A1 Pulley Release

Trigger Finger is a condition that affects the tendons in your finger or thumb, because of irritation and thickening of the tendon sheath tunnel, in which the flexor tendons of the finger and thumb slide through. Normally a snug tendon sheath covers the flexor tendons, which control movement and allow you to bend and straighten your fingers/thumb, keeping them in place. As the tendon sheath becomes irritated and thickened, nodules may form making it difficult for the flexor tendons to slide through the sheath tunnel. Specifically affected is the first annular (A1) pulley, which is located near the head of the metacarpal bones. Trigger finger results from the tendon becoming momentarily stuck, resulting in locking or catching of the affected finger/thumb while attempting to straighten. The most common symptoms of trigger finger include pain when bending/straightening finger, catching or locking sensation in affected finger/thumb, swelling, and possibly a tender lump in palm. 

Surgery to correct Trigger Finger is called an A1 pulley release.  This involves a small incision in the palm to access and release the A1 pulley. The A1 pulley is cut, allowing the flexor tendons to move through the pulley/tendon sheath without getting stuck. This will prevent the locking/popping sensation patient's with trigger finger feel. This is performed as an outpatient procedure or office procedure, meaning you will be able to go home that day. You will be discharged with an Ace wrap. Following discharge please ensure that the surgical site is kept clean and dry for 48 hours. After 48 hours you may remove the bandage and shower. While showering, you may use soap and water, but be sure to pat the incision dry. It is important that you do not submerge your surgical incision in water (i.e. no bath tubs, swimming pools, washing dishes, etc.). After patting dry, you can place a band-aid over incision line. It is important to elevate your arm on a couple of pillows to alleviate pain and swelling. You will follow up in our office 10-14 days after surgery, for suture removal.

You should immediately start to bend (open and close) and use the affected hand after surgery. Typically follow up appointments are scheduled in two-week intervals following surgery so we can monitor your recovery. Sutures are removed 10-14 days post op, and scar massage can be started when sutures are removed. This helps to flatten incision line, and reduced tenderness. Some patients may need Occupational Therapy for ROM (range of motion) and strengthening, which will be evaluated at post op visits.

You may resume your regular diet after surgery; however, you should start slow. It is a good idea to start with things like toast, Jell-O, crackers, and soup to see how your stomach tolerates food after anesthesia. Drink plenty of fluids such as water or Gatorade and limit your intake of sodas, coffee and other caffeinated beverages.  

We will send you home with a prescription for an antibiotic and a pain medication. It is important to take your antibiotic and pain medication with food to prevent nausea (unless you are instructed otherwise). Do not take your pain medication and antibiotic at the same time as this may upset your stomach; separate them by an hour or two. You cannot drive while taking pain medication.

Should you develop any of the following signs and or symptoms of possible infection, call our office immediately:

  1. Fever over 100.3
  2. Chills or night sweats
  3. Unusual swelling, redness, or warmth to your incision site
  4. Purulent drainage from incision site.

Please do not hesitate to call our office with any concerns or questions you may have.

Please remember the above instructions are only a guide. Always listen to the instructions given by your healthcare provider and follow those if in conflict with any listed above.

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