Name: A Standardized Acupotomy Protocol For The Treatment of Tenosynovitis of Hand Flexor Tendons In Human Patients (Video) | JoVE Journal
Uploaded: 2026-05-26T14:15:00.000+00:00
Duration: 7 min 5 s
Description: Learn a standardized acupotomy protocol for treating trigger finger in human patients. This minimally invasive method reduces pain and improves finger function through precise A1 pulley release.

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5 minutes

This work was supported by the Hubei Provincial Natural Science Foundation Joint Key Project (2022CFD024, 2025AFD520); Hubei University of Chinese Medicine 2023 &#8220;Double First-Class&#8221; Construction Key Special Research Project (2023ZZXT005); and Research Project of Traditional Chinese Medicine of the Administration of Traditional Chinese Medicine of Hubei Province (ZY2025Q040, ZY2025D001).

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
<ol>
	<li>Obtain patient history
	<ol>
		<li>Collect general patient information, including age, gender, occupation, and medical history (e.g., diabetes and rheumatoid arthritis), using face-to-face inquiry and a standardized medical record questionnaire (Supplementary File 1), which includes predefined fields for clinical symptoms, duration, frequency, pain intensity (VAS), Quinnell grading, and functional impact.</li>
		<li>Record clinical symptoms, including palmar pain, triggering, and limited movement. Document onset duration, symptom frequency, and severity (locking degree and pain level).</li>
		<li>Assess the effect of symptoms on daily activities, including eating, dressing, and writing.</li>
		<li>Assess pain intensity using the Visual Analog Scale (VAS).</li>
		<li>Grade clinical severity according to Quinnell’s grading criteria based on clinical observation. 
		NOTE: The VAS ranges from 0 to 10, where 0 indicates no pain and 10 indicates severe pain. 
		Quinnell’s grading system7 includes five levels (0–IV), corresponding to increasing severity of triggering and locking: 
		grade 0, normal flexion and extension of the finger without pain; 
		grade 1, normal flexion and extension with occasional pain; 
		grade 2, impaired flexion and extension accompanied by a catching sensation; 
		grade 3, presence of triggering that can be overcome with active motion; 
		​grade 4, fixed locking requiring passive manipulation for resolution.</li>
	</ol>
	</li>
	<li>Perform physical examination
	<ol>
		<li>Evaluate active range of motion by instructing the patient to flex and extend the affected finger independently. Record the maximum flexion and extension angles.</li>
		<li>Evaluate passive range of motion by gently flexing and extending the affected finger. Record the angles at which triggering or locking occurs.</li>
		<li>Identify tender points by applying gradual pressure to the palmar aspect of the MCP joint. Mark the most tender location with a marker pen.</li>
		<li>Palpate along the flexor tendon from proximal to distal to identify tendon sheath thickening or nodular changes.</li>
		<li>Record the size and hardness of any palpable induration.</li>
	</ol>
	</li>
	<li>Perform ultrasound evaluation
	<ol>
		<li>Perform transverse and longitudinal ultrasound scanning of the palmar aspect of the MCP joint using a color Doppler ultrasound system equipped with a high-frequency linear array probe (7–15 MHz). 
		NOTE: Standardized imaging parameters: (1) imaging depth: 2.0–3.0 cm; (2) overall gain: 45%–60%; (3) time-gain compensation: adjust to achieve uniform gray-scale brightness from superficial to deep layers; (4) focus position: set at the level of the flexor tendon and MCP joint space; and (5) color Doppler gain: adjust to just below the level of background noise to minimize artifacts.</li>
		<li>Apply sufficient coupling gel to the palmar skin over the MCP joint. Place the probe gently and perpendicularly on the skin without excessive compression. Move the probe slowly in transverse and longitudinal planes to obtain clear sonographic images.</li>
		<li>Assess tendon sheath thickness, tendon swelling, and the presence of peritendinous synovitis (including synovial hypertrophy and effusion) under standardized gray-scale and color Doppler settings.</li>
		<li>Instruct the patient to slowly flex and extend the affected finger during scanning.</li>
		<li>Observe dynamic tendon gliding in real time. Measure tendon sliding distance using electronic calipers on the ultrasound system, defined as the linear displacement of the proximal edge of the tendon between maximal passive extension and maximal active flexion of the affected finger.</li>
		<li>Determine the extent of stenosis by identifying thickened regions of the A1 pulley.</li>
		<li>Evaluate inclusion and exclusion criteria based on clinical symptoms, physical examination, and ultrasound findings. All criteria are assessed by a trained and experienced musculoskeletal clinician. 
		NOTE: Inclusion criteria (based on Diagnostic and Therapeutic Criteria of TCM Diseases): 
		(1) Pain and localized tenderness at the A1 annular ligament of the MCP joint, VAS ≥4; 
		(2) Triggering or limited flexion/extension, Quinnell grade ≥II; 
		(3) No concurrent treatments; 
		(4) Informed consent obtained. 
		Exclusion criteria: 
		(1) Local or systemic infection; 
		(2) Coagulation disorders; 
		(3) Failure of heart, brain, kidney, or other vital organs; 
		(4) Uncontrolled hypertension or unstable blood glucose; 
		(5) Allergy to local anesthetics; 
		(6) Pregnancy or lactation.</li>
	</ol>
	</li>
</ol>
2. Perform preoperative preparation
<ol>
	<li>Prepare the environment
	<ol>
		<li>Disinfect the operating room using ultraviolet (UV) air sterilization for 60 min prior to the procedure. Use a 253.7 nm germicidal UV lamp with an irradiation intensity of ≥70 µW/cm2 at a distance of 1.0 m from the target surface. Ensure that the room is closed and unoccupied during irradiation, and that surfaces are free of obstructions to allow uniform exposure.</li>
		<li>Clean the treatment table and surrounding area. Cover the surface with a sterile drape.</li>
	</ol>
	</li>
	<li>Prepare materials
	<ol>
		<li>Arrange all required materials on a clean and disinfected treatment table according to the procedural sequence (Figure 1). 
		NOTE: Detailed information for all materials used in this protocol is provided in the Table of Materials.</li>
	</ol>
	</li>
	<li>Position the patient
	<ol>
		<li>Instruct the patient to sit upright facing the treatment bed.</li>
		<li>Place the affected upper limb on the treatment table with the elbow flexed at 90°.</li>
		<li>Position the forearm on a soft pillow (height: 12 cm). Place the pillow to fully support the forearm from the elbow to the wrist, maintaining the arm in a relaxed, neutral position without tension on the soft tissues.</li>
		<li>Position the hand with the thumb abducted at 30°–45° and the palm facing upward.</li>
	</ol>
	</li>
	<li>Prepare the operator
	<ol>
		<li>Wear surgical attire, cap, and mask. Ensure complete coverage of the mouth, nose, and hair.</li>
		<li>Perform hand hygiene according to WHO surgical hand disinfection procedures.</li>
	</ol>
	</li>
	<li>Identify the treatment site
	<ol>
		<li>Instruct the patient to flex the affected finger to 90° at the MCP joint.</li>
		<li>Palpate the nodule on the palmar aspect of the joint.</li>
		<li>Mark the identified location using a marker pen (Figure 2A).</li>
	</ol>
	</li>
	<li>Disinfect the skin
	<ol>
		<li>Soak cotton swabs in iodophor disinfectant.</li>
		<li>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 cm proximally along the forearm from the marked point.</li>
		<li>Repeat disinfection three times, ensuring that each pass overlaps the previous area by approximately one-third.</li>
		<li>Cover the area with a sterile aperture drape, ensuring the treatment site is centered. 
		CAUTION: Maintain strict aseptic technique during skin preparation to prevent infection.</li>
	</ol>
	</li>
	<li>Administer local anesthesia
	<ol>
		<li>Draw 0.9% sodium chloride injection and 2% lidocaine hydrochloride injection into a sterile syringe at a 1:1 ratio (total volume: 5 mL).</li>
		<li>Hold the syringe with the dominant hand and stabilize the injection site with the non-dominant hand.</li>
		<li>Insert the needle at a 30° angle to the skin and advance until the needle tip reaches the subcutaneous layer superficial to the A1 pulley (approximately 2–3 mm in depth). Aspirate for 2–3 seconds to confirm the absence of blood return.</li>
		<li>Inject 0.2–0.3 mL of anesthetic solution to form a small skin wheal (0.5–1 cm in diameter).</li>
		<li>Adjust the needle to a perpendicular position and advance until the needle tip reaches the level of the A1 pulley (approximately 5–8 mm in depth).</li>
		<li>Aspirate for 2–3 s. If no blood return is observed, inject 1 mL of anesthetic solution (Figure 2B). Ensure that the total anesthetic volume does not exceed 5 mL per patient.</li>
		<li>Wait 5 min after injection.</li>
		<li>Test anesthesia using light touch with a sterile cotton swab and pinprick with a sterile needle tip.</li>
		<li>Administer an additional 0.5 mL of anesthetic if sensation persists. Reassess after 3 min. 
		CAUTION: Avoid intravascular injection and excessive anesthetic dosing. Monitor for adverse reactions. 
		PAUSE POINT: The procedure may be paused after anesthesia administration once adequate anesthesia is confirmed. 
		NOTE: Avoid injecting anesthetic into the tendon sheath lumen, as this may interfere with intraoperative assessment of tendon gliding.</li>
	</ol>
	</li>
</ol>
<img alt="Medical supplies: syringe, ampoule, cotton swabs, antiseptic jar, drapes, gauze, needle in sterile packaging." class="xfigimg" src="/files/ftp_upload/70416/70416fig1.jpg" data-altupdatedat="1782187231000" data-alt="Figure 1"> 
Figure 1: Materials used for acupotomy. (A) Sterile disposable syringe; (B) Lidocaine hydrochloride and sodium chloride injection; (C) Medical cotton swabs; (D) Iodophor disinfectant; (E) Sterile drape; (F) Surgical gloves; (G) Acupotomy instrument; (H) Surgical gauze dressing. <a href="https://www.jove.com/files/ftp_upload/70416/70416fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Hand surgery preparation showing antiseptic application and incision process." class="xfigimg" src="/files/ftp_upload/70416/70416fig2.jpg" data-altupdatedat="1782187231000" data-alt="Figure 2"> 
Figure 2: Acupotomy procedure. (A) Surface localization of the A1 pulley region by identifying and marking the tender point on the palmar aspect of the metacarpophalangeal joint. (B) Administration of local anesthesia using a sterile syringe at the marked site. (C) Acupotomy insertion and longitudinal release of the stenotic tendon sheath. <a href="https://www.jove.com/files/ftp_upload/70416/70416fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
3. Perform the acupotomy procedure
<ol>
	<li>Insert the acupotomy
	<ol>
		<li>Wear sterile surgical gloves.</li>
		<li>Remove the acupotomy from sterile packaging.</li>
		<li>Inspect the blade tip under natural light to ensure it is sharp, intact, and free of damage. Replace the instrument if defects are present.</li>
		<li>Apply pressure with the non-dominant thumb 1 cm proximal to the marked nodule, sufficient to stabilize the tendon without causing patient discomfort or tissue blanching.</li>
		<li>Tension the skin distally using the index finger to create a flat surface.</li>
		<li>Hold the acupotomy with the dominant hand.</li>
		<li>Align the blade parallel to the flexor tendon and perpendicular to the skin.</li>
		<li>Insert the acupotomy through the skin and advance through the epidermis and dermis. 
		CAUTION: Maintain alignment with the tendon axis during insertion to avoid injury to the flexor tendon, digital nerves, and blood vessels.</li>
	</ol>
	</li>
	<li>Release the tendon sheath
	<ol>
		<li>Incline the acupotomy toward the proximal end of the finger until it is parallel to the skin surface.</li>
		<li>Advance the acupotomy until resistance from the tendon sheath is felt.</li>
		<li>Continue advancing while performing controlled longitudinal cutting.</li>
		<li>Stop advancing when a loss-of-resistance sensation is detected, confirmed by improved tendon gliding and smooth, unrestricted flexion–extension of the finger (Figure 2C).</li>
		<li>Confirm release by assessing reduction of resistance under the acupotomy.</li>
		<li>Instruct the patient to actively flex and extend the finger 5–10 times.</li>
		<li>Observe whether tenderness, triggering, and locking are resolved.</li>
		<li>Confirm smooth and unrestricted finger movement.</li>
		<li>Perform 1–2 additional longitudinal cuts within an amplitude range of 1–2 mm if minor triggering persists. Maintain blade alignment parallel to the tendon axis.</li>
		<li>Stop the procedure once adequate release is achieved. 
		CAUTION: Avoid excessive cutting or deviation from the tendon axis, as this may result in tendon rupture or neurovascular injury. 
		NOTE: During release of the fibrous sheath, avoid large-amplitude transverse or rotational movements. Maintain alignment of the acupotomy with the tendon to prevent tendon injury.</li>
	</ol>
	</li>
	<li>Withdraw the acupotomy
	<ol>
		<li>Withdraw the acupotomy slowly along the insertion path.</li>
		<li>Apply pressure to the insertion site with sterile gauze for 3–5 min until visible bleeding ceases and slight local skin blanching is observed, indicating adequate hemostasis.</li>
		<li>Maintain pressure within a 1 cm radius around the insertion site during compression.</li>
		<li>Disinfect the insertion site using iodophor.</li>
		<li>Apply a sterile adhesive dressing after confirming the absence of active bleeding. 
		CAUTION: Monitor for bleeding or hematoma formation. Apply sustained pressure if bleeding persists.</li>
	</ol>
	</li>
</ol>
4. Provide postoperative management
<ol>
	<li>Provide immediate care
	<ol>
		<li>Apply moderate compression bandaging to the palm and affected finger using an elastic bandage, ensuring uniform pressure that provides mild compression without impairing tissue perfusion or causing patient discomfort.</li>
		<li>Assess fingertip blood circulation by evaluating finger color, skin temperature, and capillary refill time. Assess capillary refill by pressing the fingertip firmly for 2 s and observing recovery of color within 2 s.</li>
		<li>Assess sensory function using light touch. Confirm absence of numbness. 
		CAUTION: Ensure that bandaging does not impair circulation. Loosen the bandage if signs of ischemia are observed.</li>
	</ol>
	</li>
	<li>Guide activity
	<ol>
		<li>Instruct the patient to perform gentle finger flexion and extension exercises.</li>
		<li>Gradually increase the range of motion and frequency of exercises. Perform active finger flexion and extension exercises 3–4 times daily, with 10–15 repetitions per session, to promote circulation and prevent tendon adhesion. 
		NOTE: Avoid excessive force or vigorous movements during early rehabilitation.</li>
	</ol>
	</li>
	<li>Manage the wound
	<ol>
		<li>Keep the wound clean and dry. Avoid water exposure and contamination.</li>
		<li>Replace the sterile adhesive dressing daily or when it becomes wet, contaminated, or loosened.</li>
		<li>Monitor for signs of redness, swelling, exudation, or wound dehiscence.</li>
		<li>Seek medical attention if signs of infection occur, including redness, swelling, heat, pain, or purulent discharge.</li>
		<li>Maintain a light diet. Avoid spicy or irritating foods.</li>
		<li>Avoid smoking and limit alcohol consumption. Maintain regular sleep patterns to support recovery. 
		CAUTION: Monitor for signs of infection and delayed wound healing. Initiate medical evaluation if symptoms worsen.</li>
	</ol>
	</li>
	<li>Perform postoperative assessment
	<ol>
		<li>Schedule in-person follow-up evaluations at 1 week, 2 weeks, and 1 month postoperatively.</li>
		<li>Assess treatment outcomes using VAS and Quinnell grading at 1 month.</li>
		<li>Perform ultrasound re-examination if recurrent triggering or pain (VAS score ≥ 3) is observed. 
		PAUSE POINT: Follow-up assessments may be conducted at scheduled outpatient visits.</li>
	</ol>
	</li>
</ol>
5. Perform statistical analysis
<ol>
	<li>Collect VAS scores and Quinnell’s grades from patients before treatment and at 1 month postoperatively using in-person visits or telephone follow-up. For telephone follow-up, use a standardized structured questionnaire (Supplementary File 1) to assess pain (VAS) and finger function (Quinnell grading).</li>
	<li>Perform a paired-sample t-test to evaluate statistical significance. Define statistical significance as P &lt; 0.05.</li>
	<li>Ensure that data quantification is performed by assistants blinded to the experimental conditions by masking patient identifiers and pre- and post-treatment labels prior to analysis, with all group and time-point information concealed throughout the measurement process.</li>
	<li>Express data as mean ± standard deviation. 
	NOTE: This study is a standardized protocol study rather than a confirmatory clinical trial; therefore, no formal sample size calculation was performed. A total of 16 patients were enrolled to preliminarily verify the feasibility, safety, and operational procedures of the protocol.</li>
</ol>

The authors have nothing to disclose.

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...

Tenosynovitis of hand flexor tendons (THFT), commonly known as &#8220;trigger finger,&#8221; 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%&#8211;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 predominantly affects middle-aged and elderly women, manual laborers, patients with diabetes, and individuals with rheumatoid arthritis, most commonly involving the thumb, middle, and ring fingers3. Typical clinical symptoms include pain, tenderness, and swelling on the palmar aspect of the MCP joint, with palpable cord-like or nodular indurations4. Active flexion and extension of the affected finger are limited; in early stages, stiffness may be present, while severe cases can affect daily activities. In long-standing cases, clicking, locking, or fixation in the flexed position may occur, requiring external force for extension. Current clinical treatments include conservative methods such as immobilization, local corticosteroid injections, and medication5. Although these approaches can temporarily alleviate symptoms, long-term efficacy is suboptimal for some patients, with a tendency for recurrence6. Open surgery provides definitive treatment but is associated with surgical trauma (incision of ~1.5&#8211;2 cm), postoperative pain, risk of nerve injury, prolonged recovery time, and high cost7. Therefore, there is a need for a minimally invasive method that effectively releases the stenotic sheath, restores tendon gliding, minimizes trauma, accelerates recovery, and reduces the risk of complications. To address these limitations, this study presents a standardized acupotomy protocol for the treatment of THFT.
Acupotomy is a minimally invasive treatment method that integrates principles of traditional Chinese medicine with modern anatomy and biomechanics8. It has demonstrated advantages in orthopedics and soft tissue pain management9, particularly in the treatment of THFT. Acupotomy enables precise targeting of thickened and stenotic tendon sheath tissue, allowing rapid release of mechanical entrapment10. Patients often experience immediate or short-term relief, including improved finger movement and reduced pain, with consistent and reproducible outcomes11. The instrument is structurally simple and cost-effective, consisting of a handle, body, and blade tip with a linear edge. The procedure requires only local anesthesia, creates a minimal wound, does not require suturing, and can be performed in an outpatient setting under appropriate aseptic conditions. The wound typically heals within 1&#8211;2 days, and patients can resume moderate functional activities shortly after treatment, with minimal disruption to daily life12. When performed using standardized techniques, the risk of serious complications such as infection or neurovascular injury is low13. Systematic reviews indicate that acupotomy is more effective than acupuncture, corticosteroid injection, or oral anti-inflammatory medications in improving pain, triggering, and functional limitation14.
Modern research indicates that the therapeutic mechanism of acupotomy extends beyond simple mechanical cutting, involving a combination of needle and blade functions that enable precise minimally invasive release15. Under accurate anatomical localization, the acupotomy blade can incise the thickened and fibrotic A1 pulley ligament, which is the key step in relieving tendon entrapment16. This incision increases the tendon gliding space, immediately reducing mechanical restriction and restoring smooth tendon movement13. Traditional Chinese medicine theory suggests that acupotomy promotes the flow of Qi and blood, resolving local stagnation and restoring functional balance8. Experimental and clinical studies have shown that tendon sheath incision reduces elevated intrasheath pressure and facilitates the resolution of inflammation17,18,19. Additionally, the mechanical stimulation produced by acupotomy may promote local tissue repair, enhance circulation, and reduce inflammatory mediators, thereby supporting healing of the tendon sheath and surrounding tissues20. The overall therapeutic goal is to restore the normal biomechanical balance of the tendon&#8211;sheath system and enable smooth finger flexion and extension21.
This protocol provides comprehensive guidance on preoperative evaluation, preparation, the acupotomy procedure, and postoperative management for the treatment of THFT. It is particularly applicable to patients requiring a minimally invasive outpatient intervention and to clinicians seeking a standardized and reproducible technique. These standardized procedures are essential for ensuring safety, improving consistency, and enhancing clinical outcomes.

<table><tbody><tr><td>0.8 mm &amp;times; 50 mm disposable sterile acupotomy</td><td>Jiangxi Laozongyi Medical Devices Company Limited</td><td>N/A</td><td>For acupotomy operation</td></tr><tr><td>0.9% sodium chloride injection (10 mL)</td><td>China Otsuka Pharmaceutical Company Limited</td><td>DB01-1.0701</td><td>For anesthetic dilution</td></tr><tr><td>2% lidocaine hydrochloride injection</td><td>Hubei Tianyao Pharmaceutical Company Limited by Shares</td><td>D32411071</td><td>For local anesthesia</td></tr><tr><td>Disposable sterile aperture drape (50 cm &amp;times; 60 cm)</td><td>Henan Kang&#039;erjian Medical Technology Company Limited</td><td>N/A</td><td>For sterile field isolation</td></tr><tr><td>Iodophor disinfectant (0.5%)</td><td>Wuhan Xuehuan Medical Disinfection Supplies Company Limited</td><td>N/A</td><td>For preoperative skin antisepsis</td></tr><tr><td>Medical cotton swabs (20 cm)</td><td>Henan Yubei Medical Supplies Company Limited</td><td>N/A</td><td>For skin disinfection and cleaning</td></tr><tr><td>Sterile adhesive dressing (10 cm &amp;times; 10 cm)</td><td>Qingdao Hainuo Biological Engineering Company Limited</td><td>HN-001</td><td>For wound coverage</td></tr><tr><td>Sterile disposable syringe (5 mL)</td><td>Jiangsu Suyun Medical Devices Company Limited</td><td>N/A</td><td>For local anesthetic and saline injection</td></tr><tr><td>Sterile surgical gloves</td><td>Medicom</td><td>1144D</td><td>For aseptic operation</td></tr><tr><td>Surgical gauze dressing (8-layer, 7 cm &amp;times; 9 cm)</td><td>Qingdao Ainuan Medical Technology Company Limited</td><td>C120</td><td>For hemostasis and wound care</td></tr><tr><td>Ultrasound coupling gel</td><td>Wuhan Coupling Medical Technology Company Limited</td><td>XOH-WJJ</td><td>For ultrasound imaging</td></tr><tr><td>Ultrasound system (color Doppler)</td><td>Mindray Medical International Limited</td><td>Model: Resona R9Q</td><td>For ultrasound evaluation</td></tr></tbody></table>

a standardized acupotomy protocol for the treatment of tenosynovitis of hand flexor tendons in human patients

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

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.

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...

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.

Tenosynovitis of hand flexor tendons (THFT) is a high-incidence overuse injury of the hand. Its pathological essence is a dynamic imbalance between the ...

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.

a-standardized-acupotomy-protocol-for-treatment-tenosynovitis-hand

Research

JoVE Journal

Medicine

In vitro use of degenerative tenocytes is essential when investigating the efficacy of novel treatment on tendinopathy. However, most research studies use only the animal model or a healthy tenocyte. We propose the following protocol to isolate human degenerative tenocytes during surgery.

A Protocol to Acquire the Degenerative Tenocyte from Humans

The present protocol illustrates a method for assessing the biophysical properties of tendon repairs ex vivo. A polytetrafluoroethylene (PTFE) suture material was evaluated by this method and compared to other materials under different conditions.

Polytetrafluoroethylene (PTFE) as a Suture Material in Tendon Surgery

Calcific tendinitis of the shoulder is a relatively common condition with numerous treatment options. Here, we discuss the indications of focused shock waves generated by a single-crystal piezoelectric device, describe a treatment protocol, and present the preliminary results.

Treatment Protocol for Rotator Cuff Calcific Tendinitis Using a Single-Crystal Piezoelectric Focused Shock Wave Source

In this protocol, a knee osteoarthritis model was prepared using the modified Videman method, and the operation procedures and precautions of acupotomy are detailed. The effectiveness of acupotomy has been demonstrated by testing the mechanical properties of quadriceps femoris and tendon and the mechanical and morphological properties of cartilage.

Application of Acupotomy in a Knee Osteoarthritis Model in Rabbit

Achilles tendinopathy is a common musculoskeletal condition for which loading programs are currently the standard of care. However, the treatment protocols vary. We therefore propose a protocol for Achilles tendinopathy treatment using extracorporeal shockwave therapy.

A Treatment Protocol for Achilles Tendinopathy with Extracorporeal Shockwave Therapy

This paper introduces the operation method of ultrasound-guided acupotomy for knee osteoarthritis, which can reduce synovial thickness and improve knee joint function. It has the advantages of precise target, low treatment risk, few complications, and high safety.

Clinical Effects of Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment

The protocol presented here introduces a new surgical technique for the treatment of triangular fibrocartilage complex injuries.

Novel Triple-Loop Technique for Suturing TFCC Injuries without Transosseous Tunnel

This protocol describes ultrasound‑guided acupotomy release for trapezius myofascial pain syndrome, using shear wave elastography and digital palpation to quantify biomechanical changes. It enables real‑time fascial visualization, precise release, reduced operator dependence, and reproducible metrics, offering a safe, repeatable workflow for clinical practice and mechanistic research.

Ultrasound-Guided Acupotomy Release With Biomechanical Assessment For Trapezius Myofascial Pain Syndrome

This video demonstrates a dissection procedure for processing human pancreas into multiple storage formats. Anatomical orientation is maintained throughout the pancreatic regions to allow definition of regional islet composition and density.

Collection Protocol for Human Pancreas

Object From Motion (OFM) and Time-constrained stereo protocols are sensitive tools to identify monocular and binocular dynamic visual function deficits, which are uniquely affected in optic neuritis patients. Furthermore, these tests may be used as quantitative noninvasive tools to assess the extent of myelination along visual pathways.

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients

Learn a standardized acupotomy protocol for treating trigger finger in human patients. This minimally invasive method reduces pain and improves finger function through precise A1 pulley release.

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

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