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In patients that have failed two to three injections, the next step is trigger finger surgery. Surgery involves a small incision over the first sheet known as the A1 pulley, which is located right here at the base of the finger. This is completely opened up, allowing the tendon to glide smoothly again. In some rare cases, releasing the sheet is not enough. If that happens, I then have to cut out half of one of the tendons that bends the fingers to make room within the other tunnels. This is of the FDS tendon or the flexor digitorum superficialis.