This study aimed to show surgical technic of ulnar superficial slip resection by mini-invasive approach under WALANT. We used this procedure to treat trigger finger with pip contracture. The restitution of active extension and flexion could be controled under WALANT and shown to the patient during the procedure.

28 patients have been operated with this procedure. The surgeon did the WALANT himself 10min before. 2 incisions was used: One transversal on distal palmar crease. The A1 pulley was release. The superficial tendon was divided to isolated the ulnar slip. It was cut with the finger in extension. A second approach by a transversal incision was used on P1 before the pip joint. The A2 pulley was respected. The A3 pulley was incised and the ulnar superfical slip was resected. Post-op Dynamic plastic cast was used in 5 cases. A video of the procedure is presented.

We didn’t have any problem during the surgery. No bleeding and no ischemia. The medium time of surgery was 14min. At 1 month post-op, the medium PAin-VAS was 1/10 at rest and 3/10 during movement. The flexion was good and improved without any trigger recurence. The extension was restitued in 20/28. 3 patients (the most severe) still have −20° at the last follow-up.

WALANT is an effective and safe method of anesthesia in hand surgery. It's less invasive than axillar block and the controle of active motion during surgery is very usefull. It didn’t impact the time of the procedure. Showing the immediat result to the patient of the active motion could help to a better result. Resection of a ulnar slip is well known but we think that mini approach is as effective as extensive incision but post-op rehabilitation seems to be simpler and faster.

Ulnar superficial Slip Resection under WALANT is an effective and satisfactory procedure for unfavourable conditions of trigger finger including PIP joint pain, joint contracture.