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Ultrasonography (USG)-guided corticosteroid injection with needle release of the A1 pulley: serial case report

  • Anshory Sahlan ,
  • Aisyah ,
  • Bumi Herman ,

Abstract

Background: Trigger finger is associated with limited flexion and extension of the finger due to inflammation in the flexor tendon pulley and leads to a loss of functional capacity in the hands. There is a need for safe, fast management and a low risk of recurrence in managing this disease. This study aims to evaluate the clinical effectiveness of the USG-guided corticosteroid injection with needle release of the A1 pulley in treating the trigger finger, particularly in pain degree, joint function, and adverse effects. The parameters were evaluated, including the NRS, Quinnell grading system, and inflammation or infection signs from the physical examination.

Case Presentation: There were seven trigger fingers in five patients with various Quinnell grades ranging from 2 to 3. They received a single treatment of USG-guided corticosteroid injection with needle release of the A1 pulley. Follow-up was carried out immediately after the procedure (day 0), 1 day, and 30 days after. Improvement was seen in all fingers immediately and one day after the procedure. After 30 days, all patients no longer experienced pain, snapping, or locking sensations. No adverse events were observed during the follow-up period.

Conclusion: USG-guided corticosteroid injection with needle release of the A1 pulley in treating trigger fingers is safe and has a good effect on reducing pain and improving joint finger function.

References

  1. Langer D, Maeir A, Michailevich M, Luria S. Evaluating Hand Function in Clients with Trigger Finger. Occupational Therapy International. 2017;2017:9539206.
  2. Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: etiology, evaluation, and treatment. Current reviews in musculoskeletal medicine. 2008;1(2):92-96.
  3. Putra AANB, Kesuma AANR. Trigger finger management, comparison of conservative and surgical treatment approach in hospital decision making: a case report. Intisari Sains Medis. 2019;10(1):1-3.
  4. Yadav M, Sharma D, Kumar K, Yadav N. Comparison between percutaneous release and corticosteroid injection in the management of trigger digits. Indian Journal of Health and Wellbeing. 2016;7(9):903-908.
  5. Lapègue F, André A, Meyrignac O, Pasquier-Bernachot E, Dupré P, Brun C, et al. US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases. Radiology. 2016;280(2):493-499.
  6. Wilhelmi BJ, Mowlavi A, Neumeister MW, Bueno R, Lee WP. Safe treatment of trigger finger with longitudinal and transverse landmarks: an anatomic study of the border fingers for percutaneous release. Plastic and reconstructive surgery. 2003;112(4):993-999.
  7. Salim N, Abdullah S, Sapuan J, Haflah NH. Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers. The Journal of hand surgery, European volume. 2012;37(1):27-34.
  8. Rozental TD, Zurakowski D, Blazar PE. Trigger finger: prognostic indicators of recurrence following corticosteroid injection. The Journal of bone and joint surgery American volume. 2008;90(8):1665-1672.
  9. Everding NG, Bishop GB, Belyea CM, Soong MC. Risk factors for complications of open trigger finger release. Hand (New York, NY). 2015;10(2):297-300.
  10. Brozovich N, Agrawal D, Reddy G. A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook. Plastic and reconstructive surgery Global open. 2019;7(8):e2360.
  11. Akhtar S, Bradley MJ, Quinton DN, Burke FD. Management and referral for trigger finger/thumb. BMJ (Clinical research ed). 2005;331(7507):30-33.
  12. Wu Y-Y, He F-D, Chen K, Quan J-R, Guo X-Y. Comparison of the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger. J Xray Sci Technol. 2020;28(3):573-581.
  13. Orlandi D, Corazza A, Silvestri E, Serafini G, Savarino EV, Garlaschi G, et al. Ultrasound-guided procedures around the wrist and hand: how to do. European journal of radiology. 2014;83(7):1231-1238.
  14. Rajeswaran G, Lee JC, Eckersley R, Katsarma E, Healy JC. Ultrasound-guided percutaneous release of the annular pulley in trigger digit. European radiology. 2009;19(9):2232-2237.
  15. Singh VA, Congh S, Marriapan S. Trigger finger: Comparative study between corticosteroid injection and percutaneous release. The Internet Journal of Orthopedic Surgery. 2006;3(2):1-5.
  16. Wu YY, Chen K, He FD, Quan JR, Guo XY. Ultrasound-guided needle release of A1 pulley combined with corticosteroid injection is more effective than ultrasound-guided needle release alone in the treatment of trigger finger. BMC Surgery. 2022;22(1):221.
  17. Zhao JG, Kan SL, Zhao L, Wang ZL, Long L, Wang J, et al. Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence. The Journal of hand surgery. 2014;39(11):2192-202.
  18. Stahl S, Kanter Y, Karnielli E. Outcome of trigger finger treatment in diabetes. Journal of diabetes and its complications. 1997;11(5):287-290.
  19. Roberts JM, Behar BJ, Siddique LM, Brgoch MS, Taylor KF. Choice of Corticosteroid Solution and Outcome After Injection for Trigger Finger. Hand (New York, NY). 2021;16(3):321-325.
  20. Smith J, Rizzo M, Lai JK. Sonographically guided percutaneous first annular pulley release: cadaveric safety study of needle and knife techniques. Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine. 2010;29(11):1531-1542.
  21. Muthie FA, Komaratih E, Sutjipto, Fauziah D, Utomo B. Fibrin glue as a novel therapy for contracted socket in comparison to mitomycin-c and triamcinolone acetonide at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Bali Medical Journal. 2022;11(3):1485–1488.
  22. Mulyani WRW, Sanjiwani MID, Sandra, Prabawa IPY, Lestari AAW, Wihandani DM, Suastika K, Saraswati MR, Bhargah A, Manuaba IBAP. Chaperone-Based Therapeutic Target Innovation: Heat Shock Protein 70 (HSP70) for Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes. 2020;13:559-568.

How to Cite

Sahlan, A. ., Aisyah, & Herman, B. (2023). Ultrasonography (USG)-guided corticosteroid injection with needle release of the A1 pulley: serial case report. Bali Medical Journal, 12(1), 1009–1013. https://doi.org/10.15562/bmj.v12i1.4038

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