Yumoto Orthopaedic Clinic (JP HOME) is the Originator of
  Percutaneous Trigger Finger Release Surgery with Guided Knife		 Since
2011/07/31		  
Hand X-ray with Iron-Marker

- The Marker points whereabouts of MPj, hence A1 pulley -

X-rays

Preoperative X-ray photography plays an important role for prediction of site of incision.

[Metal mark]
Draw a small circle with water resistant dye over predicted distal margin of A1 pulley and put a metal mark on it.

[X-ray photography]
1) For Index, Middle, Ring and Little fingers:
Take X-ray photo with palm down. When viewing the X-ray film, turn it over.

2) For the Thumb:
Place thumb nail horizontal at X-ray photography.
This could be easily achieved by resting the palm 45° inclined on "regular
right triangular prism" made of radiolucent sponge. (Picture right)

[Stereo X-rays]
I prefer stereoscopic x-rays but normal x-rays will also do. All the X-rays in the VideoLibrary are stereos.

Iron Marker

First step is to palpate palm of hand, and find out A1 Pulley's distal end. Make a small circle with oily marker pen, then put Iron Marker of the same diameter there.

  

XP projection of fingers
Place the hand just over the X-ray film.
It is recommended to place the palm-side up (my choice),. And by slightly lifting fingers about 15 degrees, palm (whereas metacarpal bones) lie horizontally.

Right is the example of middle finger.
Alternative posture of palm-down is also available for x-ray projection.		  

Ring finger marker(left picture) and the correspoinding x-ray(right).
Round mark on the palm is the Landmark, to make exact site of incision (1 to 2 mm long).
  

XP projection for Thumb
For the x-ray of Thumb, place the palm of hand over inclining xp-transparent spongy mattress.
This marker is also useful as of the fingers, to deside the optimal skin incision.		  
Thumb marker(left picture), and the corresponding X-ray(right).  

Palpation technique

Examiner can place his finger over the flexor tendon, and ask the patient to move the finger (this is the case of middle finger) distally and proximally. By carefully feeling the slide of the flexor, 		 

A1 pulley and the nerves


For operational reference, digital nerves are presented. Yellow areas of the nerve are prone to surgery of Thumb.