US- Guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: Feedback on 350 Procedures

Objectives: To evaluate the efficacy of ultrasonographically-guided percutaneous treatment of the trigger finger by releasing the A1 pulley with a 21 G-gauge needle.
Materials and Methods: In the first part of this work, which was published by our team in 2016 (Lapègue et al. 2016), we performed 10 procedures on cadaver digits, followed by a dissection.
The second part reports on our 5 years of experience with a series of 350 trigger fingers in 300 patients, treated by concomitant release and infiltration. The results were evaluated by a clinical examination at Day 0 before and after the procedure, by a systematic one-month follow-up visit, and by an additional consultation in case of iterative problems.
Results: No complications were found during the cadaver study.
However, the release was considered “partial” in all fingers.
In the clinical study, the trigger finger was completely resolved in 90% (315/350) of cases immediately after the procedure. Moderate trigger finger persisted in 33 cases (9,4%), and 2 thumbs (0,6%) pulley could not be released.
At one-month follow-up, only 10 moderate trigger finger and 1 failure remain. 13% of patients (39/300) still have residual pain, moderate in 11% of cases (33 patients/300) and greater in 2% of cases (6 patients/300). In the latter 6 patients, "exudative" tenosynovitis was demonstrated. 98% of patients were satisfied with their management.
Conclusion: US-guided treatment of the trigger finger by using a 21-gauge needle is feasible in current practice, with minimal complications and with a satisfactory clinical result in 98% cases.