Comparative Clinical Outcomes Between Transverse, Oblique and Longitudinal Approach in A1 Pulley Release for Trigger Finger; A Randomized Controlled Trial Study

        Trigger finger, characterized by painful catching or locking of the affected digit, is commonly treated with surgical intervention when conservative measures fail. The optimal surgical approach for A1 pulley release in trigger finger remains a topic of considerable debate, particularly regarding postoperative rehabilitation and scar tissue formation. Various skin incision techniques have been proposed for this procedure, each with potential benefits and drawbacks.

       This study aims to compare the outcomes of three distinct incision techniques: transverse (Tr), oblique (Ob), and longitudinal (Lo). We enrolled 39 patients, each with one trigger finger, and randomly assigned them to one of the three groups. Our focus includes key postoperative outcomes such as the range of motion of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, Disability of the Arm, Shoulder, and Hand (DASH) scores, and Visual Analogue Scale (VAS) scores. These measures were recorded at two time points: 2 weeks and 3 months postoperatively. Additionally, we assessed operative times and scar area formation using quantitative ultrasound measurements to provide a comprehensive evaluation of each technique's effectiveness and impact on recovery.  

        At 2 weeks, significant differences were observed in the range of motion of both the MCP and PIP joints between the groups. The Tr group demonstrated a notably greater arc of motion compared to both the Ob and Lo groups. There were also significant differences in VAS scores, with the Ob group achieving notably better scores than both the Lo and Tr groups. Similarly, DASH scores varied significantly among the groups: the Ob group had superior scores compared to the Lo and Tr groups, with the Lo group exhibiting the poorest scores overall. 

         At 3 months, there were no significant differences in the range of motion for the PIP and MCP joints, nor in the VAS and DASH scores among the groups. However, there was a significant difference in operative times, with the Ob group demonstrating notably shorter times compared to the Lo and Tr groups. Additionally, no significant differences were observed in scar area formation between the groups.  

          The Tr incision results in earlier improvement in the range of motion for both the MCP and PIP joints during the early rehabilitation phase. The Ob incision, on the other hand, significantly reduces pain and enhances hand function more quickly. However, no significant differences were observed between the techniques in the long-term follow-up period.  

Keywords: A1 pulley release, trigger finger, incision type, range of motion, DASH, VAS, scar area