Safe Treatment of Trigger Finger with Longitudinal and Transverse Landmarks: An Anatomic Study of the Border Fingers for Percutaneous Release
- 1 September 2003
- journal article
- Published by Wolters Kluwer Health in Plastic and Reconstructive Surgery
- Vol. 112 (4), 993-999
- https://doi.org/10.1097/01.prs.0000076225.79854.f7
Abstract
Transverse landmarks have recently been determined to predict the proximal and distal edges of the A1 pulley for trigger finger release. Percutaneous A1 pulley release has been discouraged for the border digits because of the risk of injury to the neurovascular structures of the index and small fingers. The purpose of the study was to identify longitudinal surface landmarks to prevent injury to the neurovascular bundles during percutaneous A1 pulley release of the ulnar and radial border digits. Longitudinal surface landmarks were identified and marked on 29 cadaver hands. Proximal and distal landmarks for the longitudinal vector through which the A1 pulley of the small finger was released include the midline of the proximal digital crease and the scaphoid tubercle. Proximal and distal landmarks for the longitudinal line through which the index finger A1 pulley was released include the midline of proximal digital crease and radial edge of the pisiform. Longitudinal incisions were performed between these landmarks, straight through the skin and deep enough to score the A1 pulley. The distance of the medial edge of the neurovascular structures from the longitudinal incision in the A1 pulley was measured for each small finger and index finger. Using these longitudinal landmarks for the index and small fingers, none of the neurovascular structures was injured while performing these longitudinal incisions through the skin, scoring the A1 pulley. In fact, the average distance for the neurovascular structures from the longitudinal vector of the small finger was 5.4 +/- 1.4 mm radially and 6.7 +/- 1.9 mm ulnarly. The average distance for the neurovascular structures from the longitudinal line of the index finger was 8.5 +/- 1.8 mm radially and 6.2 +/- 1.7 mm ulnarly. Based on the findings of this anatomical study, these longitudinal landmarks can be used to avoid injury to neurovascular structures in the management of trigger finger involving the border digits with steroid-injection, open, or percutaneous A1 pulley release.This publication has 26 references indexed in Scilit:
- TRIGGER FINGER SPLINTING/ReplyOrthopedics, 1999
- Injection versus surgery in the treatment of trigger fingerThe Journal of Hand Surgery, 1997
- Steroid versus placebo injection for trigger fingerThe Journal of Hand Surgery, 1996
- Steroid versus placebo injection for trigger fingerThe Journal of Hand Surgery, 1995
- Controlled Study of the Use of Local Steroid Injection in the Treatment of Trigger Finger and ThumbJournal of Hand Surgery (European Volume), 1992
- The results of conservative management of trigger fingerAnnales de Chirurgie de La Main Et Du Membre Superieur, 1992
- Treatment of Flexor Tenosynovitis of the Hand ('Trigger Finger') With CorticosteroidsArchives of Internal Medicine, 1991
- Treatment of trigger finger by steroid injectionThe Journal of Hand Surgery, 1990
- A survey of ‘trigger finger’ in adultsJournal of Hand Surgery (European Volume), 1988
- THE EFFICACY OF LOCAL STEROID INJECTION IN THE TREATMENT OF STENOSING TENOVAGINITISPlastic and Reconstructive Surgery, 1973