{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:18:47Z","timestamp":1792642727940,"version":"4.5.0"},"reference-count":22,"publisher":"International College of Surgeons","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>The first annular (A1) pulley is an important structure of the hand, providing a biomechanical support to the metacarpophalangeal joint and maintaining joint stability and flexor tendon alignment. Albeit uncommon, disruption of this pulley can result in dislocation or ulnar drift of the digit, particularly pronounced in patients with rheumatoid arthritis. Despite this, the A1 pulley is commonly divided without reconstruction in trigger finger. Several annular pulley reconstructive techniques have been developed to preserve its function. However, development of recurrent triggering has been observed due to fibrosis, largely due to inadequate release of the pulley. We have developed a technique to increase the volume within the flexor sheath while preserving the A1 pulley by way of stepwise lengthening. This has enabled an increase in the diameter of the pulley to 4 times its original size. A prospective study was performed comprising 10 trigger finger releases with stepwise lengthening of the A1 pulley. In all patients, there were no complications, and good hand function was achieved with no recurrence of triggering at 6 weeks of follow-up. This technique can thus safely achieve trigger release without sacrifice of the function of the A1 pulley.<\/jats:p>","DOI":"10.9738\/intsurg-d-13-00028.1","type":"journal-article","created":{"date-parts":[[2013,11,14]],"date-time":"2013-11-14T15:04:38Z","timestamp":1384441478000},"page":"437-444","source":"Crossref","is-referenced-by-count":8,"title":["Trigger Finger Release With Stepwise Preservation of the A1 Pulley: A Functional Pulley-Preserving Technique"],"prefix":"10.9738","volume":"98","author":[{"given":"Vachara","family":"Niumsawatt","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, The Northern Hospital, Epping, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, The Northern Hospital, Epping, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Salerno","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, The Northern Hospital, Epping, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren M.","family":"Rozen","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, The Northern Hospital, Epping, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4721","reference":[{"issue":"9","key":"i0020-8868-98-4-437-b01","series-title":"J Hand Surg Am","first-page":"1486","article-title":"Stiffness of the first annular pulley in normal and trigger fingers","volume":"36","author":"Miyamoto\n              H,","year":"2011","unstructured":"Miyamoto\n              H, \n            \n              Miura\n              T, \n            \n              Isayama\n              H, \n            \n              Masuzaki\n              R, \n            \n              Koike\n              K, \n            \n              Ohe\n              T. \n          \n          Stiffness of the first annular pulley in normal and trigger fingers. J Hand Surg Am2011;36(9);1486\u20131491"},{"key":"i0020-8868-98-4-437-b02","series-title":"J Med Soc N J","first-page":"951","article-title":"Trigger finger in diabetes","volume":"74","author":"Strom\n              L.","year":"1977","unstructured":"Strom\n              L. \n          \n          Trigger finger in diabetes. J Med Soc N J1977;74:951\u2013954"},{"key":"i0020-8868-98-4-437-b03","series-title":"J Hand Surg Eur","first-page":"556","article-title":"Histopathology of the A1 pulley in adult trigger finger","volume":"32","author":"Sbernardori\n              MC,","year":"2007","unstructured":"Sbernardori\n              MC, \n            \n              Bandiera\n              P. \n          \n          Histopathology of the A1 pulley in adult trigger finger. 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Am J Med1966;198(2):150\u2013154"},{"issue":"4","key":"i0020-8868-98-4-437-b11","series-title":"J Bone Joint Br","first-page":"485","article-title":"The anatomy of the metacarpo-phalangeal joints, with observations of the aetiology of ulnar drift","volume":"57","author":"Wise\n              KS.","year":"1975","unstructured":"Wise\n              KS. \n          \n          The anatomy of the metacarpo-phalangeal joints, with observations of the aetiology of ulnar drift. J Bone Joint Br1975;57(4):485\u2013490"},{"issue":"4","key":"i0020-8868-98-4-437-b12","series-title":"J Hand Surg","first-page":"567","article-title":"Bowstringing as a complication of trigger finger release","volume":"13","author":"Heithoff\n              SJ,","year":"1988","unstructured":"Heithoff\n              SJ, \n            \n              Millender\n              LH, \n            \n              Helman\n              J. \n          \n          Bowstringing as a complication of trigger finger release. 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J Hand Surg Eur2012;37;27\u201334"},{"key":"i0020-8868-98-4-437-b16","series-title":"J Hand Ther","first-page":"336","article-title":"Effectiveness of splinting for the treatment of trigger finger","volume":"21","author":"Colbourn\n              J,","year":"2008","unstructured":"Colbourn\n              J, \n            \n              Heath\n              N, \n            \n              Manary\n              S, \n            \n              Pacifico\n              D. \n          \n          Effectiveness of splinting for the treatment of trigger finger. J Hand Ther2008;21;336\u2013343"},{"issue":"1","key":"i0020-8868-98-4-437-b17","series-title":"J Hand Surg","first-page":"110","article-title":"Trigger fingers and thumb: when to splint, inject, or operate","volume":"17","author":"Patel\n              MR,","year":"1992","unstructured":"Patel\n              MR, \n            \n              Bassini\n              L. \n          \n          Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg1992;17(1):110\u2013113"},{"issue":"8","key":"i0020-8868-98-4-437-b18","series-title":"J Hand Surg","first-page":"16","article-title":"Comparison of cortisone injection and percutaneous release of trigger thumbs","volume":"36","author":"Kang\n              K,","year":"2011","unstructured":"Kang\n              K, \n            \n              Patel\n              MR, \n            \n              Patel\n              A. \n          \n          Comparison of cortisone injection and percutaneous release of trigger thumbs. 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