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.