ultrasound-guided trigger finger release : a new …ultrasound-guided trigger finger release : a new...

Ultrasound-guidedtriggerfingerrelease:anewprocedure(50cases)HYPOTHESISUltrasound-assistedpercutaneoustriggerfingerrelease,withneedles,hasshownsomeincompletereleasesandmorbiditiesontendonsandbundles.1,2,3,4Someauthorshaveusedblades,underliningthenecessityofaspeciallydesignedblade,whichcouldallowaperoperativeultrasoundcontrolwiththebenefitsofpercutaneousprocedures.5,6,7,8Ourobjectivewastoanalyzetheoutcomesofanewspecificbladetoperformanultasound-guidedpercutaneoustriggerfingerrelease.METHODSBladespecifications:-ablunttiptopenetrateintrasheathfollowedbyasharpbladetocutthepulley-percutaneous(<2mm-thin),-cheap(nondisposable),Cadavericlab:6specimenswereoperatedonbothsides,oneachfingersexceptthumbs(48fingers).WeusedourspecificbladeandaLogiceGEultrasounddevicewithahighfrequencytransducer(theL10-22-RS).Weperformeda2mmincisionintheMPskinfoldenablingaretrogradesectionoftheA1pulleyduringanIn-Planeapproach.Then,ineverycase,weevaluatedthetendonsandtheneurovascularbundleswithanopentechnique.Prospectiveclinicalseries:Underlocalanesthesia,30consecutivepatientswereincluded,16gradeIII-IV,7failuresofsteroidinjectioningradeI-II,7gradeI-IIdiabeticpatientswithoutpreviousinjection;2forefingers,19thirds,7middles,

2littles.Ultrasound-guidedsteroidinjectionwasdoneattheendoftheprocedureineachcase.Adressingwaskeptfortwodaysandaclinicalexaminationwasperformedafter1and3months.RESULTSCadaveric(n=48):noneimpairmentofbundles,2superficialtendonslacerations,incompletesectionofA1pulleywasobservedinonly2fingers(little).Peroperative(n=30):durationofsurgerywas10minutes(5-18),triggerreleasewasobtainedimmediatelyinallgradeIII&IVClinicaloutcomes(n=30):norecurrenceoftriggerfingerwasnoticed,nonesensitivedisorders.Thesatisfactionratewas96%.3patientswerestillpainfulafter3monthsbutimprovedinallthreecases:onewasagradeIV,twoagradeI;twolittlesandoneforefinger.SUMMARYPOINTSInordertoimproveourresults,weconcentratedourworkon:

-adedicatedblade-aretrogradesection,sothatwestrictlyavoided

impairmentoftheA2pulley-anIn-Planeultrasoundapproachtogetacontinuous and

direct visualization oftheA1pulleysection-asteroidinjectionattheendoftheprocedureto

improvepainreliefandefficiency.9Ultrasound-guidedtriggerfingerrelease,withthis

procedure,isreliableandefficientontriggerrelease,withoutspecificmorbidity.

LEVELOFEVIDENCE:IVPhotos

Photo1:Specificbladefortriggerfingerrelease:ablunttiptopenetrateintrasheathbeforethecuttingedge

Photo2:installationoftheultrasounddeviceandpositionofthesurgeonREMARQUES:1-Plaiecutanée:Danslatechniquepercutàl’aiguille,3passaged’aiguille18gaugesontraportécommeetantnecessaires,horsune18gaugefaitunmmcequifaituntotalde3mmd’ouverture,cequiestplusgrandqu’aveclalame.72-Dupuytrenetalgodystrophie:l’utilisationd’unetechniquemini-invasivecombinéeàuneinjectiondecorticoidlimitelerisqued’hyper-inflammationcicatricielleetvaparticiper,àmonavis,àunediminutiondesdouleurspost-op,desproblèmesdeDupuytrenréactionnel,desproblèmesd’inflammationetdouleurchroniqueetaussid’algodystrophie.Jepensequ’onesttouslesdeuxd’accordlàdessus.Malheureusement,cetravailnepermetpasdeleprouver,donc,jeprefereraienparleràl’oraldansladiscussion.LesAmerlocsontsurtoutcasse-couillesurlamethodo

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