case_images: PMC10837285_01
case_images: Placement of the 20-guage needle. The figure on the left shows a 20-guage needle inserted immediately above the proximal end of the A1 pulley. The figure on the right shows the guide knife inserted from the eye of the needle and its insertion checked using ultrasound.
case_images: gr2.jpg
case_images: PMC10837285_01_gr2.jpg
case_images: fig2
case_images: A 20-guage needle was inserted at the same site as the local anesthetic, and a blunt Y-guided knife was inserted through the 20-guage needle hole, pointing proximally (Fig. 2).
case_images: Ultrasonography within the tendon sheath. The left figure shows a short-axis ultrasound image. The guide within the tendon sheath and the neurovascular bundles on both sides of the tendon sheath are visible. The figure on the right shows the long-axis view. The guide is visible in the tendon sheath.
case_images: gr3.jpg
case_images: PMC10837285_01_gr3.jpg
case_images: fig3
case_images: The guide was inserted into the tendon sheath and lifted under ultrasound to confirm that it had moved to the center just below the tendon sheath to prevent damage to the neurovascular bundles on both sides of the tendon sheath (Fig. 3).
case_images: Incisions and pulleys. The figure on the left shows the thrust cut while checking the running of the tendon with ultrasonography after changing to a guide knife with a sharp blade. The figure on the right shows the release of the distal remnant tendon sheath of the A1 pulley and part of the proximal end of the A2 pulley after confirmation with ultrasonography.
case_images: gr4.jpg
case_images: PMC10837285_01_gr4.jpg
case_images: fig4
case_images: The sharp guided knife was inserted distally through the same needle hole to release the thickened A1 remnant pulley and part of the proximal end of the A2 pulley (Fig. 4).
case_images: Creating the eye of the needle. The figure shows the creation of a needle in the second eye at the proximal end of the A1 pulley.
case_images: gr5.jpg
case_images: PMC10837285_01_gr5.jpg
case_images: fig5
case_images: The snapping persisted; therefore, a second needle hole was created at the proximal end of the A1 pulley, and the same procedure was repeated (Fig. 5).
case_images: Healing at 1 week after surgery. The figure shows virtually no needle marks at 1 week after surgery.
case_images: gr6.jpg
case_images: PMC10837285_01_gr6.jpg
case_images: fig6
case_images: One week after the operation, there was slight scar formation in the needle holes but no associated interruption in the daily activities of the upper extremities (eg, eating, dressing, washing the face, and bathing):except for twisting, for example, when opening a screw-thread lid of a bottle (rated as a VAS score of 1) (Fig. 6).