(Research Hub Theater) Ultrasound-guided A1 Pulley Release: A Systematic Review

Background and/or Objectives: Trigger finger, or stenosing tenosynovitis, is a common disorder of the hand. In recalcitrant cases, patients are often referred for surgical management. The ultrasound-guided A1 percutaneous A1 pulley release (USGAR) is an emerging treatment for trigger finger. The purpose of this review was to summarize the current literature pertaining to USGAR procedures.

Design: A search of the available literature was performed. The databases searched were PubMed, Cochrane Library, Embase, and Web of Science using a block search for words related to trigger finger disorders and various surgical interventions or ultrasound-guided interventions. Exclusion criteria included: studies on children 17 years or younger; non-English language articles; cadaveric studies; review articles, commentaries, letters or editorials; meeting abstracts; lacked outcome data; and percutaneous studies that did not utilize ultrasound-guidance or publications that described an open release.

Setting: Not Applicable

Participants: Not Applicable

Interventions: Not Applicable

Main Outcome Measures: Number of successful releases and complications.

Results: 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. Of the studies that specified digits treated, the thumb was treated in 26% of cases, index finger in 10%, middle finger in 32%, ring finger in 26% and little finger in 5%. Twelve of the 17 studies were published in the last 6 years with a trend toward increasing number of publications in recent years. Several different instruments have been used across studies to perform the USGAR, including hypodermic needles, customized knives and transecting threads.

Conclusions: USGAR appears to be a safe and effective treatment for trigger finger. Ultrasound guidance allows real-time intra-procedural monitoring and is a promising alternative to open release with a lower complication rate and faster recovery than the open release.