A 59-year-old female patient presents following an index trigger finger (A1 pulley) release 6 months ago by another surgeon. She states that she has continued to have ‘locking’ of the finger since the surgery. On examination, she has a proximal interphalangeal (PIP) flexion contracture of 20°. If revision surgery is performed, which of the following structures may need to be resected?
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- Flexor digitorum profundus (FDP) tendon The first-line operative treatment for trigger finger is incision of the A1 pulley. Persistent triggering can be treated with excision of one slip of the flexor digitorum superficialis (FDS) tendon. Excision of the FDP tendon should be avoided to maintain active distal interphalangeal flexion.
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- Ligament of Skoog The superficial transverse metacarpal ligament, also known as the ligament of Skoog, is a thin transverse band of the distal palmar aponeurosis. It is superficial to the deep transverse metacarpal ligament and is not resected in A1 pulley revision surgery.
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- Slip of the flexor digitorum superficialis tendon The first-line operative treatment for trigger finger is incision of the A1 pulley. Persistent triggering can be treated with excision of one slip of the flexor digitorum superficialis tendon.
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- Volar metacarpophalangeal capsule Resection of the volar metacarpophalangeal joint capsule is not a part of the algorithm for the operative treatment of recurrent trigger finger.
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