Shanavas Ebrahim Kunju1, Sethu Sivan2, Mahesh Satheeshkumar3
BACKGROUND
Trigger finger is also known as stenosing tenosynovitis and is characterized by
pain catching snapping or triggering of the affected finger leading to difficulty in
grasping objects. The surgical options include open and percutaneous release. The
percutaneous release was first reported in 1958 and has gained popularity in the
recent years with adequate success rate as open release without many
complications. But apprehension prevails in the percutaneous release of trigger
thumb due to the proximity of radial digital nerve of thumb to A 1 pulley which
was confirmed by various anatomical studies. We evaluated the results of
percutaneous release of trigger thumb with special attention to the safety of a
standard surgical technique based on anatomical landmarks. We wanted to study
the functional outcome and complications of percutaneous trigger thumb release.
METHODS
In the present retrospective study, 42 patients with isolated trigger thumb treated
at Government T.D. Medical college, Alappuzha from August 2017 to August 2018
who underwent percutaneous release and were available for follow up for 6
months were selected. The cases were managed by a single surgeon experienced
in percutaneous release by standard safe surgical technique. Percutaneous release
was done as a day care procedure. Release was done by a safe surgical technique
based on anatomical landmarks. Functional outcome was assessed in terms of
recurrence of triggering, presence of complications and a 5-point functional
assessment and ability for early return to work. Digital nerve injury was considered
as a major complication.
RESULTS
Out of 42 patients treated by percutaneous trigger thumb release using our
protocol, 41 patients had complete recovery and only 1 patient had recurrence of
symptoms requiring open release. At 6 months follow up no single patient had any
serious complication.
CONCLUSIONS
Percutaneous release of trigger finger is effective, convenient, cost effective day
care surgery without any significant complications in skilled hands. Localization of
A1 pulley using anatomical landmarks during percutaneous release can prevent
neurological injury to thumb.
