Ultrasound-Guided Percutaneous Release of the Trigger Thumb

Kwang-Hee Park; Won-Jung Shin; Dong-Ho Lee; Jong-Pil Kim

doi:10.12790/jkssh.2016.21.4.218

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Park, Shin, Lee, and Kim: Ultrasound-Guided Percutaneous Release of the Trigger Thumb

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(4):218-224.

Published online: 11 December 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.4.218

Ultrasound-Guided Percutaneous Release of the Trigger Thumb

Kwang-Hee Park¹, Won-Jung Shin², Dong-Ho Lee¹, Jong-Pil Kim^1,^2,

¹Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Korea

²Department of Kinesiology and Medical Science, Graduate School, Dankook University, Cheonan, Korea

Correspondence to: Jong-Pil Kim, Department of Orthopaedic Surgery, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea, TEL: +82-41-550-6579, FAX: +82-41-556-3238, E-mail: kimjp@dankook.ac.kr

Received 30 August 20169 November 2016 Accepted 10 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Trigger thumb is a common condition with a prevalence rate up to 3% among the adults. The main pathophysiology is locking of the flexor tendon at the A1 pulley. Treatments include nonsteroidal anti-inflammatory drug, steroid injection, and surgical A1 pulley release. The purpose of this study was to evaluate the safety and effectiveness of ultrasound-guided percutaneous release of trigger thumb.

Methods:

The author prospectively reviewed 37 patients who had undergone ultrasound-guided percutaneous release by the same surgeon from January 2012 to June 2014. The effect of ultrasound-guided A1 pulley release was evaluated by using visual analogue scale (VAS) score, disabilities of arm, shoulder, and hand (DASH) score, and grip and pinch strengths preoperatively and at 12weeks after the surgery. In addition, complications related with the procedure were evaluated.

Results:

Triggering and locking were resolved in all patients after surgery. VAS and DASH improved from 5.0±1.8 and 45.8±16.9 preoperatively to 0.3±0.6 and 16.2±6.3 at 12 weeks, respectively (p=0.019 and p=0.021). Grip and pinch strengths statistically improved from33.5±8.6 kg and 36.7±8.1 kg, preoperatively 46.2±6.1 kg and 47.1±7.4 kg, respectively (p=0.026 and p=0.041). Complications such as incomplete resection, neurologic symptoms or wound infection were not found throughout the period of the study.

Conclusion:

Ultrasound-guided percutaneous A1 pulley release provides complete relief of symptoms with no major complication in trigger thumb.

Keywords: Trigger thumb, A1 pulley, Percutaneous release, Ultrasound

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Fig. 1.

A specially designed knife (HAKI knife, BK Meditech Inc., Seoul, Korea)⁸.

Fig. 2.

A photograph of percutaneous release assisted ultrasound (ACUSON S1000, Siemens Medical Solutions Inc.). Holding the thumb at 30° abduction and 15° flexion, a HAKI knife was inserted distally to the metacarphophalangeal flexion crease.

Fig. 3.

(A) A axial view of the A1 pulley in the right thumb. Arrow indicates tip of HAKI knife which was located in A1 pulley layer, not tendon; yellow territory, radial digital nerve; red territory, radial digital artery. (B) A axial view of the A1 pulley in the right thumb using Doppler. MCP, metacarpophalangeal; FPL, flexor pollicis longus.

Fig. 4.

A sagittal view of the A1 pulley in the right thumb. Yellow arrow indicate A1 pulley at MCP joint. MCP, metacarpophalangeal; FPL, flexor pollicis longus.

Fig. 5.

A sagittal view of the A1 pulley in the right thumb. Arrow indicates tip of HAKI knife which was located in proximal A1 pulley margin, not tendon; yellow arrow, A1 pulley. MCP, metacarpophalangeal; FPL, flexor pollicis longus.

Table 1.

Demographic and baseline characteristics of the population

Variable	Value
Age (yr)	55.0 (41-74)
Sex (female:male)	18:6
Duration of symptoms (mo)	15
Dominant involvement, n (%)	17 (71)
Quinnell classification (no. of II/III/IV)	4/14/6

Table 2.

Clinical outcomes after ultra-sound guided percutaneous release

Outcome	Mean±SD (range)	p-value
VAS score		0.012
Preoperative	5.0±1.8 (2–10)
12 Weeks	0.2±0.7 (0–2)
DASH score		0.031
Preoperative	45.8±16.9 (10–74)
12 Weeks	8.2±4.7 (0–15)
Pinch strength (% of contralateral side) (kg)		0.011
Preoperative	36.7±8.1 (7–51)
12 Weeks	47.1 ±7.4 (39–68)
Grip strength (% of contralateral side) (kg)		0.035
Preoperative	33.5±8.6 (9–54)
12 Weeks	46.2±6.1 (31–72)

SD, standard deviation; VAS, visual analogue scale; DASH, disabilities of arm, shoulder, and hand.

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