Flexor Digitorum Superficialis Excision for Trigger Finger - A Systematic Literature Review

Background: Division of one or more slips of the flexor digitorum superficialis (FDS) tendon has been posited as an effective surgical modality for advanced or recurrent trigger finger. This may be an effective approach among patients with diabetes or rheumatoid arthritis, or in those with fixed flexion deformities who have poor outcomes from A1 pulley release alone. However, there is limited evidence regarding the effectiveness of this procedure. The role of this study was to systematically review the evidence on functional outcomes and safety of partial or complete FDS resection in the management of trigger finger. Methods: A systematic review was performed according to PRISMA guidelines. PubMed, Cochrane CENTRAL and Ovid Medline databases were electronically queried from their inception until February 2022. English language papers were included if they reported original data on postoperative outcomes and complications following resection of one or more slips of FDS for adult trigger finger. Results: Seven articles were eligible for inclusion, encompassing 420 fingers in 290 patients. All included studies were retrospective. Isolated ulnar slip FDS resection was the most described surgery. Mean postoperative fixed flexion deformity at the proximal interphalangeal joint was 6.0° compared to 31.5° preoperatively, and the proportion of patients with fixed flexion deformity reduced by 58%. Mean postoperative total active motion was 228.7°. Recurrence was seen in 4.7% of digits, and complications occurred in 11.2% of cases. No post-surgical ulnar drift or swan neck deformities were observed. Conclusions: FDS resection for long-standing trigger finger, or in diabetic or rheumatoid populations, is an effective and safe technique with low rates of recurrence. Prospective and comparative studies of this technique would be beneficial. Level of Evidence: Level III (Therapeutic).