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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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