Resection of the Flexor Digitorum Superficialis for Trigger Finger With Proximal Interphalangeal Joint Positional Contracture

Purpose Open release of the A1 pulley is a widely known procedure for the treatment of trigger finger. A subset of patients presents with both trigger finger and a positional contracture of the proximal interphalangeal (PIP) joint. These patients usually have a long history of trigger finger or have already undergone a surgical release of the annular pulley. This study is a retrospective review of the outcomes of resection of the flexor digitorum superficialis (FDS) for patients whose trigger finger was associated with a positional contracture of the PIP joint. Methods Thirty-six patients (39 fingers) were treated by resection of the FDS after section of the A1 pulley. The mean age of the patients was 63 years (range, 45-90 y). Seven patients (19 %) had previously undergone an open release of the A1 pulley and had developed a positional contracture of the PIP joint 2 to 5 months afterward. We performed a retrospective review with a mean follow-up of 30 months (range, 12-60 mo). No patient was lost to follow-up. The active range of motion was recorded at the PIP joint before and after surgery. Results The mean preoperative positional contracture of the PIP joint was 24 degrees (range, 15 degrees-30 degrees). The mean postoperative positional contracture of the PIP joint was 4 degrees (range, 0 degrees-10 degrees). The most commonly affected digit was the middle finger (26 fingers, 67%). In 28 fingers (72%), full extension was achieved following only the surgical procedure. The remaining 11 fingers (28%) had a postoperative residual positional contracture (range, 5 degrees-10 degrees). However, all fingers achieved a full range of motion after physical therapy and an injection of betamethasone. All of the resected tendons had histological damage. Conclusions This technique is a useful treatment for selected patients whose trigger finger is associated with a positional contracture. (J Hand Surg 2012;37A:2269-2272. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.)