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Trigger Finger Release: Who Requires Ulnar Superficialis Slip Resection?
Stephanie A. Kwan, DO
1; Jonas Matzon, MD
2; Daniel Fletcher, MD
3; Matthew Sherman, MS
41Jefferson Health - New Jersey, Stratford, NJ; 2Rothman Orthopaedics, Sewell, NJ; 3Rothman Institute, philadelphia, PA; 4Rothman Orthopaedic Institute, Philadelphia, PA
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. The secondary purpose was to identify patient characteristics and risk factors associated with persistent triggering following A1 pulley release requiring USSR. Methods We retrospectively identified 1,005 patients who underwent TFR at one institution by a single fellowship trained, orthopaedic hand surgeon under wide awake local anesthesia no tourniquet (WALANT) from 2015 to 2023. Nine hundred and ninety-two patients were treated with TFR alone. Twelve patients (1.3%) required USSR due to persistent triggering that was identified in the operating room after release of the A1 pulley. A 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 significantly more lifetime total trigger fingers compared to the control group (4 vs 1). Additionally, patients in the USSR group had significantly more lifetime TFRs for other fingers (100%) compared to the control group (36%).
Postoperatively, 6 patients (4 USSR, 2 control) underwent formal hand therapy for postoperative stiffness with USSR patients receiving therapy significantly more than controls. Conclusions While uncommon, some patients (1.3%) who undergo TFR require USSR for persistent triggering following A1 pulley release. Surgeons may consider WALANT to assess for persistent triggering for patients with a history of multiple trigger fingers and/or of previous TFR in order to determine if USSR is warranted. Ulnar superficialis slip resection seems to be safe with a low rate of complications. However, patients that undergo USSR release may benefit from hand therapy compared to those undergoing isolated TFR.
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