Impact of Flexor Tendon Traction Tenolysis on Clinical Outcomes in Open A1 Pulley Release for Trigger Finger

Abstract

Purpose: This study aims to compare the postoperative clinical outcomes of open A1 pulley release with and without flexor tendon traction tenolysis. Outcomes assessed include finger range of motion, hand function (Disabilities of the Arm, Shoulder, and Hand [QuickDASH] score), complications (eg, digital nerve injury, superficial infection, and residual trigger finger), and surgery duration. Methods: A prospective study was conducted from January 2018 to June 2019, involving patients with grade II–III trigger finger requiring surgical intervention. Patients were randomized into two groups: group I (open A1 pulley release with flexor tendon traction tenolysis) and group II (open A1 pulley release without flexor tendon traction tenolysis). Postoperative assessments were conducted at 2 weeks, 2 months, and 4 months, documenting finger range of motion, QuickDASH scores, complications, and surgery duration. Results: A total of 50 patients met the selection criteria, with 46 completing the study. The majority were women, with an average age of 56 ± 9.6 years. The patients were predominantly diabetic with the condition affecting the left hand and middle finger and presenting as grade III trigger finger. Baseline characteristics, including age, gender (female/male), ethnicity, occupational status, diabetes status, and trigger finger severity, were comparable between the two groups. Preoperative QuickDASH scores were also similar. The mean preoperative finger range of motion at the metacarpophalangeal and proximal interphalangeal joint were lower in group I but were not statistically important. Patients in group I exhibited consistently better postoperative finger range of motion and QuickDASH scores compared to group II throughout the follow-up period. The difference was statistically important at the 2-week follow-up. Although group I continued to show better outcomes at 2 and 4 months, the differences were not statistically important. Surgery duration was importantly longer in group I (16.4 ± 5.7 minutes) compared to group II (11.43 ± 3.8 minutes). Two patients in group I experienced wound infections, which resolved with a week-long course of antibiotics. Conclusions: Open A1 pulley release with flexor tendon traction tenolysis resulted in better early postoperative (2 weeks) finger flexion range of motion and QuickDASH scores, albeit with a longer surgery duration. Type of study/level of evidence: Therapeutic Ib.

Keywords

• A1 pulley
• Open release
• Stenosing tenovaginitis
• Synovium sheath
• Traction tenolysis