Palm/Thenar Eminence grip

Key feature: Fingers do NOT go in the rings of the holder.

Position: Middle+ring+little fingers wrapping around one of the rings with no fingers within the rings. Other ring resting on radial aspect of distal thenar eminence, just encircling thumb MCP. Distal part of thumb proximal phalanx against eye-ring insert. Index finger resting on the ulnar shank, or on the ulnar part of the ulnar shank.

Tripod grip

Key feature: Thumb and Ring finger placed inside rings with index finger resting in the middle.

Position: Thumb in ring, Ring finger in other ring, Middle finger tip resting on ring-insert, Index resting on ulnar shank. Little is free. Fingers in rings not to be inserted beyond distal interphalangeal joints. Use the flexed DIPJ to present the rings from going further proximal, and to stabilise the fingers on the instrument.

Common problems

Getting stuck with rings inserted all the way over the thumb and ring fingers to their base

Relax whole hand, especially thumb and ring. Close the needle-holder. Place the fully flexed index finger between palm and needle holder. Slowly straighten the index finger which pushes out the needle-holder from the thumb and index fingers.

Getting stuck with ring inserted all the way over only the thumb – other fingers free

Here the needle-holder may or may not be obliquely trapping the thumb, making it more difficult to remove it. Again, close the needle-holder. Use the index, middle and ring fingers to grip the ratchet mechanism with the ring finger on the palm side with its dorsal aspect against the other eye, and the middle finger’s volar aspect on the ratchet mechanism, and the index finger’s dorsal aspect on the ratchet mechanism. Thumb should be straight or extended as the those three fingers push out the needle-holder from the thumb.

Types of holders

If there is a golden handle, it means the tip has tungsten carbide.

Ring handle needleholders