Surgical Treatment for Trigger Thumb Using a Radial Approach

Abstract

The anatomy of the thumb flexor pulley system and surrounding structures differs from the fingers. The hand's positioning during trigger thumb release is troublesome. Iatrogenic radial digital nerve injuries of the thumb following opened or percutaneous A1 pulley release have been reported. We present the radial approach using a transverse incision for surgical release of the trigger thumb. This surgical approach aimed to restore a familiar surgical hand position, prevent radial digital nerve injury and bowstringing of the flexor pollicis longus, and decrease postoperative pain to facilitate recovery of hand function.

Keywords: A1 pulley release; radial approach; trigger thumb.

Fig. 1

In the radial approach technique, the patient's hand is set in the supinate position and the thumb in the radial abduct position ( A ). In contrast to the standard approach, sometime surgeon or assistant have to hold the thumb in the palmar abduct position ( B ).

Fig. 2

A small towel is placed under the thumb. The radial sulcus between A1 pulley and radial sesamoid bone of the thumb and the skin incision are marked with the marker pen. The 1.5 cm skin incision begins at point 1 mm proximal to the palmar digital crease, the sulcus is at the center of the skin incision.

Fig. 3

Illustration of the skin incision ( red line ), radial sulcus ( blue dashed line ), and radial sesamoid bone ( dashed oval ).

Fig. 4

Comparison between radial approach ( arrow ) and standard approach ( arrowhead ).

Fig. 5

Identification of the radial digital nerve.

Fig. 6

The radial nerve is retracted to the ulnar side.

Fig. 7

Identification of the A1 pulley.

Fig. 8

Cutting A1 pulley of the thumb from its radial border.

Fig. 9

A cross-sectional view demonstrates the technique of cutting the A1 pulley of the thumb from its radial border.

Fig. 10

Full range of motion with the Kapandji score of 10 at postoperative 3 weeks.