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Ultrasound-Guided A1 Pulley Release Versus Classic Open Surgery for Trigger Digit: A Randomized Clinical Trial
Guillermo Rodríguez-Maruri1, Jose Manuel Rojo-Manaute2, Alberto Capa-Grasa3
1Primary Care Musculoskeletal Unit, Area V, Servicio de Salud del Principado de Asturias, SESPA, Gijón, Spain.
Summary
Ultrasound-guided A1 pulley release offers superior functional recovery and fewer complications for trigger digits compared to open surgery. This minimally invasive approach accelerates return to daily activities and improves patient outcomes.
Area of Science:
- Orthopedic surgery
- Minimally invasive procedures
- Musculoskeletal disorders
Background:
- Trigger digit, a common condition, often requires surgical intervention.
- Classic open A1 pulley release is a traditional treatment method.
- Advancements in minimally invasive techniques are being explored for trigger digit treatment.
Purpose of the Study:
- To compare the efficacy and safety of ultrasound-guided percutaneous A1 pulley release versus classic open surgery for trigger digit.
- To evaluate functional recovery and complication rates between the two surgical techniques.
Main Methods:
- A single-center randomized controlled trial was conducted with 84 patients diagnosed with primary grade III trigger digit.
- Patients were allocated 1:1 to either ultrasound-guided percutaneous release or classic open surgery.
- The primary outcome measure was the Quick-Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire, with secondary outcomes including range of motion, grip strength, and time to recovery.
Main Results:
- Ultrasound-guided release showed significantly better Quick-DASH scores at 3 months compared to open surgery (7.6 vs. 15.3).
- The percutaneous group demonstrated superior outcomes in time to analgesic cessation, achieving full range of motion, and resuming daily activities.
- While grip strength was better in the percutaneous group initially, complication rates were lower, with only minor local pain in the open group and transient numbness in both.
Conclusions:
- Ultra-minimally invasive ultrasound-guided A1 pulley release is clinically superior to classic open surgery for trigger digit treatment.
- This technique leads to improved functional recovery and a reduced complication profile.
- Ultrasound guidance offers a promising alternative for trigger digit management.
