Trigger finger treatment by ulnar superficialis slip resection (USSR)

Surgical release of the A1 pulley for treatment of trigger finger normally produces excellent results. However, in patients with long-standing disease, there may be a persistent fixed flexion deformity of the proximal interphalangeal joint. This is sometimes due to a degenerative thickening of the flexor tendons and may be treated by resection of the ulnar slip of flexor digitorum superficialis tendon. One hundred seventy-two patients (228 fingers) who had undergone this procedure were reviewed at a mean follow-up of 66 months. Mean pre-operative fixed flexion deformity of the proximal interphalangeal joint was 33degrees. All but eight fingers were improved by surgery and there was an average gain of 26degrees in passive extension (7degrees residual fixed flexion deformity) of the proximal interphalangeal joint. Full extension was attained in 141 of the 228 fingers, and in all 101 fingers with a pre-operative loss of passive extension of 30degrees or less. This technique is indicated for patients with loss of passive extension in the proximal interphalangeal joint and a long history of triggering.