Trigger Finger Treatment by Ulnar Superficialis Slip Resection (U.S.S.R.)

Abstract

Surgical release of the A1 pulley for treatment of trigger finger normally produces excellent results. However, in patients with long-standing disease, there may be a persistent fixed flexion deformity of the proximal interphalangeal joint. This is sometimes due to a degenerative thickening of the flexor tendons and may be treated by resection of the ulnar slip of flexor digitorum superficialis tendon. One hundred seventy-two patients (228 fingers) who had undergone this procedure were reviewed at a mean follow-up of 66 months. Mean pre-operative fixed flexion deformity of the proximal interphalangeal joint was 33 degrees. All but eight fingers were improved by surgery and there was an average gain of 26 degrees in passive extension (7 degrees residual fixed flexion deformity) of the proximal interphalangeal joint. Full extension was attained in 141 of the 228 fingers, and in all 101 fingers with a pre-operative loss of passive extension of 30 degrees or less. This technique is indicated for patients with loss passive extension in the proximal interphalangeal joint and a long history of triggering.

Trigger Digits: Principles, Management, and Complications

“…Le Viet et al 19 described 228 such fingers in 172 patients who were treated with a resection of the ulnar slip of the superficialis tendon. His patients had an average of 48 months of preoperative symptoms and 11 had a previous A-1 pulley release that was unsuccessful.…”

“…If direct visualization confirms this to be the site of restriction then the ulnar slip of the superficialis tendon is resected. 19 Le Viet et al 19 used a Bruner palmar-digital incision to expose the tendon sheath to the middle phalanx. The ulnar slip of the FDS tendon is released at the distal aspect of the carpal tunnel and then at the distal edge of the A-3 pulley with care taken to preserve that pulley.…”

Trigger Fingers Requiring Simultaneous Division of the A1 Pulley and the Proximal Part of the A2 Pulley

“…The pathology of this type extends under the entire length of both the A1 and A2 pulleys. Le Viet et al (2004) believe that these patients initially have classic A1 pulley triggering. As a result of being neglected for a long time, the finger attains a fixed flexion posture, resulting in degeneration and enlargement of the flexor superficialis tendon under the A2 pulley.…”

Case of Trigger Finger Related to an Intertendinous Connection between the Flexor Tendons

“…Yuasa and Kiyoshige (2002) identified that triggering at the chiasma tendinum occurred near the fully extended position of the finger whereas routine triggering at the A1 pulley occurred in the nearly fully flexed finger position. Le Viet et al (2004) also reported treatment by superficialis slip resection for trigger fingers presenting with a long history of triggering and locking of the proximal interphalangeal joint in flexion. These authors reported restoration of full extension of the proximal interphalangeal joint if the pre-operative fixed flexion deformity was 301 or less with this technique.…”