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This study examines the effectiveness of combined A1 pulley release, A2 pulley partial release, and FDS splitting in reducing recurrence of pediatric trigger fingers.

May 26, 2026Open Access

Resolution of Pediatric Trigger Finger After Combined A1 Pulley Release, A2 Pulley Partial Release, and Flexor Digitorum Superficialis Tendon Split

Key Points

This study examines the effectiveness of combined A1 pulley release, A2 pulley partial release, and FDS splitting in reducing recurrence of pediatric trigger fingers.
Retrospective review of patients aged >18 years with pediatric trigger fingers treated surgically between January 2010 and July 2025.
Descriptive statistics assessed rates of retrigger and average length of follow-up after surgery.
Follow-up median was 6 years (range, 2-13 years) after initial postoperative visit.
Of 38 treated digits, no cases of recurrence were observed at the first postoperative visit or final follow-up.
Symptoms of stiffness and pain were reported by 3 patients but resolved with mobilization.
The technique resulted in favorable outcomes, indicating a reduction in recurrence rates following surgery.

Abstract

PURPOSE: Unlike pediatric trigger thumb, which is cured by A1 pulley release, pediatric trigger fingers (PTFs) have a high rate of recurrence with A1 pulley release alone. The flexor digitorum superficialis (FDS) splitting technique has the potential to mitigate recurrence without the need for more extensive dissection. This study investigates the clinical outcomes of A1 pulley release with concomitant A2 pulley partial release and FDS splitting in the treatment of PTF. METHODS: A retrospective review was conducted at our institution, examining patients with PTF from January 2010 to July 2025. Inclusion criteria consisted of patients aged >18 years who underwent surgical treatment for PTF. Descriptive statistics were used to determine the rate of retrigger and the average length of follow-up after surgery. RESULTS: A total of 25 patients and 38 fingers met the inclusion criteria. Average age at surgery was 7 years (range, 1-16 years) with most patients being woman (60%), not Hispanic or Latino (63%), and White (90%). Of the treated digits, 8% were index fingers, 18% were ring fingers, 26% were little fingers, and 47% were middle fingers. No cases of recurrent PTF were observed at the first postoperative visit, occurring at a median of 14 days (range, 4-79 days) after surgery. Three patients did report stiffness and pain, but these symptoms resolved with continued mobilization. At final follow-up, which occurred at a median of 6 years (range, 2-13 years) after the initial postoperative visit, no patients reported pain or recurrence of PTF. CONCLUSIONS: The A1 pulley release with concomitant A2 pulley partial release and FDS splitting demonstrated favorable outcomes in the treatment of PTF. Of the 38 treated digits, no cases of recurrence or pain were observed at the final postoperative follow-up. This suggests that incorporating FDS splitting may help reduce early recurrence without requiring extensive dissection beyond the A2 pulley. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

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