Biomechanical analyses of the human flexor tendon adhesion models in the hand: A cadaveric study

Kim, Jihyeung; Rhee, Seung Hwan; Gong, Hyun Sik; Oh, Sohee; Baek, Goo Hyun

doi:10.1002/jor.22798

Cited by 7 publications

(8 citation statements)

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“…Percutaneous release has been introduced as a convenient and reliable procedure because of its effective outcomes [ 41 – 43 ], but the success rate in different studies and with different tools has been different; however, potential disadvantage has been suggested previously, where this method may be associated with damage to either nerve or tendon and recurrent triggering, depending on the type of device used for surgery [ 20 , 28 , 41 , 44 , 45 ]. In the present study, with the use of 15° stab knife due to its fineness and short length and width, only 17 flexor tendons were superficially damaged and no damage to arteries, nerves, and A2 pulley was observed.…”

Section: Discussionmentioning

confidence: 99%

A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

et al. 2021

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Percutaneous release of the A1 pulley has been introduced as a therapeutic approach for trigger fingers and is suggested as an effective and safe alternative, where conservative treatments fail. The aim of the current study was to determine if percutaneous release with a 15° stab knife can effectively result in acceptable efficacy and lower complication rate. Methods In the present study, the percutaneous release of the A1 pulley was evaluated by percutaneous release using a 15° stab knife in 20 fresh-frozen cadaver hands (10 cadavers). One hundred fingers were finally included in the present study. The success rate of A1 pulley release as well as the complications of this method including digital vascular injury, A2 pulley injury, and superficial flexor tendon injury was evaluated, and finally, the data were analyzed by the SPSS software. Results The results showed a success rate of 75% for A1 pulley release in four fingers, followed by eleven fingers (90%) and eighty-five fingers (100%). Therefore, the A1 pulley was found to be completely released in eighty-five fingers (100%). Overall, the mean of A1 pulley release for these fingers was determined as 97.9%, indicating that percutaneous trigger finger release can be an effective technique using a 15° stab knife. Furthermore, our findings revealed no significant difference in the amount of A1 pulley release in each of the fingers in the right and left hands. Additionally, 17 fingers developed superficial scrape in flexor tendons, while 83 fingers showed no flexor tendons injuries and no other injuries (i.e., vascular, digital nerve, and A2 pulley injuries). Conclusions Percutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.

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Section: Discussionmentioning

confidence: 99%

A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

et al. 2021

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“…However, we noticed that some patients could not reach active full extension in 1 week but were restored to a full ROM gradually. Previous studies have postulated incomplete release [14], chronic adhesion of flexor tendon [15,16], or postprocedure inflammation or pain [17,18] as the three main mechanisms leading to residual ROM limitation after surgical A1 pulley release.…”

Section: Discussionmentioning

confidence: 99%

“…Moriya et al [25] reported that a PIP joint flexion contracture prolonged the duration of pain until the symptoms subsided. Kim et al [16] reported that the adhesion of the FDS and flexor digitorum profundus (FDP) resulted in a PIP joint flexion contracture. They postulated that, instead of PR or steroid injections, only open A1 pulley release with synovectomy and tenolysis of the FDP and FDS can treat trigger fingers with a PIP joint flexion contracture [16].…”

Section: Discussionmentioning

confidence: 99%

“…Kim et al [16] reported that the adhesion of the FDS and flexor digitorum profundus (FDP) resulted in a PIP joint flexion contracture. They postulated that, instead of PR or steroid injections, only open A1 pulley release with synovectomy and tenolysis of the FDP and FDS can treat trigger fingers with a PIP joint flexion contracture [16]. However, we conjectured that a PIP flexion contracture can be caused by chronic pain and reluctance to fully move the finger.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies [13e18] have focused on outcomes and complications of PR in pain, recurrent triggering, and nerve injury, but there has been less emphasis on extensor lag. The possible mechanism of a postprocedure residual extensor lag might be incomplete release [14], adhesion of the flexor tendon [15,16], or postprocedure inflammation or pain [17,18].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of percutaneous trigger finger release with concurrent steroid injection

Liu

Lin

et al. 2016

The Kaohsiung J of Med Scie

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Percutaneous release (PR) of the A1 pulley is a quick, safe, and minimally invasive procedure for treating trigger fingers. The purpose of this study is to identify if PR with additional steroid injections can shorten the recovery to reach unlimited range of motion. Between January 2013 and December 2013, we included 432 trigger fingers with actively correctable triggering or severer symptoms without previous surgical release or steroid injections from two hand clinic offices (A and B). The same experienced surgeon performed PR at the office. Patients from Clinic A received PR with steroid injections and those from Clinic B received PR without steroid injections. Patients returned for follow-up 1 week, 6 weeks, and 12 weeks after the procedure. Between the steroid group and the nonsteroid group, there is no significant difference in the mean time for patients to return to normal work and the rate of residual extensor lag. Middle fingers showed a 5.09-fold chance of having a residual extensor lag over that of the other fingers. High grade trigger fingers recovered more slowly than low grade ones. The success rate of a 12-week follow-up was 98.4%. There was no significant difference between the steroid group (97.5%) and the nonsteroid group (99.1%). PR can treat trigger fingers effectively, but additional steroid injection does not provide more benefit. Some fingers showed temporary extensor lag, especially in middle fingers and high grade trigger fingers, but 85% of those will eventually reach full recovery after self-rehabilitation without another surgical release.

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Ulnar Superficial Slip Resection for Resistant Trigger Finger: A Minimally Invasive Technique

Azarpira

Asmar

Falcone

2022

Techniques in Hand &Amp; Upper Extremity Surgery

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Primary trigger finger is a common hand disorder for which nonoperative treatment or release of A1 pulley is usually effective. For resistant or recurrent cases, there are different surgical techniques including partial or complete opening of A2 pulley, reduction tenoplasty, and resection of the ulnar slip of the flexor digitorum superficialis tendon. Here, we present our minimally invasive technique for ulnar superficial slip resection surgery. Our indications are the patients with persistent residual proximal interphalangeal joint contracture after A1 pulley release and also the recurrent cases. Then, we report the clinical outcomes of our patients operated using this technique.

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Biomechanical analyses of the human flexor tendon adhesion models in the hand: A cadaveric study

Cited by 7 publications

References 20 publications

A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

Outcomes of percutaneous trigger finger release with concurrent steroid injection

Ulnar Superficial Slip Resection for Resistant Trigger Finger: A Minimally Invasive Technique

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