A Standardized Acupotomy Protocol For The Treatment of Tenosynovitis of Hand Flexor Tendons In Human Patients

Summary

This protocol standardizes preoperative evaluation, stepwise acupotomy, and postoperative care for treating tenosynovitis of the hand flexor tendons in human patients, aiming to improve procedural safety, enhance recovery, and reduce complications.

Abstract

Tenosynovitis of hand flexor tendons (THFT) is a high-incidence overuse injury of the hand. Its pathological essence is a dynamic imbalance between the volume of the tendon sheath and the tendon caused by fibrous connective tissue hyperplasia in the A1 pulley region, leading to mechanical entrapment and typical clinical symptoms, including palmar pain, triggering, and limited movement. Traditional conservative treatments yield suboptimal long-term efficacy, while open surgery is associated with high trauma and complication risks, creating demand for a minimally invasive therapeutic approach. Acupotomy, an integrated therapy of traditional Chinese and Western medicine, achieves minimally invasive release of the stenotic tendon sheath with minimal trauma and rapid recovery. Standardized operation is critical for its clinical application; however, detailed and standardized protocols are currently lacking. This protocol details the key steps of acupotomy for THFT, including preoperative multidimensional evaluation (history taking, physical examination, and ultrasonic assessment) with strict inclusion and exclusion criteria, standardized preoperative preparation (environment, materials, patient positioning, disinfection, and local anesthesia), the stepwise acupotomy procedure (precise insertion, targeted longitudinal release, and safe withdrawal), and comprehensive postoperative management (immediate care, functional exercise guidance, wound care, and regular follow-up assessment). The primary purpose of this protocol is to standardize acupotomy surgery for THFT, providing a structured framework for safe implementation and facilitating consistent procedural application in clinical practice.

Introduction

Tenosynovitis of hand flexor tendons (THFT), commonly known as “trigger finger,” is a frequent hand disorder caused by repeated friction and overuse of the flexor tendons and their fibrous tendon sheaths (primarily the A1 pulley) at the level of the metacarpophalangeal (MCP) joint, leading to thickening and stenosis of the tendon sheath, impeded tendon passage, and the development of aseptic inflammation¹. Epidemiological data show that the incidence is ~2%–3% and can be as high as 10% in patients with diabetes, making it an important cause of hand dysfunction and reduced working ability². The condition....

Protocol

This study was approved by the Medical Research Ethics Committee of Hubei University of Chinese Medicine (Approval No: 2025011). All patients provided written informed consent prior to participation in the study.

NOTE: The procedure should be performed by clinicians trained in hand anatomy and acupotomy techniques with prior supervised experience.

1. Perform preoperative evaluation

1. Obtain patient history
   1. Collect general patient information, including age, gender, occupation, and medical history (e.g., diabetes and rheumatoid arthritis), using face-to-face ....

Results

Sixteen patients with THFT were treated using the protocol, and no adverse events were observed. VAS scores and Quinnell’s grades showed improvement following the procedure. These findings indicate that the protocol can be implemented safely and provides a structured approach for performing the procedure, with consistent short-term clinical outcomes observed.

Pain outcome (VAS scores):

The mean preoperative VAS score was 6.31 ± 1.01, which decreased to 0.81 ± 1.10 a.......

Discussion

This study presents a standardized protocol for acupotomy in the treatment of THFT and demonstrates that the procedure can be performed safely, with favorable short-term clinical outcomes. Improvements in pain and functional mobility were observed following the procedure, suggesting that the protocol is feasible under the conditions described. THFT has a high incidence in the population²², being particularly common among individuals who frequently use their hands for fine motor tasks. Patients oft.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
0.8 mm × 50 mm disposable sterile acupotomy	Jiangxi Laozongyi Medical Devices Company Limited	N/A	For acupotomy operation
0.9% sodium chloride injection (10 mL)	China Otsuka Pharmaceutical Company Limited	DB01-1.0701	For anesthetic dilution
2% lidocaine hydrochloride injection	Hubei Tianyao Pharmaceutical Company Limited by Shares	D32411071	For local anesthesia
Disposable sterile aperture drape (50 cm × 60 cm)	Henan Kang'erjian Medical Technology Company Limited	N/A	For sterile field isolation
Iodophor disinfectant (0.5%)	Wuhan Xuehuan Medical Disinfection Supplies Company Limited	N/A	For preoperative skin antisepsis
Medical cotton swabs (20 cm)	Henan Yubei Medical Supplies Company Limited	N/A	For skin disinfection and cleaning
Sterile adhesive dressing (10 cm × 10 cm)	Qingdao Hainuo Biological Engineering Company Limited	HN-001	For wound coverage
Sterile disposable syringe (5 mL)	Jiangsu Suyun Medical Devices Company Limited	N/A	For local anesthetic and saline injection
Sterile surgical gloves	Medicom	1144D	For aseptic operation
Surgical gauze dressing (8-layer, 7 cm × 9 cm)	Qingdao Ainuan Medical Technology Company Limited	C120	For hemostasis and wound care
Ultrasound coupling gel	Wuhan Coupling Medical Technology Company Limited	XOH-WJJ	For ultrasound imaging
Ultrasound system (color Doppler)	Mindray Medical International Limited	Model: Resona R9Q	For ultrasound evaluation