Method for minimally invasive tendon sheath release using device with hemi-cannula
Inventors
Assignees
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Publication Number
US-8771303-B1
Publication Date
2014-07-08
Expiration Date
Abstract
A method for minimally invasive tendon sheath release is presented herein. The method enables a surgeon to cut (“open”) a pulley that is obstructing a nodule and keeping a tendon from sliding smoothly. A guide probe of the device is inserted through a small incision and is used to find the edge of the pulley. Once found, the probe is guided to an end of the pulley. Proper placement of the device may be confirmed through the use of ultrasound. After proper position is assured, a hemi-cannula is moved over the guide probe to isolate the pulley from the surrounding tissue. A cutting blade is then used to sever the pulley. A dilation device may be inserted prior to the insertion of the spherical tipped guide probe to dilate the area.
Core Innovation
The invention describes a minimally invasive tendon sheath release method and device for severing an A-1 pulley in a finger. The method makes an incision at, or just proximal to, a proximal flexion crease of a finger containing an A-1 pulley, and a device is inserted under an edge of the pulley.
The device includes a handle having a cavity, a sheath with proximal and distal ends, and a hemi-cannula disposed on the distal end of the sheath. A guide probe having a spherical tip is attached to the bottom portion of the distal end of the sheath, a dorsal outrigger guide having a spherical tip is attached at the top portion of the distal end of the sheath, and a cutting blade is disposed between the guide probe and the dorsal outrigger guide.
The top portion of the distal end is downwardly tapered, and the bottom portion extends distally from an opening for less than half of a longitudinal distance of a tubular structure, with sliding means disposed at the proximal end of the top portion. The hemi-cannula is slid over the guide probe whereby the guide probe, blade, and pulley are contained within the hemi-cannula, the blade is deployed to sever the pulley, and the device is retracted from the incision and the incision is closed.
Claims Coverage
The provided claims cover one independent claim for a minimally invasive tendon sheath release method with five inventive features. Dependent claims add peri-procedural refinements and placement verification modalities.
Minimally invasive tendon sheath release incision and pulley edge positioning
Making an incision at, or just proximal to, a proximal flexion crease of a finger containing an A-1 pulley; inserting a device under an edge of the pulley; and positioning a spherical tipped guide probe under the edge of the A-1 pulley.
Spherical-tipped guide probe and dorsal outrigger guide with cutting blade between them
Providing a guide probe having a spherical tip attached to the bottom portion of the distal end of the sheath; providing a dorsal outrigger guide having a spherical tip attached at the top portion of the distal end of the sheath; and disposing a cutting blade between the guide probe and the dorsal outrigger guide.
Hemi-cannula geometry and sliding means to contain guide probe and blade
Providing a hemi-cannula disposed on the distal end of the sheath with a tubular structure including a proximal end adapted to receive the device via a rounded opening; providing sliding means disposed at the proximal end of the top portion; and configuring the top portion of the distal end as downwardly tapered and the bottom portion extending distally for less than half of the longitudinal distance of the tubular structure.
Contained severing by sliding hemi-cannula and deploying the blade
Sliding the hemi-cannula over the guide probe whereby the guide probe, blade and pulley are contained within the hemi-cannula; deploying the blade of the device and pushing the device along the pulley to sever the pulley; and retracting the device from the incision and closing the incision.
Peri-procedural and placement verification refinements
Injecting a local anesthetic at the A-1 pulley before making an incision; inserting a dilation device before inserting the guide; verifying device placement by wiggling the device back and forth on a plane of an operating surface to confirm it is contained in the A-1 pulley; and confirming placement using ultrasonic imaging or fluoroscopic imaging.
The claims center on positioning a spherical tipped guide probe under the edge of an A-1 pulley and using a device architecture with a dorsal outrigger guide and a cutting blade disposed between spherical tips. The hemi-cannula and sliding means cooperate to contain the guide probe, blade, and pulley during blade deployment to sever the pulley, with dependent claims adding local anesthetic injection, optional dilation, and placement confirmation by manual wiggling, ultrasonic imaging, or fluoroscopic imaging.
Stated Advantages
Documented Applications
Minimally invasive tendon sheath release in a finger for releasing an A-1 pulley.
Other tendon sheath releases including DeQuervain’s release, posterior tibial tendon release, tarsal tunnel release, carpal tunnel release, plantar fascial release, and fasciotomy for compartment syndromes.
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