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Minimally Invasive High Resolution Ultrasound Guided Trigger Finger Release
Brian Jurbala, MD
Highland Center for Orthopaedics, Lakeland, FL

Introduction: We hypothesized that a new technique utilizing a sonographically enhanced knife and High Resolution Ultrasound guidance for A-1 pulley release could be performed safely, effectively and reproducibly in both the operating room and office environments. Furthermore, we hypothesized that there would be cost savings for the patient (and 3rd party payer) when the procedure was performed in the office.

Materials and Methods: 54 fingers in 41 consecutive patients underwent a minimally invasive A-1 pulley release by a single surgeon utilizing a distal to proximal technique with a sonographically enhanced knife and High Resolution Ultrasound guidance. A preliminary cadaveric study was performed confirming the safety and efficacy of the technique. In the present study, 28 Trigger Fingers in 18 patients were performed in the operating room under combination of local anesthetic and conscious sedation. 26 Trigger Fingers in 23 patients were completed in the office completely under local anesthetic with no sedation. The average incision sized measured 4 mm and no stitches were used for wound closure. All patients were examined postoperatively for evidence of incomplete release, neurovascular and/or wound complications. Evidence of any complications and any subsequent treatments were noted. We compared total costs for all services related to the procedure in both the office and in the operating room (based on Medicare reimbursement rates).

Results: Follow-up was an average of 6 weeks postoperatively (Range 2 to 12 weeks). All 54 fingers in 41 patients had absence of triggering on follow-up examination. There were no neurovascular complications, tendon injuries, recurrences, or wound infections. There was one reoperation for a painful benign follicular cyst which had formed at the incision site at 10 weeks postoperatively. 3 patients had some mild prolonged serous drainage from the wound which resolved by 4 weeks postoperatively. One patient had some mild crepitus just proximal to the A-1 pulley area on her first postoperative visit which resolved completely with a single steroid injection. The overall cost of the procedure was less when performed in the office.

Conclusions: In the current study, we found that A-1 pulley release was performed safely, effectively and reproducibly in both the operating room and office environments by a single surgeon utilizing a sonographically enhanced knife and High Resolution Ultrasound guidance. Furthermore, overall cost savings (based on Medicare reimbursement rates) was noted for the patients in which the procedure was performed in the office when compared to procedures performed in the hospital or surgical center.


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