Factors affecting prognosis in open A1 pulley release surgery for trigger finger

Abstract

Objectives: This study aims to investigate the frequency of recurrence and prolonged postoperative symptoms in patients undergoing open A1 pulley release for trigger finger and to identify potential associated factors.

Patients and methods: Between October 2021 and December 2023, a total of 72 patients (30 males, 42 females; mean age: 58.0±11.6 years; range, 32 to 84 years) who underwent trigger finger surgery with at least six months of follow-up were retrospectively analyzed. Patients were followed prospectively and relevant data were collected from patient files retrospectively. Demographics, finger symptoms, associated pathologies, clinical grades, Quinnell scores, Disabilities of the Arm, Shoulder and Hand (DASH) scores, grip strength, and surgeon experience were evaluated. Prolonged symptoms lasting over eight weeks postoperatively were also assessed.

Results: Comorbidities included carpal tunnel syndrome (13.89%), De Quervain tenosynovitis (13.89%), diabetes (8.33%), Bouchard's node (2.78%), ganglion cyst (8.33%), and calcium deposition (2.86%). Fourteen patients (19.44%) had additional trigger fingers. Loupe was used in 32 surgeries, resulting in significantly fewer prolonged symptoms (12.50% vs. 35.00%, p=0.028). The mean DASH scores significantly improved after surgery (53.07±13.43 vs. 18.41±11.26, p=0.000), with a greater improvement in the loupe group (46.52±6.50 vs. 25.18±13.96, p=0.0000). The mean grip strength did not significantly differ between the surgical and control sides in the loupe group (27.29±7.58 vs. 26.36±7.85 lb, p=0.0887); however, it was weaker on the surgical side in the nonloupe group (23.87±7.81 vs. 25.28±6.96 lb, p=0.0067). Loupe usage was the sole significant factor which was absent in 77.78% of the patients with prolonged symptoms.

Conclusion: Trigger finger surgery, though typically simple and routine, may benefit from loupe-assisted procedures due to reduced postoperative symptoms and improved functional outcomes. Consideration of loupe use is warranted in such surgeries.