A1 Pulley Surgery Techniques for Trigger Finger

Not currently recruiting at 5 trial locations

Overseen By Eric Wagner, MD, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Emory University

Disqualifiers: Pregnancy, Prisoners, Minors, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 1 day

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial compares two surgical methods for treating trigger finger, a condition where a finger becomes stuck in a bent position due to tendon issues. Researchers aim to determine whether removing (excision) or cutting (incision) a part of the tendon sheath (A1 pulley) more effectively reduces symptoms like pain and stiffness. The trial includes patients already scheduled for trigger finger surgery who are willing to follow up for a year post-surgery. Ideal participants have been diagnosed with trigger finger and plan to undergo surgery. As an unphased trial, this study provides patients the chance to contribute to valuable research that could enhance surgical outcomes for trigger finger.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with your doctor or the study team.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that both cutting and removing the A1 pulley safely treat trigger finger.

For the removal method, studies have found it simple and safe, yielding good results. Most patients recover well without major issues. For example, one study found that over 90% of the A1 pulley was successfully treated without damaging nearby areas.

The cutting method also reassures. Studies report no complications, and patients maintained good hand function afterward. At six-week follow-ups, the condition did not return.

Overall, both surgical methods are well-tolerated and commonly used to treat trigger finger. They have strong safety records, making them reliable options for those considering joining related clinical trials. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial comparing A1 pulley excision and incision techniques for treating trigger finger because it aims to refine and potentially improve surgical outcomes. Unlike standard treatments that typically involve simple incision, excision might offer a more comprehensive approach by entirely removing the problematic tissue, which could reduce recurrence rates or improve finger mobility. By comparing these two surgical techniques directly, researchers hope to determine the most effective method, potentially leading to faster recovery and better long-term results for patients.

What evidence suggests that this trial's treatments could be effective for trigger finger?

Research shows that open surgery to release the A1 pulley effectively treats trigger finger. Studies indicate this method succeeds almost 100% of the time, meaning it nearly always works. Patients typically resume normal activities quickly, with a success rate of 97.6% and few complications, such as nerve injuries or recurrence. In this trial, participants will undergo either excision or incision of the A1 pulley in the standard fashion. Early results for those having the A1 pulley removed often show improved finger movement soon after surgery. Both treatments are effective, but removing the A1 pulley might offer better long-term relief from pain and stiffness. ^{6 7 8 9 10}

Who Is on the Research Team?

Eric Wagner, MD, MS

Principal Investigator

Emory University

Are You a Good Fit for This Trial?

This trial is for adults over 18 with trigger finger syndrome who are undergoing surgery and can give informed consent. It excludes those unable to consent, minors, pregnant women, and prisoners.

Inclusion Criteria

I am having surgery for trigger finger.

I am willing and able to agree to participate in the study.

Exclusion Criteria

Pregnant women

I am under 18 years old.

I am unable to give consent for medical procedures.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo surgical treatment with either excision or incision of the A1 pulley for trigger finger

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at multiple time points

1 year

Visits at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Excision of the A1 pulley
• Incision of the A1 pulley in the standard fashion

Trial Overview The study compares two surgical treatments for trigger finger: excision (complete removal) versus incision (cutting) of the A1 pulley. The goal is to see which method offers better pain relief, less stiffness, and lower recurrence rates.

How Is the Trial Designed?

Group I: excision of the A1 pulley Experimental Treatment 1 Intervention

Group II: incision of the A1 pulley in the standard fashion Active Control 1 Intervention

Excision of the A1 pulley is already approved in United States, European Union for the following indications:

Approved in United States as A1 Pulley Release for:

• Trigger Finger
• Stenosing Tenosynovitis

Approved in European Union as Trigger Finger Release for:

• Trigger Finger
• Stenosing Tenosynovitis

Who Is Running the Clinical Trial?

Emory University

Lead Sponsor

Trials

1,735

Recruited

2,605,000+

Published Research Related to This Trial

Patients treated with a nonpalmar endoscopic approach for trigger finger showed significantly better scar outcomes compared to those who underwent standard open surgery, particularly noticeable at 1 week and 1 month post-operation.

Both techniques were equally effective in treating trigger finger, with the endoscopic group returning to work sooner and reporting higher overall satisfaction, although these differences were not statistically significant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nonpalmar Endoscopic versus Open Trigger Finger Release: Results from a Prospective Trial. Brown, AM., Tanabe, KL., DellaMaggiora, RJ., et al.[2022]

In a study of 36 patients with trigger finger and associated proximal interphalangeal (PIP) joint contractures, resection of the flexor digitorum superficialis (FDS) after A1 pulley release significantly improved PIP joint extension, reducing the mean contracture from 24° preoperatively to 4° postoperatively.

The procedure was effective, with 72% of fingers achieving full extension immediately after surgery, and all fingers eventually reaching full range of motion after physical therapy and a betamethasone injection, indicating a promising treatment option for this specific patient group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resection of the flexor digitorum superficialis for trigger finger with proximal interphalangeal joint positional contracture. Favre, Y., Kinnen, L.[2022]

The study demonstrated that percutaneous release of the A1 pulley using a 15° stab knife achieved a high success rate of 100% in releasing the pulley in 85 out of 100 fingers, indicating its effectiveness as a treatment for trigger fingers.

The procedure showed a relatively low complication rate, with only 17 fingers experiencing superficial tendon scrapes and no significant injuries to digital nerves, blood vessels, or the A2 pulley, suggesting it is a safe alternative when conservative treatments fail.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications. Abdoli, A., Asadian, M., Banadaky, SHS., et al.[2021]

In a study using 14 cadaveric hands, percutaneous release of the A1 pulley for trigger fingers showed a high success rate, with 72% of releases being complete and no significant neurovascular injuries reported.

While there were some instances of tendon scoring and partial lacerations, the overall safety and efficacy of using a #15 scalpel blade for this procedure suggest it could be a viable treatment option for patients with trigger finger.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Percutaneous release of the A1 pulley: a cadaver study. Habbu, R., Putnam, MD., Adams, JE.[2022]

In a study of 28 operative thumbs from 24 pediatric patients, a surgical technique involving complete release of the annular pulley and partial release of the oblique pulley resulted in no recurrence of thumb locking or triggering, indicating a successful treatment for locked trigger thumb.

Post-surgery, most patients experienced resolution of Notta's node and high satisfaction rates, with only minor reductions in thumb motion observed, suggesting that the procedure is both effective and safe for treating this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Complete annular and partial oblique pulley release for pediatric locked trigger thumb. Kuo, M., Rayan, GM.[2022]

In a case series of three patients who underwent open A1 pulley release for trigger finger, all developed severe postoperative infections that led to significant complications, including flexor tenosynovitis and the need for multiple surgeries.

Despite the rarity of major complications (less than 1% to 4%), this study emphasizes that untreated infections, especially in diabetic patients, can result in permanent functional deficits, highlighting the need for prompt diagnosis and treatment of postoperative infections.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Not Just Another Trigger Finger. Effendi, M., Yuan, F., Stern, PJ.[2023]

In a study of 43 patients who underwent 78 open trigger finger releases, the major complication rate was found to be low at 3%, with only two cases requiring further intervention.

However, the minor complication rate was notably high at 28%, with issues such as decreased range of motion and scar tenderness being common, indicating that patients should be informed about these potential outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Complications of open trigger finger release. Will, R., Lubahn, J.[2010]

In a review of 7 randomized controlled trials involving 676 patients, percutaneous A1 pulley release surgery for trigger digit showed no significant difference in treatment failure or complication rates compared to open surgery.

Patients who underwent percutaneous release experienced significantly lower treatment failure rates and higher satisfaction levels compared to those treated with corticosteroid injections.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Percutaneous release, open surgery, or corticosteroid injection, which is the best treatment method for trigger digits? Wang, J., Zhao, JG., Liang, CC.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7920009/

Outcome of percutaneous trigger finger release technique ... Releasing the A2 pulley increases work of flexion by 22% and releasing both A1 and A2 pulley increases flexion work by 62%. Though there is an ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S2589514124000562

Percutaneous Surgery for Trigger Finger Treatment Using ... The new device group and the ultrasound-guided group demonstrated 100% complete release of the A1 pulley, whereas the needle group achieved only 38% success.

3. frontiersin.org frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1509292/full

Comparative results of percutaneous and open surgery for ... Conclusions: Percutaneous release resulted in an earlier return to work and a high success rate (97.6%) with no nerve injuries or recurrences ...

4. jhsgo.org jhsgo.org/article/S2589-5141(24)00198-1/fulltext

Impact of Flexor Tendon Traction Tenolysis on Clinical ... Open A1 pulley release with flexor tendon traction tenolysis resulted in better early postoperative (2 weeks) finger flexion range of motion and ...

5. surgicoll.scholasticahq.com surgicoll.scholasticahq.com/article/68065-trigger-finger-evaluation-management-and-outcomes

Trigger Finger: Evaluation, Management, and Outcomes Open surgical trigger finger release remains the most effective treatment modality, with success rates nearing 100%.16 Patients with a long ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10901604/

Serious Complications of the Percutaneous A1 Pulley ... ... trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3829078/

Trigger Finger Release With Stepwise Preservation of the ... We present a prospective study of surgical release and reconstruction of the A1 pulley with stepwise lengthening. ... Surgical outcome (Fisher exact test).

8. irispublishers.com irispublishers.com/arar/fulltext/outcomes-after-a-pulley-resection-versus.ID.000506.php

Outcomes after A1 Pulley Resection versus Release for ... This study aims to compare outcomes of A1 pulley resection versus the standard release (or division) for patients with trigger finger.

9. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0363502305800267

Safety and efficacy of percutaneous trigger finger release Over 90% of the length of each individual finger and thumb A1 pulley were successfully released in the cadaveric digits with no injuries to the A2 pulley, ...

10. orthobullets.com orthobullets.com/hand/6027/trigger-finger

Trigger Finger - Hand Treatment: Nonoperative: splinting, activity modification, NSAIDs. Indications: first line of treatment. Outcomes: relief in 40% to 97% of cases.