Ultrasound-guided trigger thumb release

IF 0.9 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2025-05-01 DOI:10.1016/j.hansur.2025.102084

Francisco Javier Ferreira Villanova , Vincent Martinel , Olivier Marès

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引用次数: 0

Abstract

The purpose of this study was to evaluate the results of a novel retrograde ultrasound-guided A1 pulley release technique for the treatment of trigger thumb.

We conducted a retrospective, single-center study of 42 patients who underwent ultrasound-guided A1 pulley release for clinically diagnosed trigger thumb between September 2022 and December 2023. All cases were graded according to the Green classification of trigger finger severity. Inclusion criteria were patients aged >18 years who failed conservative treatment (non-steroidal anti-inflammatory drugs, physical therapy, or steroid injections) for at least six weeks. Exclusion criteria were previous trigger thumb surgery, metacarpophalangeal or trapeziometacarpal arthrodesis, and documented allergy to local anesthetics. Outcome measures were pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores, and complication rates.

The mean age of the patients was 37.8 years (range: 27–72). Based on Green’s classification, we treated 5 grade I, 26 grade II, 6 grade IIIA, and 5 grade IIIB cases. At one month follow-up, all patients had resolution of the triggering. The mean VAS score improved significantly from 7.2 to 1.3 and the Quick-DASH score decreased from 51 to 9.1. There were no major complications.

Open A1 pulley release for trigger thumb is effective but carries risks to the palmar radial digital nerve, especially in open surgery. Alternative methods such as ultrasound-guided and percutaneous release offer similar results with fewer complications. Recovery is faster for trigger thumb (2 weeks) compared to trigger finger (5 weeks). Some patients may experience prolonged symptoms after surgery. Open surgery has a 12% complication rate and a 2.4% revision rate. Ultrasound-guided percutaneous release is safer and allows real-time visualization during the procedure.

Retrograde ultrasound-guided A1 pulley release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus. It offers advantages over traditional approaches, including improved cosmetic outcomes, the absence of sutures, and the ability for patients to resume daily activities and light work immediately postoperatively.

查看原文本刊更多论文

超声波引导触发拇指释放。

本研究的目的是评估一种新型逆行超声引导的A1滑轮释放技术治疗触发拇指的结果。我们对2022年9月至2023年12月期间因临床诊断为触发拇指而接受超声引导A1滑轮释放的42例患者进行了回顾性单中心研究。所有病例均按扳机指严重程度Green分级。纳入标准为年龄在bb0 ~ 18岁，保守治疗（非甾体抗炎药、物理治疗或类固醇注射）至少6周失败的患者。排除标准为以前的触发拇指手术，掌指关节或斜跖关节融合术，并记录对局部麻醉剂过敏。结果测量是疼痛强度（视觉模拟量表，VAS），手臂、肩膀和手的快速残疾（Quick- dash）评分和并发症发生率。患者平均年龄37.8岁（范围27-72岁）。根据Green的分类，我们治疗了5例I级，26例II级，6例IIIA级，5例IIIB级。在一个月的随访中，所有患者的触发都得到了解决。VAS平均评分从7.2分显著提高到1.3分，Quick-DASH评分从51分下降到9.1分。没有重大并发症。开放式A1滑轮松解对触发拇指是有效的，但对掌桡指神经有风险，特别是在开放式手术中。替代方法，如超声引导和经皮释放提供类似的结果，并发症更少。触发拇指（2周）比触发手指（5周）恢复得更快。有些病人在手术后症状可能会延长。开放手术的并发症发生率为12%，翻修率为2.4%。超声引导的经皮释放更安全，并且可以在手术过程中实时可视化。超声引导下逆行A1滑轮松解术是治疗拇长屈肌狭窄性腱鞘炎的一种安全有效的方法。与传统方法相比，它具有许多优点，包括改善美容效果，无需缝合线，以及患者术后立即恢复日常活动和轻度工作的能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.