Clinical Results of Trigger Finger Release Using Ultrasound Guidance (TFR-US) In Multiple Practice Settings
Richard Schaefer, MD1; Alan Blackburn, MD2; Brett J Kindle, MD3; Craig Chappell, DO4; Joseph McGinley, MD5; Douglas Hoffman, MD6
1SSM Health, Fond du Lac, WI; 2South Florida Orthopaedics and Sports Medicine, Stuart, FL; 3Andrews Institute for Orthopaedics and Sports Medicine, Gulf Breeze, FL; 4In2it Medical, Pleasant Grove, UT; 5Wyoming Medical Center, Casper, WY; 6Essentia Health, Duluth, MN
Introduction Trigger finger release using ultrasound guidance (TFR-US) may reduce surgical morbidity and facilitate recovery. However, concerns regarding safety, effectiveness, and generalizability may slow adoption. We hypothesized that TFR-US would be safe, effective, and result in high patient satisfaction in diverse practice settings.
Methods During January-April 2022, 13 physicians from different practices started performing TFR-US using a commercially available device (UltraGuideTFR™). Patients prospectively reported intraoperative pain, triggering, return to activity (RTA), return to work (RTW), stiffness, QDASH, and global satisfaction. The current study includes all patients providing post-operative data through May 20, 2022.
Results One hundred and eight patients (52% female, mean age 65) enrolled, totaling 118 fingers (11% index, 45% long, 41% ring, 3% small). Seventy-one percent of patients had ?1 comorbidity (including diabetes in 35% and rheumatoid/inflammatory arthritis in 14%). Most procedures were performed using local anesthesia in a procedure room. Incisions were 3-4 mm and did not require suture closure. The mean intra-operative pain score (0-10 scale) was 1.6 with 87% identifying the local anesthesia needle as most painful. There were no infections, neurovascular injuries, or tendon injuries. Mean pain scores decreased from 4.0 pre-op to 0.78 at day 7 (p<0.001), and 0.1 at 3 months (p<0.001). The mean Quinnell Score was 1.9 pre-op, and 0.2 at 0.5, 1.0, and 3 months (Figure 1). Median RTA was 2 days (n=77) and median RTW among employed patients was 2 days (n=46), with 89% returning within 7 days (including 17 manual laborers). Mean finger stiffness (1=none, 4=severe) was 2.58 pre-op and 1.65 at 0.5 month, 1.58 at 1 month, and 1.08 at 3 months. Compared to pre-op, mean QDASH scores significantly decreased at each time-point (pre-op=30.4, 0.5 month=14.1, 1 month=12.4, 3 month=7.5, p<0.001) and exceeded minimal clinically important differences. Wounds/scars were graded as excellent (indistinguishable from surrounding skin) or very good (barely noticeable) by >90% of patients at all time points (Figure 2). Mean global satisfaction (1=very dissatisfied, 5=very satisfied) was >4.3 at all post-operative time points.
Conclusions TFR-US is safe, effective, generalizable, and provides patients the opportunity to quickly return to normal activities.
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