Trigger Finger Release: A Technique for Ensuring Safe and Adequate Release

Although trigger finger release is a safe and effective procedure, complications occur due to improper technique. Incomplete release of the A1 pulley risks relapse of triggering, whereas release of the A2 pulley places patients at risk for bowstringing. Complications are often the result of poor exposure, misplaced incisions, and difficulty visualizing where the A1 pulley ends and the A2 pulley begins. The transition between A1 and A2 may be distinct in some patients and obscure in others. With the A1 pulley being the most common site of triggering, the purpose of this article was to illustrate a safe, effective, and reproducible technique for A1 pulley release. The following technique relies upon the anatomical principle that the A1 pulley is contiguous with the volar plate. The technique begins with the surgeon sharply incising the A1 pulley proximally. To assess adequate release, surgeons can place the cut portion of the pulley on lateral tension while shifting the visible flexor tendons either radially or ulnarly with the goal of visualizing the "underside" (eg, synovial side) of the A1 pulley where it is contiguous with the volar plate. Because the demarcation of the borders of the A1 pulley is clearer and more distinct on the synovial side, and because the A1 pulley is contiguous with the volar plate, visualization of the adequacy of release is easily achieved. If release of the A1 pulley is inadequate, the entire volar plate will not be easily visualized. This technique ensures safe, effective, and reproducible outcomes.