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Immediate A-1Pulley Release Versus Conventional Treatment In Diabetic Patients
Miguel J. Saldana, MD;
San Antonio, TX

PURPOSE: Percutaneous trigger finger release: is it safer and more cost effective to perform on
first encounter with diabetic patients?

DESIGN: One hundred consecutive diabetic patients with flexor sheath tenosynovitis seen in
the office between January 2005 and January 2006 were included in the study. Odd numbered
patients (1,3,5,etc) were treated with an immediate percutaneous A-1 pulley release. Even
numbered patients (2,4,6, etc.) were treated conservatively with a steroid injection of 10mg.
Kenalog mixed with a 1 cc. 1% Xylocaine and 1cc. .25% Marcaine. This injection was repeated
within a year if recurrence happened. More than one recurrence in a year let to percutaneous
release. Fifty patients were treated in each treatment arm.

Follow up for the fifty injected patients was at six weeks, three months, six months, nine
months one year, and yearly thereafter until five years elapsed. Follow up for the odd
numbered patients were at six weeks and if they noticed recurrence. The study ended in
December 31, 2011.

RESULTS: There were 13 long fingers, 13 ring fingers, 10 index fingers, 8 small fingers and 6
thumbs involved in the odd numbered group with immediate release. There were 10 long
fingers, 13 ring fingers, 12 index, 6 small fingers, and 9 thumbs in the even numbered injected
group.

None of the odd numbered group patients had a recurrence at five years. Five were lost to
follow up at five years.

Seventeen of the fifty injected patients had an A-1 pulley release in the first year. Eight more
of the fifty patients had the A-1 pulley released in the follow up years. A total of 25 patients
out of the 50 patients in the even numbered treatment arm eventually had to have a trigger
finger releases. Four patients in the even numbered injected group were lost to follow up.

COSTS: The average reimbursement for a percutaneous release is \.00. \ X 50 releases
equal \,223.00 . The average reimbursement for a trigger injection is \.81 X 100 equaled
\.00. Twenty five even patients recurred and were released. \.00/trigger release x 25
patients equal \.00.The cost for the injected group was \.00 plus \.00 equaled
\,381.00.

CONCLUSION: In a private office setting on diabetic tenosynovitis, it is better as far as the
recurrence rate and the cost comparison of injections versus release, to do a percutaneous
release on the first office visit. Sixty patients had no idea what there serum glucose level was
on the day of the first examination.


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