Journal List > J Korean Soc Surg Hand > v.21(2) > 1106554

J Korean Soc Surg Hand. 2016 Jun;21(2):89-92. Korean.
Published online June 24, 2016.  https://doi.org/10.12790/jkssh.2016.21.2.89
Copyright © 2016. The Korean Society for Surgery of the Hand
Trigger Finger of a Distal A2 Pulley
Jin Woo Jin, Byoung Youl Kang and Dong Hee Kim
Departments of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Correspondence to: Dong Hee Kim. Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Paryong-ro, Masanhoewon-gu, Changwon 51353, Korea. TEL: +82-55-290-6030, FAX: +82-55-290-6888, Email: dhkim1149@gmail.com
Received February 24, 2015; Revised May 10, 2015; Accepted May 11, 2016.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Trigger finger commonly occurs in A1 pulley. However, there have been occasional reports of proximal or distal A2 pulley and A3 pulley at other sites. Especially, trigger finger that occurs in A2 pulley is usually due to thickening of flexor tendon. Flexor tendon plasty surgery or A2 pulley partial release are well known treatments of A2 pulley trigger finger. We conducted pulley lengthening of the A2 pulley to a 62-year-old man who has trigger finger occurring in distal portion of the A2 pulley, and we report about this with good results obtained.

Keywords: A2 pulley; Trigger finger; Pulley lengthening

Figures


Fig. 1
Intraoperative photograph. Note the thickness of flexor digitorum profundus tendon (*) at distal portion of A2 pulley in tendon retracted distally after A2 pulley is released.
Click for larger image


Fig. 2
Z-plasty of A2 pulley. A2 pulley has been extended with the use of Z-plasty technique.
Click for larger image

References
1. Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg Am 2006;31:135–146.
2. Nagaoka M, Yamaguchi T, Nagao S. Triggering at the distal A2 pulley. J Hand Surg Eur Vol 2007;32:210–213.
3. Rayan GM. Distal stenosing tenosynovitis. J Hand Surg Am 1990;15:973–975.
4. Seradge H, Kleinert HE. Reduction flexor tenoplasty: treatment of stenosing flexor tenosynovitis distal to the first pulley. J Hand Surg Am 1981;6:543–544.
5. Mitsionis G, Bastidas JA, Grewal R, Pfaeffle HJ, Fischer KJ, Tomaino MM. Feasibility of partial A2 and A4 pulley excision: effect on finger flexor tendon biomechanics. J Hand Surg Am 1999;24:310–314.
6. Peterson WW, Manske PR, Bollinger BA, Lesker PA, McCarthy JA. Effect of pulley excision on flexor tendon biomechanics. J Orthop Res 1986;4:96–101.
7. Al-Qattan MM. Trigger fingers requiring simultaneous division of the A1 pulley and the proximal part of the A2 pulley. J Hand Surg Eur Vol 2007;32:521–523.
8. Hirata H, Fujisawa K, Sasaki H, Morita A, Matsumoto M. Congenital triggering of the index finger at the A2 pulley. J Hand Surg Br 1996;21:609–611.
9. Tanaka T, Amadio PC, Zhao C, Zobitz ME, An KN. The effect of partial A2 pulley excision on gliding resistance and pulley strength in vitro. J Hand Surg Am 2004;29:877–883.