Percutaneous Release of the Trigger Finger using Newly Designed Scalpel

Park, Min Jong; Ha, Kwon Ick

Abstract

Percutaneous method of Al pulley release for the trigger fingers using hypodermic needle or small sharp scalpel has been described by some authors. In our experience, however, these methods had some difficulties in handling the instruments and not easy to utilize proper technique. Therefore we designed a special scalpel for easy and safe percutaneous release of the Al pulley. The scalpel has a hook shaped end with a blade on the inner side. Insertion site through the skin should be 0.5cm distal to the Al pulley, and the hooked end is located at the proximal margin of the Al pulley followed by longitudinal cut of the pulley distally. We performed this procedure in 44 trigger fingers of 41 patients in our out-patient clinic. There were 9 males and 32 females with a mean age of 54.4 years (range, 24 to 83 years). Affected digits were 23 thumbs, 1 index, 13 middle, 5 ring and 2 little fingers. 9 of them were locked in flexion or extension. The duration of symptom was an average of 7.9 months. After a mean follow up of 11.3 months, 42 fingers (95.4%) were completely free of symptoms including triggering. One had mild residual triggering due to incomplete release of the pulley and another had re-release of the pulley for remaining flexion limitation. One finger showed mild bowstringing after release, which subsided in 3 months. One patient complained of persistent pain and tenderness over the release site. There were no injuries of nerves or vessels and no infections. The duration of discomfort after release ranged from 3 to 70 days (av. 18.5 days). All patients, except one, were satisfied with the treatment method and their results. We think that percutaneous release of trigger fingers using our special scalpel is a very effective and convenient procedure both to surgeons and patients. It can be easily and safely performed in out-patient clinic with successful results.