Does Bowstringing Affect Hand Function in Patients Treated With A1 Pulley Release for Trigger Fingers?

Abstract

We aimed to inspect bowstringing after percutaneous and open release of the A1 pulley for trigger digits and its influence on hand function. Sixty-two patients with a resistant trigger digit were randomized to undergo either open release or percutaneous release of the A1 pulley. We quantified bowstringing of the digit using ultrasonography preoperatively and at 12 and 24 weeks after surgery. Pain on a visual analog scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; pinch power; and grip strength were assessed. Bowstringing was significantly increased at 12 weeks after surgery in both groups, and the mean value of the open release group was significantly greater than that of the percutaneous group (2.30 ± 0.58 mm vs 1.46 ± 0.51 mm, respectively; P = 0.035). However, the bowstringing was decreased at 24 weeks without showing significant difference between the 2 groups. The clinical outcomes of each cohort improved significantly, with no difference between the groups at final follow-up. No association was found between bowstringing and any clinical outcome measure. Bowstringing occurred by A1 pulley release with either the percutaneous or open technique does not affect clinical hand function in patients with trigger fingers.

Ultrasound‐Guided A1 Pulley Release: A Systematic Review

“…While all digits that underwent open release had complete resolution of symptoms, 3% of the digits that underwent USGAR had persistent triggering which resolved after repeat USGAR. There were no major or minor complications reported in this study 21 …”

“…Two studies did not specify which digits were treated 11,19 . Three studies excluded the treatment of the thumb 12,13,21 . Case numbers ranged from 15 to 104 procedures.…”

“…One study performed corticosteroid injection on the day of the procedure if a concomitant tenosynovitis diagnosis was made, which occurred in 14 of the 20 cases 23 . Three studies compared USGAR to open release 11,19,21 . Three studies compared USGAR to non‐image guided release 12,20,24 …”

“…This blade is advanced under ultrasound guidance through the A1 pulley to incise it and eliminates the need for fenestration 14 . Several studies developed a customized knife designed to release the A1 pulley, while aiding in skin incision and soft tissue advancement 9,11–13,19–21,24,25 . No studies have compared these various cutting tools clinically, but in a cadaveric study, USGAR using a hooked knife resulted in a statistically significant improvement in complete releases compared with the percutaneous needle release technique (88 vs 32%, P < .01) with no difference in neurovascular or A2 pulley injuries 38 .…”

Sonographically controlled percutaneous A1 pulley release using a new guide instrument – a case series of 106 procedures in 64 patients

“…In our experience, Pseudo-Dupuytren tissue of the palmar aponeurosis present at time of open trigger nger release may be worsened by surgery in the already transformed aponeurosis. Recently published biomechanical studies found possible bow stringing phenomenon of exor tendons after pulley release which may be another factor contributing to postoperative discomfort 8,9 .…”