Ultrasound-guided trigger thumb release

Abstract

The purpose of this study was to evaluate the results of a novel retrograde ultrasound-guided A1 pulley release technique for the treatment of trigger thumb. We conducted a retrospective, single-center study of 42 patients who underwent ultrasound-guided A1 pulley release for clinically diagnosed trigger thumb between September 2022 and December 2023. All cases were graded according to the Green classification of trigger finger severity. Inclusion criteria were patients aged >18 years who failed conservative treatment (non-steroidal anti-inflammatory drugs, physical therapy, or steroid injections) for at least six weeks. Exclusion criteria were previous trigger thumb surgery, metacarpophalangeal or trapeziometacarpal arthrodesis, and documented allergy to local anesthetics. Outcome measures were pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores, and complication rates. The mean age of the patients was 37.8 years (range: 27-72). Based on Green's classification, we treated 5 grade I, 26 grade II, 6 grade IIIA, and 5 grade IIIB cases. At one month follow-up, all patients had resolution of the triggering. The mean VAS score improved significantly from 7.2 to 1.3 and the Quick-DASH score decreased from 51 to 9.1. There were no major complications. Open A1 pulley release for trigger thumb is effective but carries risks to the palmar radial digital nerve, especially in open surgery. Alternative methods such as ultrasound-guided and percutaneous release offer similar results with fewer complications. Recovery is faster for trigger thumb (2 weeks) compared to trigger finger (5 weeks). Some patients may experience prolonged symptoms after surgery. Open surgery has a 12% complication rate and a 2.4% revision rate. Ultrasound-guided percutaneous release is safer and allows real-time visualization during the procedure. Retrograde ultrasound-guided A1 pulley release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus. It offers advantages over traditional approaches, including improved cosmetic outcomes, the absence of sutures, and the ability for patients to resume daily activities and light work immediately postoperatively.

Keywords: Minimally invasive surgery; Thumb trigger; Trigger finger; Ultrasound-guided procedure; Ultrasound-guided surgery.