A new in-office solution for trigger finger

Lakeland hand surgeon’s invention contributes to lower healthcare costs

Improving care and saving money always has been important to physicians, but this concept has taken on new meaning since the implementation of the Patient Protection and Affordable Care Act— commonly referred to as Obamacare.

Lakeland orthopedic surgeon and Polk County Medical Association member Dr. Brian Jurbala’s contribution to improving care and saving money comes in the form of a technique he developed for percutaneous, high resolution, ultrasound-guided trigger finger release.

He spent four years researching and developing the device.  The result of that research and development is a trigger finger release system known as the Trigger Tome™, which Dr. Jurbala developed in response to patient demand for a less expensive office-based procedure, as well as physician demand for a more straight-forward, safe technique that could be reproduced.

Trigger finger is a common pathology that affects the flexor pulley system.  Numerous studies discuss the benefits of percutaneous release of the A1 pulley using a needle or push knife over open trigger finger release, including less pain and quicker recovery.  However, until now these methods have been done blindly and the instruments used were not specifically designed for the procedure.  The needle and push knife methods are without specific safety features, resulting in an incision that can be imprecise and can put the nearby tendons, nerves, and vessels at risk of being damaged during the procedure.  “Any time you try to reduce the size of the incision, you risk injury because you cannot see the structure you’re cutting,” Dr. Jurbala observes.

Because the nerves and vessels are so close to the A1 pulley, it is important to have an instrument that has safety features to prevent inadvertent damage to these important adjacent structures, as well as a way to see the instrument you are using under the skin so you can reduce the size of the incision safely.  Doing so paves the way to a successful procedure and reduces the risk of complications.  Dr. Jurbala’s Trigger Tome™ procedure accomplishes both of these goals by combining a precision, patented cutting instrument with specific safety features that is designed to be visible under ultrasound guidance.

“You have to know what you’re looking for,” says Dr. Jurbala, who is fellowship trained and board-certified in orthopedic surgery and holds certificates of added qualifications in hand surgery and sports medicine from the American Board of Orthopaedic Surgery.  “You can see the device under the skin with ultrasound, which enables you to always verify the A1 pulley’s location before you cut.”

Open trigger release can leave a painful scar in the palm and stitches that later must be removed.  Percutaneous needle release is imprecise.  It can result in an incomplete release and actually damage the surrounding nerves and vessels.  The Trigger Tome™ procedure uses a specially guided instrument that is visible under ultrasound guidance.  The device is positioned properly under the A1 pulley and verified with ultrasound before the blade is ever exposed.  Special patented safety features protect the tendon, blood vessels, and nerves of the hand from injury when the cut is made.

After spending years developing the device, the next step for Jurbala was demonstrating it and training other surgeons to use the Trigger Tome™ from some of the main institutions in the country, including Mayo Clinic and Thomas Jefferson University.  His goal is to train all orthopedic surgeons throughout the U.S. to use the Trigger Tome™ in their practices.

Retired orthopedic surgeon Dr. Frank Bertram, age 71, underwent the procedure with Dr. Jurbala in 2013 and describes the device as “brilliant.”

“We’re lucky to have someone this talented and innovative in our own back yard,” Bertram says.  Dr. Bertram, who retired 10 years ago, recalls that prior to his procedure, he didn’t realize how well a surgeon could see things with the ultrasound Dr. Jurbala uses.  Knowing that now, he adds, “I really might have tried to use that ultrasound for other things.”

“I don’t think there are too many orthopedists who are using that routinely,” he says.  “That’s what’s neat about Dr. Jurbala, he’s definitely innovative and he thinks about things in a new and different way.”

Gaining A Wider Circle of Acceptance

“We’ve completed a study of our early results, and that study demonstrated the safety and cost effectiveness of the method and device,” Dr. Jurbala says.  “Furthermore, Medicare patients can save 40 to 60 percent off the cost of the procedure when performing it in the office under ultrasound guidance, and they can avoid the need for medical clearance, general anesthesia, and discontinuing blood thinners prior to the procedure.”

The study includes Dr. Jurbala’s first 54 cases with the Trigger Tome™ device.  It recently was accepted as a podium presentation and presented at the American Association of Hand Surgery meeting in Hawaii in January.

The study’s results show the procedure is safe, effective, has a low complication rate, and results in high patient satisfaction rates.  The whole process from diagnosis to treatment can often be done in the same day.  The first step is to be evaluated.  If the patient is a candidate for the trigger finger release procedure, most times Dr. Jurbala can do it the same day in the office.

This device marries the safety and visualization of ultrasound with the convenience and minimally invasive characteristics of percutaneous needle, while eliminating the complications of percutaneous needle release such as incomplete release and damaged blood vessels, according to Dr. Jurbala.

“Because this is done in such a safe and a minimally invasive fashion, we have been able to bring it into an office environment to make it convenient and cost-effective for the patient,” he says.  “In my mind, it’s the best free market solution.  What will solve the health care crisis is when doctors can find ways to do things for patients in a more cost-effective manner.  I feel like I’ve been able to solve a problem and improve a procedure for my patients without a bureaucrat at a hospital telling me it can’t be done that way.”

Insurance companies appreciate these sorts of solutions, too.  Many insurance companies list Dr. Jurbala and other physicians throughout the country who use the Trigger Tome™ as preferred providers.

Dr. Jurbala’s device and the method used in the procedure have patents through the U.S. Patent and Trademark Office: US8608765 and US8608763.  Doctors interested in referring patients for this procedure, or in being trained to perform the procedure may do so by visiting Jurbala’s website: www.triggerfingerdoctor.com or calling 1-888-268-2782.



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