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Objectives: Updated retrospective review of the sonographic appearance of palmar fibromatosis (PF) with evaluation of the utility of the Comb Sign previously described in plantar fibromas. Additional evaluation was conducted on the location relative to the flexor tendon, anatomic proximity of palmar fibromas to the A1 pulley and evaluate any potential association with trigger finger. Methods: Medical record and imaging review was performed from 2017 to 2023, for patients with a new onset ultrasound or clinical diagnosis of PF. Clinical associations and imaging morphology were reviewed including presence of the Comb Sign, fibroma association with the A1 pulley, and fibroma association with trigger finger. Results: Exactly 87 total fibromas in 53 patients were evaluated. The Comb Sign was present in 39% of fibromas, usually seen in transverse plane, more prevalent in multifocal disease and larger fibromas. Most (72%) palmar fibromas were within 1 cm of, contacted, or covered the A1 pulley (P <.001). Lateral extension beyond the flexor tendon axis can be seen (44%). Trigger finger and tenosynovitis were rare. However, volume and SI dimension of fibromas were associated with tenosynovitis (P <.0001) and all nine patients with concomitant trigger finger had fibromas within 1 cm from the A1 pulley. Conclusions: The Comb Sign can aid in sonographic diagnosis of PF. Lateral extension of fibromas can occur. Most palmar fibromas have a significant intimate association with the A1 pulley, and presence of trigger finger with adjacent palmar fibroma can exist and is important for hand surgeons to know preoperatively. [ABSTRACT FROM AUTHOR]

The purpose of this review was to summarize the current literature pertaining to ultrasound‐guided percutaneous A1 pulley release procedures. We searched PubMed, Cochrane Library, Embase, and Web of Science for clinical studies examining ultrasound‐guided percutaneous A1 pulley release. A total of 17 studies involving 749 procedures were included in this review. The overall success rate was 97%. There were 23 minor complications (4 cases of hematomas, 15 cases of persistent pain, and 4 cases of transient numbness) and no major complications reported. Ultrasound‐guided A1 pulley release is an effective and safe procedure for the treatment of trigger fingers and thumb. [ABSTRACT FROM AUTHOR]

Pediatric trigger finger (PTF) is an acquired condition that is uncommon and anatomically complex. Currently, the literature is characterized by a small number of retrospective case series with limited sample sizes. This investigation sought to evaluate the presentation, management, and treatment outcomes of PTF in a large, multicenter cohort. A retrospective review of pediatric patients with a diagnosis of PTF between 2009 and 2020 was performed at three tertiary referral hospitals. Patient demographics, PTF characteristics, treatment strategies, and outcomes were abstracted from the electronic medical records. Patients and families also were contacted by telephone to assess the downstream persistence or recurrence of triggering symptoms. In total, 321 patients with 449 PTFs were included at a mean follow-up of 3.9 ± 4.0 years. There were approximately equal numbers of boys and girls, and the mean age of symptom onset was 5.4 ± 5.1 years. The middle (34.7%) and index (11.6%) fingers were the most and least commonly affected digits, respectively. Overall, PTFs managed operatively achieved significantly higher rates of complete resolution compared with PTFs managed nonsurgically (97.1% vs 30.0%). Seventy-five percent of PTFs that achieved complete resolution with nonsurgical management did so within 6 months, and approximately 90% did so within 12 months. Patients with multidigit involvement, higher Quinnell grade at presentation, or palpable nodularity were significantly more likely to undergo surgery. There was no significant difference in the rate of complete resolution between splinted versus not splinted PTFs or across operative techniques. Only 30% of the PTFs managed nonsurgically achieved complete resolution. Splinting did not improve resolution rates in children treated nonsurgically. In contrast, surgical intervention has a high likelihood of restoring motion and function of the affected digit. Therapeutic IV. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of the present study was to evaluate the clinical effectiveness of ultrasonography-guided needle release of A1 pulley combined with corticosteroid injection by comparing it with ultrasound-guided needle release of the A1 pulley alone. Methods A total of 49 patients (55 fingers, thumb) with trigger fingers were included in this retrospective study. Twenty-seven fingers were treated with ultrasound-guided needle release of the A1 pulley alone (monotherapy group), and 28 fingers were treated with needle release of the A1 pulley combined with corticosteroid injection (combination group). Visual analog scale (VAS), Froimson scale, postoperative recurrence rate, and thickness of A1 pulley at baseline, Week-2, Week-12, and Month-6 were recorded. Results Higher clinical cure rates were observed in the combination group at Week-2 after treatment among patients with the Froimson scale Grade III and IV (p 0.05). Conclusions Ultrasonography-guided needle release of A1 pulley plus corticosteroid injection was superior to ultrasonography-guided A1 pulley needle release alone during early-stage treatment of severe patients with trigger fingers. Moreover, ultrasonography-guided A1 pulley needle release combined with corticosteroid injection narrows the thickness of the A1 pulley. It is necessary to carry out preoperative evaluation and individualized treatment for patients of various severities.

To compare the efficacy and safety of the USG-guided vs blind pulley release (PR) for Trigger Finger by performing a meta-analysis of all relevant studies in the published literature. A thorough and methodical search of the PubMed, Embase, Scopus, and Cochrane Library databases was carried out. Review Manager Software (RevMan) 5.4.1 was used to analyze the extracted data, and the results were displayed as forest plots with matching 95 % confidence intervals. The primary efficacy outcome i.e. residual triggering was significantly lower in USG-guided PR as compared to blind PR with a risk ratio of 0.16 (95 % CI 0.03–0.87), p = 0.03. The primary safety outcome i.e., percentage of complications was lower in the USG-guided procedure group, although the result was not statistically significant with a risk ratio of 0.25 (95 % CI 0.05–1.16), p = 0.08 with I2 of 0 %. The operation time was longer in the USG-guided PR as compared to the blind procedure, although the difference was not statistically significant with a mean difference of 5.36 (95 % CI: −3.73, 14.46), p = 0.25. The postoperative visual analog scale (VAS) score at 4 weeks was significantly lower in USG-guided PR versus blind PR with a mean difference of −0.40 (95 % CI: −0.68, −0.33), p = 0.004. When compared to blind PR, ultrasound-guided A1 PR for trigger finger was proven to be a safer and more economical method. [ABSTRACT FROM AUTHOR]

Purpose: To study the efficacy of three kinds of surgery for trigger thumb.Methods: A total of 60 cases of trigger thumb (Quinnell Grade IV) were randomly divided into three groups. The A1 pulley was disconnected at the middle in Group A, at the extreme radial side in Group B, excised in Group C. The following indicators were recorded pre-operatively (D0), and at one (D1), three (D3), seven (D7), 14 (D14), and 28 (D28) days post-operatively: 1. the pain visual analogue score (VAS) when flexing the affected thumb; 2. range of motion (ROM) of the interphalangeal joint with pain tolerance; 3. the time of pain disappearance when flexing the affected thumb.Results: The differences of VAS and ROM between D1 and D0, D3 and D1, D7 and D3, D14 and D7, D28 and D14 were statistically significant (P < 0.05). There was no significant difference in changes of VAS (or ROM) at D1 or D28 in contrast to D0 among the three groups. The differences of VAS (or ROM) changes at D3, D7, and D14 in contrast to D0 among the three groups were statistically significant (P < 0.05). The difference of the time when the pain disappearing in the normal range of motion among the three groups were statistically significant (P < 0.05).Conclusion: Disconnecting the A1-pulley at the extreme radial side is better than another two methods for treating the trigger thumb (Quinnell Grade IV). It has been shown to effectively accelerate postoperative pain relief and functional recovery.Trial Registration: Clinical trial registry number: ChiCTR2100051193. [ABSTRACT FROM AUTHOR]

Trigger finger is a common pathology, caused by inflammation and subsequent narrowing of the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger. It is seen more commonly in the diabetic population and in women, typically in the fifth to sixth decade of life. The diagnosis is usually straightforward. Conventional treatment modalities include splinting, corticosteroid injection, or surgical release. Recent and minimally invasive techniques include ultrasound-guided needle fenestration and hydrodissection resulting in immediate relief of symptoms. This case report is done to assess the efficacy of needle fenestration and hydrodissection in a case of the right index and middle trigger finger A1 pulley. Under ultrasound guidance, A1 pulley fenestration and hydrodissection were done and it is found to be an effective treatment modality in our patient. [ABSTRACT FROM AUTHOR]

ObjectiveThe present study aimed to assess the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife.MethodsThe author performed percutaneous A1 pulley release in 84 cadaveric hands fixed with 10% formalin. The cadaveric hands were divided into three groups: 28 hands in each group (group U: ultrasound-guided needle knife pushing group, group N: non-ultrasound-guided needle knife pushing group, group T: classical needle knife operation puncture group). Percutaneous A1 pulley release was performed, the soft tissue was dissected layer by layer, and the relevant anatomical data were measured.ResultsThe injured cases were as follows: group U, 29 (20.7%); group N, 36 (25.7%); and group T, 28 (20.0%). There is no significant difference between different tissue injury types in different intervention methods. The missed release cases were as follows: group U, 8 (5.7%); group N, 4 (2.9%); and group T, 13 (9.3%). The percentage of released A1 pulley were as follows: group U, 71.4% ± 30.7%; group N, 66.0% ± 20.3%; and group T, 61.0% ± 30.4%. The percentage of released A1 pulley of the three groups were compared: group U > group N > group T, and there was statistical difference between the three groups. The full release rates of the three groups were compared: group U(31.4%) > group N(15.7%) > group T(13.6%), and there were significant difference in the full release of A1 pulley between group U and group T, group N.ConclusionBased on the cadaver specimen, the length and percentage of released A1 pulley is longer by ultrasound-guided percutaneous A1 pulley release using a needle-knife. and there was no statistical difference in the injury rate between the three techniques.Type of Study and Clinical RelevanceClinical anatomic study. To test the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife in cadaveric hands, and provide an anatomically based support in clinic.

Background: The purpose of the present study was to evaluate the clinical effectiveness of ultrasonography-guided needle release of A1 pulley combined with corticosteroid injection by comparing it with ultrasound-guided needle release of the A1 pulley alone.Methods: A total of 49 patients (55 fingers, thumb) with trigger fingers were included in this retrospective study. Twenty-seven fingers were treated with ultrasound-guided needle release of the A1 pulley alone (monotherapy group), and 28 fingers were treated with needle release of the A1 pulley combined with corticosteroid injection (combination group). Visual analog scale (VAS), Froimson scale, postoperative recurrence rate, and thickness of A1 pulley at baseline, Week-2, Week-12, and Month-6 were recorded.Results: Higher clinical cure rates were observed in the combination group at Week-2 after treatment among patients with the Froimson scale Grade III and IV (p < 0.05). Among Froimson scale Grade IV patients, the combination group had a significantly thinner thickness of A1 pulley and better articular pain relief at Week-2 (all p < 0.05). No significant differences were found in the clinical cure rate, the thickness of the A1 pulley, articular pain relief, and recurrence rate between the two groups at Week-12 and Month-6 (all p > 0.05).Conclusions: Ultrasonography-guided needle release of A1 pulley plus corticosteroid injection was superior to ultrasonography-guided A1 pulley needle release alone during early-stage treatment of severe patients with trigger fingers. Moreover, ultrasonography-guided A1 pulley needle release combined with corticosteroid injection narrows the thickness of the A1 pulley. It is necessary to carry out preoperative evaluation and individualized treatment for patients of various severities. [ABSTRACT FROM AUTHOR]

Purpose: Trigger finger release (TFR) is a commonly performed procedure in hand surgery. Trigger finger release has a high success rate, but recurrence can occur. Data on revision TFR (rTFR) are sparse, with little known regarding factors associated with the need for revision surgery. Our purpose was to analyze risk factors associated with rTFR procedures., Methods: Using a national database (PearlDiver Research Program), patients who underwent TFR between 2015 and 2022 were identified using Current Procedural Terminology and International Classification of Diseases (ICD)-10 codes. Patients were included if they received an ICD-10 diagnosis of trigger finger on the same day as their release or within 2 weeks of their procedure. Patients who underwent rTFR were determined through identification of a secondary procedure completed in the same digit on the ipsilateral hand performed after the index procedure. Revision rates at 1, 3, and 5 years were recorded. Demographics and comorbidities were categorically examined via univariate and multivariable logistic regression analyses., Results: A total of 46,613 patients meeting inclusion criteria were identified after TFR with 1,793 (3.85%) undergoing revision release. Multivariable analysis demonstrated that diabetes, ischemic heart disease, and male sex were associated with statistically significantly increased odds of revision procedures at 1, 3, and 5 years from the initial operation. Age >65 years and hypertension were associated with an increased odds of revision surgery at 3 and 5 years, and carpal tunnel syndrome as a risk factor at 1 and 3 years only. Hypothyroidism was associated with a decreased revision rate at all time points and tobacco use at 5 years only., Conclusions: These data demonstrate that male sex, diabetes, and heart disease are risk factors for requiring revision TFR in the short and medium terms. This information can add to preoperative counseling with patients undergoing surgical treatment of trigger digits., Type of Study/level of Evidence: Prognostic II., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose. Stenosing tenosynovitis of the flexor tendons which readily causes the alleged "trigger finger" is a common and yet not completely understood phenomenon. The A1 Pulley is the pivot point at which the force protracted by the flexors of the digits acts upon the fulcrum at the leading edge of the pulley. We performed a histopathological study aimed at assessing the A1 Pulley of digits 2 through 5 in cadaver hands in an effort to delineate the changes the A1 pulley undergoes through the cycle of life and its repetitive motion tasks. Methods. Thirty-Nine A1 Pulley specimens were included in the study. These specimens were assessed as to physical width utilizing a caliper and as to histological characteristics following embedment and pertinent staining. Results. Our findings suggest the proximal leading edge of the A1 Pulley to be significantly (p < 0.05) thicker than the more distal aspect of the A1 pulley when pulley data were stratified for handedness and gender. We found insignificant differences within each digit as to differences between the radial and ulnar aspects of the denoted numerated digit. Conclusions. We believe our study sheds further light on the mechanism leading to digital triggering and that further studies may substantiate our preliminary findings as to the differences in radial versus ulnar aspects of each designated digital A1 pulley. [ABSTRACT FROM AUTHOR]

Background: Trigger finger is one of the most frequent causes of hand pain and disability. Recently, an endoscopic trigger finger release technique was developed, but outcomes have rarely been reported. Here, we present the outcomes of 2154 endoscopic trigger finger release procedures in a single center., Methods: In this retrospective study, 2154 endoscopic trigger finger release procedures were performed on 2034 patients. Outcome assessment at 90 days after surgery was classified as excellent, good, fair or poor according to a combination of patient satisfaction with the scar and pain at rest or under load on a numeric rating scale., Results: The therapeutic outcomes were: 1027 excellent, 607 good, 400 fair, and none poor. No major surgical complications were observed. Minor complications occurred in 231 fingers (10.7%)., Conclusions: All patients were satisfied with their outcome after endoscopic trigger finger release. Endoscopic release can be an effective and efficient therapeutic method for the treatment of trigger finger., (Copyright © 2024 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Objective: Trigger finger is one of the most common pathologies of the finger flexor mechanism. Previous studies have shown the value of ultrasound-guided percutaneous tenolysis. The aim of this study was to compare the efficacy and safety of anterograde versus retrograde percutaneous ultrasound-guided tenolysis., Materials and Methods: This was a comparative cadaver study performed between December 2021 and April 2022 in France, with 40 fresh cadaver fingers. Thumbs were excluded. A single surgeon performed 20 ultrasound-guided anterograde releases and 20 ultrasound-guided retrograde releases, using a second-generation minimally invasive surgical knife, and a multipurpose linear ultrasound transducer. The primary endpoint was the success of ultrasound-guided release, defined as complete opening of the A1 pulley along its entire length., Results: The success rate was 90% in the retrograde group and 95% in the anterograde group (non-significant difference: p = 0.56). There was no significant difference in superficial flexor tendon slip injuries or partial A2 pulley injuries. There were no neurovascular pedicle lesions., Conclusion: The choice of anterograde or retrograde ultrasound-guided tenolysis should be left to the surgeon's discretion., (Copyright © 2023 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Variations in the description of the flexor pulley system exist, particularly in whether the A1 and A2 pulleys represent discrete or confluent entities. This has potentially important clinical relevance at the time of A1 pulley release for symptomatic trigger finger, given the goal of adequate release without overrelease. The purpose of this study was to determine the relative prevalence of confluent A1 pulleys on a digit-by-digit basis employing 2.5× loupes alone, thereby simulating a clinical surgical environment. Cadaveric anatomic specimens underwent flexor pulley system dissection under 2.5× loupe magnification by 2 hand surgeons. The presence of pulley confluence and length (measured from the proximal aspect to the distal aspect) was recorded and compared on a digit-to-digit basis. Forty-five digits, comprising 9 adult forearm or hand specimens (5 right and 4 left) obtained from 6 donors (4 men and 2 women, age: 67 ± 8 years), were dissected. A total of 19 confluent A1 pulleys were encountered, with notable digit-by-digit variation in the prevalence of confluent pulleys. There were 0 confluent pulleys observed in the thumb, compared with 6 confluent pulleys observed in the middle finger. The average overall A1 pulley length was 5.0 ± 1.5 mm, with a similar pulley length observed between the digits. A1 pulley confluence varies on a digit-to-digit basis, with no observed confluence in the thumb and the most common confluence observed in the middle finger. In the setting of intraoperatively observed pulley confluence, we suggest pulley release under traction in order to develop the plane between the A1 and A2 pulleys and, thus, confirm the complete and isolated release of the A1 pulley. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to assess the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife., Methods: The author performed percutaneous A1 pulley release in 84 cadaveric hands fixed with 10% formalin. The cadaveric hands were divided into three groups: 28 hands in each group (group U: ultrasound-guided needle knife pushing group, group N: non-ultrasound-guided needle knife pushing group, group T: classical needle knife operation puncture group). Percutaneous A1 pulley release was performed, the soft tissue was dissected layer by layer, and the relevant anatomical data were measured., Results: The injured cases were as follows: group U, 29 (20.7%); group N, 36 (25.7%); and group T, 28 (20.0%). There is no significant difference between different tissue injury types in different intervention methods. The missed release cases were as follows: group U, 8 (5.7%); group N, 4 (2.9%); and group T, 13 (9.3%). The percentage of released A1 pulley were as follows: group U, 71.4% ± 30.7%; group N, 66.0% ± 20.3%; and group T, 61.0% ± 30.4%. The percentage of released A1 pulley of the three groups were compared: group U > group N > group T, and there was statistical difference between the three groups. The full release rates of the three groups were compared: group U(31.4%) > group N(15.7%) > group T(13.6%), and there were significant difference in the full release of A1 pulley between group U and group T, group N., Conclusion: Based on the cadaver specimen, the length and percentage of released A1 pulley is longer by ultrasound-guided percutaneous A1 pulley release using a needle-knife. and there was no statistical difference in the injury rate between the three techniques., Type of Study and Clinical Relevance: Clinical anatomic study. To test the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife in cadaveric hands, and provide an anatomically based support in clinic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Qiu, Li, Shen, Jia, Sun, Zhou, Li and Zhang.)

The present study aimed to evaluate conformational changes in the flexor pollicis longus (FPL) tendon and inner space of the A1 pulley during spontaneous resolution of pediatric trigger thumb (PTT) and to compare them versus the normal contralateral side. We enrolled 36 patients with unilateral PTT who underwent ultrasonography twice between January 2016 and July 2020 and showed >10° improvement in thumb interphalangeal (IP) joint extension lag. Ultrasonography was used to measure the anteroposterior (AP) and radioulnar (RU) diameters of the FPL tendon proximal to the A1 pulley and of the inner space of the A1 pulley. On the side of the PTT, the average extension lag in the thumb IP joint significantly improved, from 35.6° to 14.2°. The AP and RU diameters of the FPL tendon increased by 0.3% and 1.9%, respectively, and those of the inner space of the A1 pulley increased by 15.3% and 5.0%, respectively. In the contralateral normal thumb, the AP and RU diameters of the FPL tendon increased by 12% and 9.3%, respectively, and those in the inner space of the A1 pulley increased by 9.9% and 4.6%. During improvement in IP joint extension lag, the mismatch between the enlarged FPL tendon and the inner space of the A1 pulley was reduced by their asymmetric growth., (Copyright © 2022 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

To identify the anatomic relationship between the distal extent of the A1 pulley and the distalmost insertion point of the palmar plate into the base of the proximal phalanx at a metaphyseal bony ridge, the "P1 peak" (P1P), which is a bony acoustic landmark easily identifiable on sonography of the finger. We studied 48 fingers (no thumbs) from 12 fresh frozen cadavers with high-resolution ultrasound. A 20-gauge hypodermic needle was directed perpendicular to the long axis of the tendon sheath along a plumb line drawn at the level of the bony flare of the proximal metaphyseal-diaphyseal junction of the proximal phalanx, or the P1P, under high-resolution ultrasound guidance. Dissection was then performed, and the distance of the needle barrel and the actual distance of the P1P from the distal edge of the A1 pulley were recorded. The study demonstrated that accurate placement of the needle within 1 mm of the actual P1P was possible using ultrasound guidance and that the P1P was within 1 mm of the distal edge of the actual A1 pulley in all specimens studied. In all the specimens studied, we found that the P1P may be used as a clearly identifiable sonographic reference landmark to identify the distal extent of the A1 pulley. Using the P1P landmark as a guide to judge the completeness of ultrasound-guided percutaneous trigger finger release may reduce the risks of incomplete distal release and inadvertent release of the A2 pulley. [ABSTRACT FROM AUTHOR]