title: Sonographically guided intrasheath percutaneous release of the first annular pulley for trigger digits, part 1: clinical efficacy and safety.
abstract: OBJECTIVE
  For trigger digits, intrasheath sonographically guided first annular (A1) pulley release has shown safety and effectiveness in cadavers. This clinical study describes sonographically guided A1 pulley release results in terms of resolution of symptoms, safety, and functional recovery.
  
  
  METHODS
  Sonographically guided A1 pulley release (11-MHz probe) was used in 48 digits of 48 patients prospectively followed for 11.3 months and examined 1, 3, and 6 weeks, 3 and 6 months, and 1 year later. Resolution of triggering (primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, grip strength, QuickDASH test scores, return to normal activities (including work), cosmetic results, satisfaction, and complications were assessed.
  
  
  RESULTS
  The success rate was 100%, and no cases recurred. Mean times were 1.9 days for taking pain killers, 6.6 days for returning to normal activities, and 9.9 and 3.8 days for complete extension and flexion recovery, respectively. Mean QuickDASH scores were 39.8 preoperatively and 7.8, 1.7, and 0 after 6 weeks, 6 months, and 1 year postoperatively. Grip strength reached greater than 90% of the individual's normal strength by the sixth week in men and by the third month in women (P < .001). Radial digital nerve numbness developed in 1 finger, which disappeared by the third week. No other complications were noted. All wounds were cosmetically excellent, and final satisfaction was excellent or good in 98%.
  
  
  CONCLUSIONS
  With adequate anatomic knowledge, technical training, and a basic ultrasound machine, sonographically guided A1 pulley release can be performed safely and successfully, offering an alternative to classic open surgery in the ambulatory setting.
authors.affiliation: Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007 Madrid, Spain. k2rojo@yahoo.com
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Rojo-Manaute
authors.forename: Guillermo
authors.initials: G
authors.lastname: Rodríguez-Maruri
authors.forename: Alberto
authors.initials: A
authors.lastname: Capa-Grasa
authors.forename: Francisco
authors.initials: F
authors.lastname: Chana-Rodríguez
authors.forename: Miguel Del Valle
authors.initials: Mdel V
authors.lastname: Soto
authors.forename: Javier Vaquero
authors.initials: JV
authors.lastname: Martín
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D004954:Esthetics; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D052582:Trigger Finger Disorder / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D018084:Ultrasonography, Interventional / Q000379:methods*