From the Research
Definition and Causes of Bowstringing
- Bowstringing is a rare complication of trigger finger release caused by excessive loss of the proximal pulleys 1
- It occurs when the flexor tendon moves away from the center of rotation of the metacarpophalangeal joint, increasing the flexion moment arm and giving the flexors an increased mechanical advantage over the extensors 1
- This can result in limited digital extension, pain, and altered digital function 1
Relationship with Pulley Release
- Release of the A1 pulley can lead to bowstringing if excessive release of the A2 pulley occurs 2
- Release of up to 25% of the A2 pulley can be performed safely without causing bowstringing 2
- Release of 50% or more of the A2 pulley can result in bowstringing 2
Clinical Presentation and Treatment
- Bowstringing can result in significant impairment and limited range of motion 3
- Early recognition and treatment are necessary to maximize recovery and minimize return to athletic competition 3
- Conservative treatment, including splinting and occupational therapy, can be effective in treating bowstringing, especially in acute and subacute cases 4
- Pulley reconstruction can be necessary in chronic cases or when conservative treatment fails 4