Outcome of Pulley Release via a Radial Mid-Lateral Approach for the Trigger Finger at the A2 Pulley.

Abstract

Background: Trigger finger occurs primarily at the A1 pulley. However, triggering of the flexor tendon can also occur at the A2 pulley. The full release of the A2 pulley should be avoided because it may cause bowstringing and flexion weakness. To reduce the incidence of postoperative complications, we have performed a complete release of the A1 pulley via a volar approach and a complete release of the A2 pulley at the radial edge via a radial mid-lateral approach. This study aimed to investigate the outcome of our procedure. Methods: Seventeen fingers underwent A2 pulley release at the radial edge via a mid-lateral approach after complete release of the A1 pulley via a volar approach. The mean age of patients was 68 years. Regarding the Quinnell classification, 15 fingers were grade IV, 1 finger was grade II with triggering at the A2 pulley level and 1 finger was grade I with a ganglion on the A1 pulley. Results: The mean extension loss of the PIP joint was 23° preoperatively and 2° at the final examination, and the respective mean tip-palmar distances were 19 mm and 3 mm. No symptoms or signs suggested the bowstring of the flexor tendon during the observation period (mean: 99 weeks; range: 19-180 weeks). Conclusions: Our procedure is preferable for managing the tenosynovitis at the A1 and A2 pulleys. The release of the A2 pulley at the radial edge via a radial mid-lateral approach yielded a favourable result without bowstringing. Level of Evidence: Level IV (Therapeutic).