Purpose
To identify the anatomic relationship between the distal extent of the A1 pulley and
the distalmost insertion point of the palmar plate into the base of the proximal phalanx
at a metaphyseal bony ridge, the “P1 peak” (P1P), which is a bony acoustic landmark
easily identifiable on sonography of the finger.
Methods
We studied 48 fingers (no thumbs) from 12 fresh frozen cadavers with high-resolution
ultrasound. A 20-gauge hypodermic needle was directed perpendicular to the long axis
of the tendon sheath along a plumb line drawn at the level of the bony flare of the
proximal metaphyseal-diaphyseal junction of the proximal phalanx, or the P1P, under
high-resolution ultrasound guidance. Dissection was then performed, and the distance
of the needle barrel and the actual distance of the P1P from the distal edge of the
A1 pulley were recorded.
Results
The study demonstrated that accurate placement of the needle within 1 mm of the actual
P1P was possible using ultrasound guidance and that the P1P was within 1 mm of the
distal edge of the actual A1 pulley in all specimens studied.
Conclusions
In all the specimens studied, we found that the P1P may be used as a clearly identifiable
sonographic reference landmark to identify the distal extent of the A1 pulley.
Clinical relevance
Using the P1P landmark as a guide to judge the completeness of ultrasound-guided percutaneous
trigger finger release may reduce the risks of incomplete distal release and inadvertent
release of the A2 pulley.
Key words
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References
- Trigger digits: principles, management, and complications.J Hand Surg Am. 2006; 31: 135-146
- Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence.J Hand Surg Am. 2014; 39: 2192-2202
- Percutaneous release of the trigger finger: an office procedure.J Hand Surg Am. 1992; 17: 114-117
- Percutaneous release of trigger digits.Am J Orthop (Belle Mead NJ). 2017; 46: E263-E267
- Sonographically assisted percutaneous release of the A1 pulley: a new surgical technique for treating trigger digit.J Hand Surg Br. 2006; 31: 191-199
- Kinematical and functional improvements of trigger digits after sonographically assisted percutaneous release of the A1 pulley.J Orthop Res. 2009; 27: 891-896
- Sonographically guided intrasheath percutaneous release of the first annular pulley for trigger digits, part 1: clinical efficacy and safety.J Ultrasound Med. 2012; 31: 417-424
- The thickness of the A2 pulley and the flexor tendon are related to the severity of trigger finger: results of a prospective study using high-resolution ultrasonography.J Hand Surg Eur Vol. 2016; 41: 204-211
- Ultrasound-assisted percutaneous trigger finger release: is it safe?.Hand (NY). 2009; 4: 35-37
- Trigger finger release with hand surface landmark ratios: an anatomic and clinical study.Plast Reconstr Surg. 2001; 108: 908-915
- Assessment of the distal extent of the A1 pulley release: a new technique.Eplasty. 2008; 8: e44
- Anatomy of the finger flexor tendon sheath and pulley system.J Hand Surg Am. 1988; 13: 473-484
Article info
Publication history
Published online: June 17, 2021
Accepted:
April 29,
2021
Received:
February 1,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
