Ultrasound‐Guided First Annular Pulley Injection for Trigger Finger

Objective. The purpose of this study was to develop an ultrasound‐guided first annular (A1) pulley injection technique for trigger finger with documentation of outcomes at 1 year. Methods. We performed a short‐axis injection into a triangle bordered by the A1 pulley, the flexor digitorum superficialis and profundus tendons and volar plate, and the distal metacarpal bone with a 10‐mg median dose of triamcinolone acetonide and 2% lidocaine. This was a prospective study of 50 of 52 consecutive trigger fingers from 24 patients recruited from a physical medicine and rehabilitation private practice. Results. All patients were available for follow‐up, with 94% (47 of 50) of fingers having complete resolution of symptoms at 6 months, 90% (37 of 41) at 1 year, 65% (17 of 26) at 18 months, and 71% (12 of 17) at 3 years after a single injection. Conclusions. Our ultrasound‐guided A1 pulley injection technique is a highly effective and minimally invasive treatment option for trigger finger with a 90% success rate at 1 year for complete resolution of symptoms after a single injection. Assuming similar patient populations, our results were statistically significant ( P < .01) compared with the 56% to 57% success rates recently reported for blind injections.