Introduction
Stenosing tenosynovitis is a commonly encountered pathology in orthopedic hand surgery. Traditional open trigger finger release may leave patients with a visibly unappealing scar. Endoscopic release may mitigate these scar concerns while producing effective outcomes. The purpose of this study is to introduce a novel endoscopic technique for the treatment of patients with stenosing tenosynovitis of the fingers. We present the short term functional and objective outcomes of patients treated with this technique. We believe that our improved endoscopic trigger finger release technique and associated outcomes will support the effectiveness and efficiency of an endoscopic approach.
Methods
48 patients (62 fingers) who failed conservative treatment for trigger finger were admitted to an outpatient surgery center for surgical treatment. For this endoscopic technique, a 0.5cm transverse incision is made at the distal palmar crease proximal to the A1 pulley of the affected finger. Release of the A1 pulley was performed with a scope mounted blade and a 2.7 mm, 0-degree arthroscope. Patients returned for follow-up where outcomes were assessed via grip and pinch strength, finger range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires, and Visual Analog Scale (VAS) pain score.
Results
Outcomes are reported for 48 patients, 28 males and 20 females. Mean age was 69.1 years. Of the 62 fingers operated on, 9 were index, 21 were middle, 28 were ring, and 4 were little fingers. No thumbs were operated on. Compared to the contralateral side, gross grasp, lateral pinch, three-jaw chuck, and precision pinch recovered 85%, 90%, 82%, and 90% respectively. At final follow up, average extension/flexion for the MP, PIP, and DIP joints were 2/85, 3/96, and 0/71 respectively. Mean VAS scores decreased from 5.7 preoperatively to 1.0 postoperatively (p<0.01). The mean DASH score at final follow-up was 11. There were no instances of a A2 pulley severance or digital nerve injury.
Conclusion
This novel technique offers an effective, minimally invasive approach for the surgical treatment of trigger finger. Endoscopic visualization provided by this technique may decrease the incidence of complications compared to percutaneous measures. Furthermore, the minimally invasive nature of this technique may reduce visible scar appearance compared to open release measures. All patients returned to normal functionality of the hand within one month and reported significant subsidence in pain.