A Standardized Acupotomy Protocol For The Treatment of Tenosynovitis of Hand Flexor Tendons In Human Patients
May 26th, 2026
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.
Our study defines a standardized acupotomy protocol for flexor tenosynovitis to enhance safely recovery and the therapeutic efficacy. Conventional treatments are limited by poor outcomes or high invasiveness. Our protocol offers a standardized, minimally-invasive stenotic tendon sheath release.
To begin the physical evaluation, instruct the patient to flex and extend the affected finger independently to evaluate active range of motion. Record the maximum flexion and extension angles. Gently flex and extend the patient's affected finger to evaluate passive range of motion.
Record the angles at which triggering or locking occurs. Identify tender points by applying gradual pressure to the palmar aspect of the metacarpophalangeal, or MCP, joint. Mark the most tender location using a marker pen.
Palpate along the flexor tendon in the proximal to distal direction to identify tendon sheath thickening or nodular changes. Record the size and hardness of any palpable induration. Determine patient eligibility for the acupotomy procedure based on clinical symptoms, physical examination, and ultrasound findings.
First, disinfect and clean the treatment table and surrounding area. Cover the surface with a sterile drape. Arrange all required materials on the clean, disinfected treatment table in the procedural sequence.
To identify the treatment site, instruct the patient to flex the affected finger to 90 degrees at the MCP joint. Palpate the nodule on the palmar aspect of the joint. Using a marker pen, mark the identified location.
Disinfect the skin starting from the marked point and moving outward in concentric circles. Ensure that the disinfection area covers the entire hand and extends at least 15 centimeters proximally along the forearm from the marked point. Perform three rounds of disinfection, ensuring a 1/3 overlap between successive passes for complete coverage.
To administer local anesthesia, draw a one-in-one ratio of 0.9%saline and 2%lidocaine hydrochloride into a sterile syringe for a total volume of five milliliters. Insert the needle at a 30-degree angle to the skin, and advance until the needle tip reaches the subcutaneous layer superficial to the A1 pulley at a depth of approximately two to three millimeters. Aspirate for two to three seconds to confirm the absence of blood return.
Inject 0.2 to 0.3 milliliters of anesthetic solution to form a small skin wheal measuring 0.5 to one centimeter in diameter. Adjust the needle to a perpendicular position and advance until the needle tip reaches the level of the A1 pulley at a depth of approximately five to eight millimeters. Aspirate for two to three seconds.
If no blood return is observed, inject one milliliter of anesthetic solution. Test anesthesia with light touch using a sterile cotton swab. Pinprick the area with a sterile needle tip, and if sensation persists, administer an additional 0.5 milliliters of anesthetic, then reassess after three minutes.
Using the non-dominant thumb, apply pressure proximal to the marked nodule while simultaneously flexing and extending the finger to stabilize the tendon. Insert the acupotomy needle through the skin until tendon sheath resistance is felt. Continue with controlled longitudinal cutting until the resistance releases, and then slowly withdraw the needle.
If minor triggering persists, perform one to two additional longitudinal cuts, and stop the procedure once adequate release is achieved. Have the patient flex and extend the finger five to 10 times to confirm smooth tendon gliding and resolution of tenderness, triggering, and locking. Apply pressure to the insertion site with sterile gauze for three to five minutes until visible bleeding ceases and slight local skin blanching is observed, indicating adequate hemostasis.
Disinfect the insertion site using iodophor. After confirming the absence of active bleeding, apply a sterile adhesive dressing, and proceed with postoperative management. The pain outcome represented by the mean visual analog scale, or VAS, scores in 16 patients with trigger finger was approximately 6.31 preoperatively and decreased to 0.81 after treatment, showing a significant reduction in pain.
The functional outcome represented by Quinnell's grade was approximately 3.19 preoperatively and decreased to 0.75 after treatment, indicating a significant improvement in functional mobility following the acupotomy procedure. This protocol evaluates clinical outcomes of acupotomy for trigger finger by narrowing vein pain scores and the Quinnell functional grades. The king challenge is precise localization of the A1 pulley and the strict adherence to anatomy to prevent injury.
Future studies can carry out standardized, multicenter, randomized controlled trials to verify long-term efficacy and safety.
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Overview
This article presents a detailed, standardized protocol for acupotomy in the treatment of tenosynovitis of hand flexor tendons (THFT), commonly known as trigger finger. The protocol aims to provide a minimally invasive alternative to traditional treatments, emphasizing safety, efficacy, and reproducibility through precise procedural steps and comprehensive perioperative management.
Key Study Components
Area of Science
- Orthopedics
- Hand surgery
- Minimally invasive procedures
- Rehabilitation medicine
Background
- THFT is a prevalent overuse injury characterized by fibrous tissue hyperplasia at the A1 pulley, leading to pain, triggering, and limited finger movement.
- Conservative treatments often have limited long-term success, while open surgery carries higher risks and trauma.
- Acupotomy integrates traditional Chinese and Western medicine, offering a minimally invasive approach for tendon sheath release.
- Standardized, detailed protocols for acupotomy are lacking, hindering consistent clinical application.
Purpose of Study
- To establish a standardized, stepwise protocol for acupotomy in THFT.
- To enhance procedural safety and therapeutic efficacy.
- To facilitate consistent and reproducible clinical outcomes.
Methods Used
- Comprehensive preoperative evaluation: history, physical examination (active/passive range of motion, tenderness, nodule assessment), and ultrasound.
- Strict inclusion and exclusion criteria for patient selection.
- Standardized preoperative preparation: sterile environment, material setup, patient positioning, skin disinfection, and local anesthesia administration.
- Stepwise acupotomy procedure: precise site marking, controlled needle insertion, targeted longitudinal release of the A1 pulley, and safe withdrawal.
- Immediate postoperative care: hemostasis, wound dressing, functional exercise guidance, and regular follow-up.
Main Results
- Significant reduction in pain: mean VAS scores decreased from 6.31 preoperatively to 0.81 postoperatively in 16 patients.
- Marked improvement in function: Quinnell's grade improved from 3.19 to 0.75 after treatment.
- Demonstrated rapid recovery and minimal trauma with the standardized acupotomy protocol.
- Precise localization of the A1 pulley and strict anatomical adherence are critical for safety and efficacy.
Conclusions
- The standardized acupotomy protocol provides a safe, effective, and minimally invasive treatment for THFT.
- Structured procedural steps and perioperative management facilitate consistent clinical outcomes.
- Further multicenter, randomized controlled trials are needed to validate long-term efficacy and safety.
