Treating Trigger Finger in Diabetics Using Excision of the Ulnar Slip of the Flexor Digitorum Superficialis with or without A1 Pulley Release

Abstract

The purpose of this study was to evaluate the results of excision of the ulnar slip of the flexor digitorum superficialis tendon, with or without A1 pulley release, for the treatment of trigger finger in diabetic patients. We performed a retrospective review with long-term follow-up examinations. Short-term data was obtained on 18 consecutive patients (37 fingers). Long-term information was collected on 14 of these patients (24 fingers) at an average of 48 months after surgery. Short-term follow-up revealed average proximal interphalangeal joint (PIP) flexion of 81 degrees . One patient had slight residual triggering. At long-term follow-up, 93% of patients were completely or very satisfied with the procedure. Total active finger motion averaged 218 degrees , and PIP extension deficit averaged less than 5 degrees . Pinch strength was equal to the contralateral corresponding finger. There were no significant complications. One finger had minimal residual triggering. In conclusion, this procedure is a safe and effective treatment for the often-difficult problem of stenosing flexor tenosynovitis in the diabetic patient.

Primary ulnar superficial slip resection in complicated trigger finger

“…Satisfaction rate was high and disability returned to normal after surgery. The patients with diabetes, a known metabolic disturbance quite often leading to therapy resisting tendinosis, all recovered as well after surgery as the idiopathic forms [9,10].…”

The Value of High-Frequency Ultrasonographic Imaging for Quantifying Trigger Digits: A Correlative Study with Clinical Findings in Patients with Different Severity Grading

“…Therefore, for these severe contracture digits, treatment is difficult and the cost is higher. Some studies (Al-Qattan 2007;Le Viet et al 2004;Marcus et al 2007) have emphasized the possibility of using more extensive surgical techniques, such as resection of the ulnar slip of the flexor digitorum superficialis tendon and simultaneous division of the proximal A2 pulley as well as the A1 pulley. The diagnosis of trigger digit is based on a characteristic setting of symptoms of tenderness at the site of the first annular pulley with increased friction, overt locking or triggering.…”

Deteriorating tactile sensation in patients with hand syndromes associated with diabetes: A two-year observational study

“…Skin thickening and neuropathy are thought to contribute to the associated stiffness and clumsiness (Kapoor & Sibbitt, 1989). Excision of the ulnar slip of the flexor digitorum superficialis has been recommended as an additional procedure to A1 pulley release to improve tendon excursion (Marcus, Culver, & Hunt, 2007) and limited joint mobility has complicated recovery following fasciectomy for Dupuytren's contracture (Fournier, Papanas, Compson, & Maltezos, 2008). Many uncertainties remain regarding which factors may be responsible for differences in outcomes for these hand syndromes, strategies for prevention or more successful intervention.…”