The trigger finger release was performed in 34 digits (11 thumbs and 23 fingers) of 24 patients through the thread transecting technique with the tip-to-tip approach, in which a 22-gauge needle inserts into a 18-gauge needle when both needles are inside the hand, guiding the 22-gauge needle to exit the hand at the same access point of 18-gauge needle. We prospectively evaluated the effectiveness and functional recovery of these patients. In all 34 digits, triggering and locking were resolved, and complete extension and flexion occurred immediately following the release. There were no complications, such as incomplete release, neurovascular or flexor tendon or A2 pulley injury, infection, or tendon bow-stringing. Patients did not require prescription pain medications. Most patients used their hands to meet their basic living needs the same day of the procedure. The hand function evaluated with the Quick Disabilities of the Arm, Shoulder and Hand questionnaire, and scored 4 within 3 months. Level of evidence: II.

This cadaveric study tested the feasibility of decompressing the ulnar nerve across the elbow percutaneously with a commercially available surgical dissection thread, a guiding needle, hydrodissection and ultrasound guidance. We performed the procedure in 19 fresh-frozen cadaveric upper extremities. Subsequently, we did an anatomical dissection of the specimens to visualize the extent of ulnar nerve decompression and the extent of damage to surrounding structures. The cubital tunnel and deep across the medial elbow were completely transected leaving the ulnar nerve fully decompressed in all cases. There was no evidence of direct injury to the ulnar nerve or adjacent neurovascular structures. A prerequisite knowledge of sonographic anatomy and experience with interventional ultrasound is essential. Future clinical studies should evaluate this technique’s safety and efficacy compared with conventional ones.

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Drastic and rapid changes to medical education are uncommon because of regulations and restrictions designed to ensure consistency among medical school curriculums and to safeguard student well-being. As a consequence of the COVID-19 pandemic, medical education had to break away from its conventions and transition from time-honored teaching methods to innovative solutions. This article explores the anticipated and actual efficacy of the swift conversion of a specialty elective from a traditional in-person format to a fully virtual clerkship. In addition, it includes a noninferiority study to determine where a virtual classroom may excel or fall short in comparison with conventional clinical rotations.

Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.