Surgical Treatment for Trigger Thumb Using a Radial Approach

Abstract

The anatomy of the thumb flexor pulley system and surrounding structures differs from the fingers. The hand's positioning during trigger thumb release is troublesome. Iatrogenic radial digital nerve injuries of the thumb following opened or percutaneous A1 pulley release have been reported. We present the radial approach using a transverse incision for surgical release of the trigger thumb. This surgical approach aimed to restore a familiar surgical hand position, prevent radial digital nerve injury and bowstringing of the flexor pollicis longus, and decrease postoperative pain to facilitate recovery of hand function.

Keywords

A1 pulley release - radial approach - trigger thumb

Publikationsverlauf

Artikel online veröffentlicht:
06. Juni 2022

• References

• 1 Wolfe SW. Tendinopathy. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, eds. Green's Operative Hand Surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2011: 2067-2088
• 2 Saldana MJ. Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 (04) 246-252
• 3 Kosiyatrakul A, Loketkrawee W, Luenam S. Different dosages of triamcinolone acetonide injection for the treatment of trigger finger and thumb: a randomized controlled trial. J Hand Surg Asian Pac Vol 2018; 23 (02) 163-169
• 4 Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg Am 2006; 31 (01) 135-146
• 5 Eastwood DM, Gupta KJ, Johnson DP. Percutaneous release of the trigger finger: an office procedure. J Hand Surg Am 1992; 17 (01) 114-117
• 6 Pope DF, Wolfe SW. Safety and efficacy of percutaneous trigger finger release. J Hand Surg Am 1995; 20 (02) 280-283
• 7 Gilberts EC, Beekman WH, Stevens HJ, Wereldsma JC. Prospective randomized trial of open versus percutaneous surgery for trigger digits. J Hand Surg Am 2001; 26 (03) 497-500
• 8 Guler F, Kose O, Ercan EC, Turan A, Canbora K. Open versus percutaneous release for the treatment of trigger thumb. Orthopedics 2013; 36 (10) e1290-e1294
• 9 Nowinski RJ, Bamberger HB. Midlateral incision for trigger thumb release. Orthopedics 2001; 24 (04) 334-336
• 10 Bayat A, Shaaban H, Giakas G, Lees VC. The pulley system of the thumb: anatomic and biomechanical study. J Hand Surg Am 2002; 27 (04) 628-635
• 11 Schubert MF, Shah VS, Craig CL, Zeller JL. Varied anatomy of the thumb pulley system: implications for successful trigger thumb release. J Hand Surg Am 2012; 37 (11) 2278-2285
• 12 Carrozzella J, Stern PJ, Von Kuster LC. Transection of radial digital nerve of the thumb during trigger release. J Hand Surg Am 1989; 14 (2 Pt 1): 198-200
• 13 Patel RM, Chilelli BJ, Ivy AD, Kalainov DM. Hand surface landmarks and measurements in the treatment of trigger thumb. J Hand Surg Am 2013; 38 (06) 1166-1171
• 14 Jolley BJ, Stern PJ, Starling T. Patterns of median nerve sensory innervation to the thumb and index finger: an anatomic study. J Hand Surg Am 1997; 22 (02) 228-231
• 15 Lange-Riess D, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of trigger finger and trigger thumb in adults. Arch Orthop Trauma Surg 2009; 129 (12) 1617-1619
• 16 Moriya K, Uchiyama T, Kawaji Y. Comparison of the surgical outcomes for trigger finger and trigger thumb: preliminary results. Hand Surg 2005; 10 (01) 83-86
• 17 Will R, Lubahn J. Complications of open trigger finger release. J Hand Surg Am 2010; 35 (04) 594-596
• 18 Bruijnzeel H, Neuhaus V, Fostvedt S, Jupiter JB, Mudgal CS, Ring DC. Adverse events of open A1 pulley release for idiopathic trigger finger. J Hand Surg Am 2012; 37 (08) 1650-1656
• 19 Björing G, Johansson L, Hägg GM. Surface pressure in the hand when holding a drilling machine under different drilling conditions. Int J Ind Ergon 2002; 29: 255-261
• 20 Fransson-Hall C, Kilbom A. Sensitivity of the hand to surface pressure. Appl Ergon 1993; 24 (03) 181-189
• 21 Laing TA, Sierakowski A, Elliot D. Management of painful scar-tethered cutaneous nerves of the upper limb. Hand Surg Rehabil 2017; 36 (03) 208-214