Differential Pulley Release in Trigger Finger: A Prospective, Randomized Clinical Trial

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Musculoskeletal Disorders

Background:

• Trigger finger, a common condition, involves digital flexor tendon sheath stenosis.
• The role of the palmar aponeurosis (A0 pulley) in trigger finger pathology is not fully understood.
• This study investigates the A0 pulley's involvement in trigger finger release outcomes.

Purpose of the Study:

• To assess the contribution of the A0 pulley to trigger finger symptoms.
• To compare the outcomes of releasing the A0 pulley versus the A1 pulley first.
• To determine if combined A0 and A1 pulley release improves symptom resolution.

Main Methods:

• A prospective, randomized clinical trial involving patients with symptomatic trigger finger.
• Intraoperative randomization via coin toss determined the initial release sequence (A0 or A1 pulley).
• Active digit flexion/extension and clinical trigger status were assessed after each sequential release.

Main Results:

• Following initial A0 release, 47% had complete symptom resolution, while 46% had complete resolution after initial A1 release.
• Neither initial A0 nor A1 pulley release alone was statistically superior for symptom resolution.
• All patients achieved complete symptom resolution after both A0 and A1 pulleys were released.

Conclusions:

• The A0 pulley is a significant factor in 31% to 47% of trigger finger cases.
• Releasing both A0 and A1 pulleys may lead to better symptom resolution than releasing only the A1 pulley.
• Larger trials are recommended to validate these findings on A0 pulley involvement in trigger finger.