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

Abstract

In a prospective study of 50 adult patients with primary idiopathic trigger finger, four patients (8%) required simultaneous division of the proximal 3 to 4mm of the A2 pulley as well as the A1 pulley in order to completely resolve the triggering. At final follow up at 6 to 12 months, all patients were symptom-free with a full range of motion of the fingers. This entity is discussed.

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.…”

Kinematic evaluation of the finger’s interphalangeal joints coupling mechanism—variability, flexion–extension differences, triggers, locking swanneck deformities, anthropometric correlations

“…Exclusion of flexor tendon triggers: The general cause for clinically treated trigger fingers is obstructed flexor tendon gliding through the ring-shaped flexor pulleys because of local thickening of tendons or conjointly moving tissues, often at the MCP joint pulley (A1 pulley) (Benson and Ptaszek, 1997;Topper et al, 1997;Turowski et al, 1997;Gaffield and Mackay, 2001;Finsen et al, 2003;Akhtar and Burke, 2006;Ryzewicz et al, 2006;Al-Qattan, 2007;Nagaoka et al, 2007;Peters-Veluthamaningal et al, 2008;Rozental et al, 2008;Bodor et al, 2009). As tendon forces are increased to overcome the blockage, elastic energy accumulates and propels trajectory acceleration when the obstruction releases.…”

Acquired triggering of the fingers and thumb in adults

“…Intraoperative active movement will assess adequacy of release, but the proximal 3-4 mm of the A2 pulley is also released in 8% to correct any residual impingement. 86 Any synovitis is excised, and unusual causes of triggering excluded (eg, bony exostoses or ganglia). Immediate mobilisation is encouraged.…”

“…90 Minor issues include scar pain, superficial infection, stiffness (3%), and protracted wound care (2%). 86 Bowstringing from over-release of the pulley system 91 and nerve injuries 86 …”