Percutaneous A 1 pulley release vs steroid injection for trigger digit: the results of a prospective,randomized trial

Abstract

This study compared the results of percutaneous A1 pulley release and steroid injection in 105 trigger digits in 95 patients. The patients were randomly assigned to either surgery (43 patients, 46 digits) or steroid injection (52 patients, 59 digits). The results were assessed at 1 and 6 months and the measurements included rate of recurrence (primary outcome measure), pain on movement, active range of movement of the affected digit and grip strength. No recurrences were seen at 1 month. At the 1 month assessment, patients after steroid injection achieved greater active range of movement of the fingers (270° vs 264°) and stronger grip (99% vs 85%) than those treated by percutaneous release. At the 6 month assessment six recurrences (11%) occurred in the steroid injection group and none in the percutaneous release group (P = 0.005). Patients after percutaneous release had less pain on movement of the involved digit (VAS 0.4 vs 1.3), but still had lower AROM of the fingers (265° vs 270° after steroid injection). We conclude that percutaneous A1 pulley release is more effective medium-term therapy for trigger digit than steroid injection, because of lower risk of recurrence.

Keywords

trigger digit percutaneous release corticosteroid injection

Get full access to this article

View all access options for this article.

References

Blumberg

Arbel

Dekel

. Percutaneous release of trigger digit. J Hand Surg Br. 2001, 26: 256–7.

Chao

Yan

. The effect of miniscalpel-needle versus steroid injection for trigger thumb release. J Hand Surg Eur. 2009, 34: 522–5.

Cihantimur

Akin

Ozcan

. Percutaneous treatment of trigger finger: 34 fingers followed 0.5–2 years. Acta Orthop Scand. 1998, 69: 167–8.

Eastwood

Gupta

Johnson

. Percutaneous release of the trigger finger: an office procedure. J Hand Surg Am. 1992, 17: 114–17.

Froimson

. Tenosynovitis and tennis elbow. In: Green

(Ed.) Operative hand surgery. 4th Edn. 2. Philadelphia, Churchill Livingstone, 1999.

Huang

Tien

. Revison of incompletely released trigger fingers by percutaneous release: results and complications. J Hand Surg Am. 2006, 31: 1288–91.

Gilberts

Beekman

Stevens

Wereldsma

. Prospective randomized trial of open versus percutaneous surgery for trigger digits. J Hand Surg Am. 2001, 26: 497–500.

Park

. Percutaneous release of trigger digits. A technique and results using a specially designed knife. J Bone Joint Surg Br. 2001, 83: 75–7.

Jou

Chern

. Sonographically assisted percutaneous release of the A₁ pulley: a new surgical technique for treating trigger digit. J Hand Surg Br. 2006, 31: 191–9.

10.

Kazuki

Egi

Okada

Takaoka

. Clinical outcome of extrasynovial steroid injection for trigger finger. Hand Surg. 2006, 11: 1–4.

11.

Lorithior

Jr . Surgical treatment of trigger finger by a subcutaneous method. J Bone Joint Surg Am. 1958, 40: 793–5.

12.

Maneerit

Sriworakun

Budhraja

Nagavajara

. Trigger thumb: results of a prospective, randomised study of percutaneous release with steroid injection versus steroid injection alone. J Hand Surg Br. 2003, 28: 586–9.

13.

Nimigan

Ross

Gan

. Steroid injections in the management of trigger fingers. Am J Phys Med Rehabil. 2006, 85: 36–43.

14.

Park

. A₁ pulley release of locked trigger digit by percutaneous technique. J Hand Surg Br. 2004, 29: 502–5.

15.

Ragoowansi

Acornley

Khoo

. Percutaneous trigger finger release: the ‘lift-cut’ technique. Br J Plast Surg. 2005, 58: 817–21.

16.

Ryzewicz

Moriatis-Wolf

. Trigger digits: principles, management and complications. J Hand Surg Am. 2006, 31: 135–47.

17.

Sbernardori

Bandiera

. Histopahology of the A₁ pulley in adult trigger fingers. J Hand Surg Eur. 2007, 32: 556–9.

18.

Turowski

Zdankiewicz

Thomson

. The results of surgical treatment of trigger finger. J Hand Surg Am. 1997, 22: 145–9.