What is the role of surgery in the treatment of trigger finger (TF)?

Updated: Apr 26, 2021
  • Author: Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD  more...
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Answer

Trigger digits that fail to respond to two injections usually require surgical treatment, in the form of surgical release of the A1 pulley, under local anesthesia. During the procedure, the proximal edge of the A1 pulley is identified, and a scalpel blade is used to divide the entire A1 pulley in the midline under vision. Dissection of the nodule in the tendon is rarely indicated and may actually cause tendon weakening or rupture. With relief of triggering and friction following the release of the A1 pulley, the nodule usually regresses in size.

If a percutaneous approach is favored, a pair of blunt-tipped, fine scissors is introduced through the incision, and the A1 pulley is transected.

The open technique is absolutely essential for the thumb or little finger or in the presence of PIP contractures. Percutaneous release should be reserved for the index, middle, and ring fingers. [6, 7, 8, 9]

See Treatment and Medication for more detail.


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