Trigger Finger: A Prospective Randomised Control Trial Comparing Percutaneous Release versus Open Release

Abstract

Introduction: Trigger Finger (TF) is frequently encountered problem by an orthopaedic surgeon which, if not managed, causes pain, discomfort and disability in hand function. Patient presents with pain at Metacarpo-phalangeal (MCP) or Proximal Inter-phalangeal (PIP) joint or clicking of the thumb, ring or long fingers. It is commonly caused by mismatch between the flexor sheath and the flexor tendon, which may be because of enlargement of the tendon or thickening of the fibrous flexor sheath of the first annular pulley. Aim: To compare percutaneous release with that of open surgery in terms of its effectiveness in releasing the A1 pulley and their complications and also to determine if the results are comparable with those observed in other studies. Materials and Methods: From January to December 2016, 56 patients presented to Manipal Teaching Hospital, Kaski, Nepal, with diagnosis of TF, were blindly randomised to two groups with 28 patients and 30 fingers each. One group was treated with percutaneous release while the other group was treated with open release. All the patients were followed up in OPD on two days, two weeks and eight weeks and were evaluated for postoperative pain, presence of infection, persistence or recurrence of triggering, presence of digital nerve injury and finger range of motion. Results: There was no statistical difference between the two groups with regard to the above parameters. Although, there was a trend to earlier return to full activities of daily living and full range of motion in the percutaneous group and also the complication rates were low and without any surgical scar, the difference was insignificant compared to the open release group. Conclusion: The present study recommend that both the open and percutaneous release is equally effective in treating TFs. Depending on the surgeon’s preference and experience the surgeon may opt to choose any of the surgical procedure for his patients.

Keywords

• open release technique
• percutaneous release group
• stenosing tenosynovitis