Risk Factors for Requiring Ulnar Superficialis Slip Resection During Trigger Finger Release

Stephanie A Kwan; Matthew B Sherman; Daniel Fletcher; Jonas L Matzon

doi:10.1016/j.jhsa.2024.08.013

Risk Factors for Requiring Ulnar Superficialis Slip Resection During Trigger Finger Release

J Hand Surg Am. 2024 Oct 1:S0363-5023(24)00405-2. doi: 10.1016/j.jhsa.2024.08.013. Online ahead of print.

Authors

Stephanie A Kwan¹, Matthew B Sherman², Daniel Fletcher², Jonas L Matzon³

Affiliations

¹ Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
² Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.
³ Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA. Electronic address: jonas.matzon@rothmanortho.com.

PMID: 39352348
DOI: 10.1016/j.jhsa.2024.08.013

Abstract

Purpose: Ulnar superficialis slip resection (USSR) has been described to address persistent postoperative triggering following trigger finger release (TFR). The primary purpose of our study was to evaluate the results of simultaneous TFR and USSR under wide-awake local anesthesia no tourniquet (WALANT). The secondary purpose was to identify patient characteristics and risk factors associated with persistent triggering following A1 pulley release requiring USSR.

Method: We retrospectively identified 1,005 patients who underwent TFR at one institution by a single fellowship-trained, hand surgeon under WALANT from 2015 to 2023. Nine hundred ninety-two patients were treated with TFR alone. Twelve patients (1.2%) underwent USSR because of persistent triggering that was identified in the operating room after release of the A1 pulley. An age-, sex-, and body mass index-matched cohort of 28 patients who underwent TFR alone was created. Medical records were reviewed for demographics and complications.

Results: A total of 12 patients (14 digits) underwent TFR with USSR. The long finger was the most commonly affected finger (6, 42%). Patients in the USSR group had more average lifetime trigger fingers compared with the control group (4 vs 1). Additionally, the percentage of patients who had previously undergone TFRs for other fingers was higher in the USSR group (100%) compared with the control group (36%). After surgery, 6 patients (4 USSR and 2 control) underwent formal hand therapy for postoperative stiffness with USSR patients receiving therapy more often than controls.

Conclusions: Although uncommon, some patients (1.2%) who undergo TFR require USSR for persistent triggering following A1 pulley release. Patients who have had more lifetime trigger fingers and/or who have previously undergone TFR for other fingers are more likely to need USSR. No serious complications were incurred by patients who underwent USSR, but these patients may benefit from hand therapy compared to those undergoing isolated TFR.

Type of study/level of evidence: Therapeutic III.

Keywords: Flexor digitorum superficialis; hemislip; surgery; tenosynovitis; trigger finger; ulnar superficialis slip resection.