Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger

Figure 1 Longitudinal view of the middle finger’s flexor tendons (white arrows) volarly to the metacarpal-phalangeal joint (blue double arrow). The A1 pulley appears swollen and anechoic (yellow arrows), establishing the trigger finger disease.

Figure 2 Positioning of the V-Lance Knife almost parallel to the probe.

Figure 3 Longitudinal ultrasound-guided release of the A1 pulley. The knife -with its acoustic shadowing (green arrows) - is clearly visible (white arrows). Its tip is advanced over the metacarpal-phalangeal joint (yellow arrow), parallel to the superficial flexor tendon.

Figure 4 In order to be assured for the right position of the knife, we are transferred in transverse view of the tendons (flexor’s transverse cut: Yellow arrows, lying on the bone: Light blue arrow). Here, we certify that the tip of the knife (tip as a white dot: white arrows, sending its characteristic acoustic shadow: Green arrows) is attaching the volar end of the tendons (without penetrating them), under the A1 pulley (the sheath is appeared as a thin line under the red arrows). Moreover, it is vital to avoid the neurovascular digital structures (digital artery in the curved side of the purple moon).

Figure 5 The Q-DASH fluctuation per patient in (A) and (B) respectively.

Figure 6 Regarding the cosmetic results, there is a clear difference between the two groups, in favor of the ultrasound-treated patients.