RELEASE OF THE A1 PULLEY

Method: Release of the A1 pulley for trigger finger

Duration: 15 to 30 minutes

Recovery time: 2 to 4 weeks

Release of the A1 pulley is a surgical procedure for treating trigger finger (tenosynovitis stenosans). The thickened pulley is divided so that the tendon can glide freely again and the painful catching is removed.

Trigger finger arises from inflammation and thickening of the flexor tendons and of the surrounding pulley. This leads to pain, stiffness and a characteristic snapping when the finger is bent and straightened.

What is a release of the A1 pulley?

Indications for a release of the A1 pulley

Painful catching when bending and straightening the finger
Thickening and swelling in the region of the flexor tendons
Failure of conservative treatment
Restricted movement of the finger
Chronic symptoms despite rest and physiotherapy

How the operation proceeds

Local or regional anaesthetic
Small incision over the affected pulley
Exposure and division of the A1 pulley
Checking that the tendon glides freely
Closure of the wound and a sterile dressing

Rehabilitation after a release of the A1 pulley

Rehabilitation after a release of the A1 pulley is comparatively straightforward. Most patients can move the fingers again on the day of the operation.

Phase I (0-3 days): immediate aftercare

Elevation of the hand to reduce swelling
Gentle mobilisation exercises for the fingers
Wound check and change of dressing
Avoiding overloading

Phase II (4-14 days): functional mobilisation

Increasing the mobilisation exercises
Taking up everyday activities again step by step
Removal of sutures after 10-14 days
Physiotherapy where needed

Phase III (from week 3): full loading

Full loading possible
Taking up sport and heavy work again
Checking that the tendon glides freely
Further physiotherapy where needed