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Ultrasound Guided Percutaneous Annular Pulley Release for Trigger Finger
Julia C. Ruston, MBBS; Oliver Bassett, MD; Rupert Eckersley, MD; Robert Pearce, MD; Gajan Rajeswaran, MD; Effie Katsarma, MD
Chelsea and Westminster Hospital, London, United Kingdom

Introduction: Trigger digit is a common cause of hand pain and loss of function. Treatment consists of hand therapy, splints, corticosteroid injections and finally open release of the constricting annular pulley. Our department piloted the use of ultrasound guided percutaneous annular pulley release, using a standard hypodermic needle bent at 2 points. Published by the senior authors in 2009, this technique allows visualization of the tendon and neurovascular bundle, and in a pilot study was found to be promising. This study aimed to evaluate the long-term use of this technique.

Methods: Retrospective case note review of all patients undergoing ultrasound guided A1 pulley release for trigger digit, between 2009 and 2014. All patients had first trialled conservative and corticosteroid treatments within the hand surgery department. Presenting symptoms, ultrasound findings and outcomes were evaluated.

Results: Following a pilot study of 35 patients, we present a case series of 200 patients, who underwent ultrasound guided percutaneous A1 pulley release between 2009 and 2014. We believe this is the largest series described thus far. In concordance with the original paper, up to 90% of patients had complete resolution of symptoms, with minimal complications (1%) and high patient satisfaction.

Conclusion: We support that A1 pulley release under ultrasound guidance for the treatment of severe triggering of the digit is a safe and effective procedure, well tolerated by patients and performed in an outpatient setting.

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