 The flexor sheath was opened under direct vision with a scalpel, and then a scissor was used to release the A1 pulley under direct vision on the radial side, from its proximal extent to its distal extent at the junction of the proximal and middle thirds of the proximal phalanx. 
The flexor sheath was opened under direct vision with a scalpel , and then a scissor was used to release the A1 pulley under direct vision on the radial side , from its proximal extent to its distal extent at the junction of the proximal and middle thirds of the proximal phalanx .