons and other connective tissue structures. J Med Imaging Radiat Oncol 2013; 58:327-30. [PMID: 25088140 DOI: 10.1111/1754-9485.12113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/16/2013] [Indexed: 12/12/2022]
Abstract
A variety of surgical procedures derive therapeutic benefit from the division of retinacular, ligamentous or tendinous structures. Examples include carpal tunnel release for median nerve impingement, annular pulley release for trigger finger and tendon division for spastic muscular contractures. Here, using an animal cadaveric model, we describe the first steps in determining the feasibility of a novel, percutaneous, ultrasound-guided needle-cutting technique to achieve the same ends. The technique we describe involves the creation of an effective needle tenotomy device via a simple modification to an 18G coaxial, beveled needle. The technique holds promise for the development of a minimally invasive alternative approach that utilises readily available technology and equipment with minimisation of morbidity and cost associated with open procedures.
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Affiliation(s)
- James Hopkins
- Repat Radiology, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Abstract
The purpose of this retrospective study was to compare the outcomes and complications of conventional open surgical release and percutaneous needle release in the treatment of trigger thumb. The study comprised 87 patients with trigger thumb who were treated with either open pulley (n=52) or percutaneous (n=32) release between 2008 and 2011. All patients were reevaluated at a mean follow-up of 22.7±9.6 months (range, 9-44 months). Main outcome measures were the rate of recurrence, pain on movement or tenderness over the pulley, infection rate, digital nerve injury, tendon bowstringing, joint stiffness or loss of thumb range of motion, and patient satisfaction. The groups were statistically similar regarding age, sex, laterality, dominant side involvement, and trigger thumb grade on initial admission. At final follow-up, no patient had recurrence, tendon bowstringing, joint stiffness, or loss of thumb range of motion. No patients in the open pulley release group and 2 (5.7%) patients in the percutaneous release group had a digital nerve injury (P=.159). No statistical difference was found in the infection rate between groups (P=.354). A total of 98.1% of patients in the open pulley release group and 97.1% of patients in the percutaneous release group were satisfied with treatment (P=.646). Both techniques resulted in similar therapeutic efficacy, and the rate of potential complications was also statistically similar in each group. Although statistically insignificant, the authors believe that the 5.7% rate of iatrogenic digital nerve injury seen in the percutaneous release group is clinically significant and serious. Therefore, they advocate using open surgical release of trigger thumb.
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Fowler JR, Baratz ME. Percutaneous trigger finger release. J Hand Surg Am 2013; 38:2005-8. [PMID: 23643795 DOI: 10.1016/j.jhsa.2013.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/03/2013] [Indexed: 02/02/2023]
Affiliation(s)
- John R Fowler
- Department of Orthopaedics, University of Pittsburgh; and Orthopaedic Specialists - University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Chiang CH, Kuo LC, Kuo YL, Wu KC, Shao CJ, Chern TC, Jou IM. The value of high-frequency ultrasonographic imaging for quantifying trigger digits: a correlative study with clinical findings in patients with different severity grading. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:967-974. [PMID: 23562016 DOI: 10.1016/j.ultrasmedbio.2013.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 11/29/2012] [Accepted: 01/12/2013] [Indexed: 06/02/2023]
Abstract
Trigger digit is recognized as thickening and constriction of the flexor tendon sheath at the base of digits. This study investigates the correlation between the severity grading of trigger digits and clinical findings from high-frequency ultrasonography. We measured and compared thicknesses, areas and pathological changes of the flexor digit tendons among total, contracture and noncontracture trigger digits and noninvolved contralateral digits. Forty-seven patients with 55 idiopathic trigger digits (36 contracture and 19 noncontracture) and 55 noninvolved contralateral digits were examined using high-frequency ultrasonography. The thickness of the flexor tendons was measured in a longitudinal plane at the A1 pulley: Inlet (metacarpal head-neck junction), Outlet (proximal phalangeal base-shaft junction) and Interpulley (middle of Inlet and Outlet). The cross-sectional and extratendinous tissue areas of the flexor tendons in a transverse plane at the point of Interpulley were measured. Pathological changes including irregular internal echotextures, fluid collection, dominant A1 pulley and abnormal metacarpophalangeal joint were analyzed. All thicknesses and areas of total and contracture trigger digits were significantly greater than those of noninvolved contralateral digits (p < 0.05), whereas no significant difference was observed in noncontracture trigger digits. The pathological changes were all significantly different from noninvolved contralateral digits in total, contracture and noncontracture trigger digits (p < 0.05). In contracture and noncontracture trigger digits, there were significant differences only in the thickness of the Inlet and the pathological change of the dominant A1 pulley (p < 0.05). In conclusion, the results of the ultrasonographic measurements and findings provided evidence of Notta's node and correlated with clinical findings and severity grades.
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Affiliation(s)
- Chen-Hao Chiang
- Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan
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Royall NA, Farrin E, Bahner DP, Stawicki SP. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop 2012. [PMID: 22474637 DOI: 10.5312/wjo.v2.i7.] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.
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Affiliation(s)
- Nelson A Royall
- Nelson A Royall, David P Bahner, Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Rojo-Manaute JM, Capa-Grasa A, Del Cerro-Gutiérrez M, Martínez MV, Chana-Rodríguez F, Martín JV. Sonographically guided intrasheath percutaneous release of the first annular pulley for trigger digits, part 2: randomized comparative study of the economic impact of 3 surgical models. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:427-438. [PMID: 22368133 DOI: 10.7863/jum.2012.31.3.427] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Trigger digit surgery can be performed by an open approach using classic open surgery, by a wide-awake approach, or by sonographically guided first annular pulley release in day surgery and office-based ambulatory settings. Our goal was to perform a turnover and economic analysis of 3 surgical models. METHODS Two studies were conducted. The first was a turnover analysis of 57 patients allocated 4:4:1 into the surgical models: sonographically guided-office-based, classic open-day surgery, and wide-awake-office-based. Regression analysis for the turnover time was monitored for assessing stability (R(2) < .26). Second, on the basis of turnover times and hospital tariff revenues, we calculated the total costs, income to cost ratio, opportunity cost, true cost, true net income (primary variable), break-even points for sonographically guided fixed costs, and 1-way analysis for identifying thresholds among alternatives. RESULTS Thirteen sonographically guided-office-based patients were withdrawn because of a learning curve influence. The wide-awake (n = 6) and classic (n = 26) models were compared to the last 25% of the sonographically guided group (n = 12), which showed significantly less mean turnover times, income to cost ratios 2.52 and 10.9 times larger, and true costs 75.48 and 20.92 times lower, respectively. A true net income break-even point happened after 19.78 sonographically guided-office-based procedures. Sensitivity analysis showed a threshold between wide-awake and last 25% sonographically guided true costs if the last 25% sonographically guided turnover times reached 65.23 and 27.81 minutes, respectively. However, this trial was underpowered. CONCLUSIONS This trial comparing surgical models was underpowered and is inconclusive on turnover times; however, the sonographically guided-office-based approach showed shorter turnover times and better economic results with a quick recoup of the costs of sonographically assisted surgery.
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Affiliation(s)
- Jose Manuel Rojo-Manaute
- Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007 Madrid, Spain.
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Rojo-Manaute JM, Rodríguez-Maruri G, Capa-Grasa A, Chana-Rodríguez F, Soto MDV, Martín JV. Sonographically guided intrasheath percutaneous release of the first annular pulley for trigger digits, part 1: clinical efficacy and safety. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:417-424. [PMID: 22368132 DOI: 10.7863/jum.2012.31.3.417] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES For trigger digits, intrasheath sonographically guided first annular (A1) pulley release has shown safety and effectiveness in cadavers. This clinical study describes sonographically guided A1 pulley release results in terms of resolution of symptoms, safety, and functional recovery. METHODS Sonographically guided A1 pulley release (11-MHz probe) was used in 48 digits of 48 patients prospectively followed for 11.3 months and examined 1, 3, and 6 weeks, 3 and 6 months, and 1 year later. Resolution of triggering (primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, grip strength, QuickDASH test scores, return to normal activities (including work), cosmetic results, satisfaction, and complications were assessed. RESULTS The success rate was 100%, and no cases recurred. Mean times were 1.9 days for taking pain killers, 6.6 days for returning to normal activities, and 9.9 and 3.8 days for complete extension and flexion recovery, respectively. Mean QuickDASH scores were 39.8 preoperatively and 7.8, 1.7, and 0 after 6 weeks, 6 months, and 1 year postoperatively. Grip strength reached greater than 90% of the individual's normal strength by the sixth week in men and by the third month in women (P < .001). Radial digital nerve numbness developed in 1 finger, which disappeared by the third week. No other complications were noted. All wounds were cosmetically excellent, and final satisfaction was excellent or good in 98%. CONCLUSIONS With adequate anatomic knowledge, technical training, and a basic ultrasound machine, sonographically guided A1 pulley release can be performed safely and successfully, offering an alternative to classic open surgery in the ambulatory setting.
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Affiliation(s)
- Jose Manuel Rojo-Manaute
- Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007 Madrid, Spain.
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Soubeyrand M, Begin M, Pierrart J, Gagey O, Dumontier C, Guerini H. L’échographie pour le chirurgien de la main (conférence d’enseignement XLVe congrès de la Société française de chirurgie de la main). ACTA ACUST UNITED AC 2011; 30:368-84. [DOI: 10.1016/j.main.2011.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 08/30/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
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Royall NA, Farrin E, Bahner DP, Stawicki SPA. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop 2011; 2:57-66. [DOI: 10.5312/wjo.v2.i7.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.
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Royall NA, Farrin E, Bahner DP, Stawicki SP. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop 2011; 2:57-66. [PMID: 22474637 PMCID: PMC3302042 DOI: 10.5312/wjo.v2.i7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 06/28/2011] [Accepted: 07/05/2011] [Indexed: 02/06/2023] Open
Abstract
Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.
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Affiliation(s)
- Nelson A Royall
- Nelson A Royall, David P Bahner, Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH 43210, United States
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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. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1517-1529. [PMID: 20966463 DOI: 10.7863/jum.2010.29.11.1517] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this study was to define in volunteers a safe area for performing a percutaneous intrasheath first annular (A1) pulley release under ultrasonographic guidance in cadavers for the treatment of trigger fingers. METHODS First, in 100 fingers of 10 volunteers, we used Doppler ultrasonography to determine the limits of the sectors enclosing structures at risk (arteries and tendons). From the synovial sheath's most volar point, we determined the relative position of the arterial walls and the distance to the flexor tendons. A scatterplot overlay of the arterial positions was digitally analyzed for determining the limits of the safe area. Second, we released the A1 pulley in 46 fingers from 5 cadavers, directing the edge of the cutting device toward our safe area from an intrasheath instrument position. The precision, safety, and efficacy of the release were evaluated by surgical exposure of the A1 and A2 pulleys and the neurovascular bundles. RESULTS In our volunteers, we observed a volar safe area from +6.1° to +180°. Surgical precision was good in the cadavers, with no injuries to adjacent structures, a complete release in 44 fingers (95.7%), and an incomplete release of less than 1.6 mm in 2 fingers. CONCLUSIONS This study determined a safe volar area for aiming surgical instruments from an intrasheath position for percutaneous ultrasonographically guided A1 pulley release. The technique can be performed safely in all fingers, but we suggest being cautious in the thumb and converting the surgery to an open procedure if ultrasonographic visualization is not optimal.
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Affiliation(s)
- Jose Manuel Rojo-Manaute
- Department of Orthopedic Surgery, Hospital Gregorio Marañón, Calle del Doctor Esquerdo 46, Madrid, Spain.
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Smith J, Rizzo M, Lai JK. Sonographically guided percutaneous first annular pulley release: cadaveric safety study of needle and knife techniques. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1531-1542. [PMID: 20966464 DOI: 10.7863/jum.2010.29.11.1531] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the safety of sonographically guided percutaneous finger and thumb first annular (A1) pulley releases performed using needle and hook knife techniques in an unembalmed cadaveric model. METHODS A single operator completed 50 (40 fingers and 10 thumbs) sonographically guided percutaneous A1 pulley releases in unembalmed cadavers using previously described needle and hook knife techniques and simulated local anesthesia. Half of the fingers and thumbs were completed with each technique. An experienced observer blinded to the technique dissected each specimen and assessed for neurovascular, flexor tendon, and A2 pulley injury. Completeness of release was also recorded as a secondary outcome. RESULTS No neurovascular or A2 pulley injury occurred in any digit, regardless of technique. No significant flexor tendon injury was seen in any digit, although minor surface scratches were visualized in 3 cases (6%; 2 knife and 1 needle). The hook knife technique was significantly more likely to result in a complete pulley release compared to the needle technique (22 of 25 [88%] versus 8 of 25 [32%]; P < .001). CONCLUSIONS Sonographically guided percutaneous A1 pulley releases can be performed safely using previously described needle and hook knife techniques. The safety margin for thumb releases is less than that for finger releases, particularly with respect to the radial digital nerve. These cadaveric data support recently published clinical investigations recommending consideration of sonographically guided percutaneous A1 pulley release in the management of patients with a disabling trigger finger.
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Affiliation(s)
- Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905 USA.
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