Purpose
Trigger finger is a common condition with a lifetime prevalence of 2%. Corticosteroid
injection is a treatment often considered as a first-line intervention with reported
cure rates between 60% and 90% in observational cohorts. Nevertheless, open surgery
remains the most effective treatment with reported cure rates near 100%. Head-to-head
trials on these treatments are limited. We investigated the efficacy of open surgery
compared with ultrasound-guided corticosteroid injections.
Methods
The study was performed as a single-center, randomized, controlled trial with a 1-year
follow-up. A total of 165 patients received either open surgery (n = 81) or ultrasound-guided
corticosteroid injection (n = 84). Follow-up was conducted at 3 and 12 months. If
the finger had normal movement or normal movement with discomfort at latest follow-up,
the outcome was considered a success. Secondary outcomes were postprocedural pain
and complications.
Results
The groups were similar at baseline except for lower alcohol consumption in the open
surgery group. At 3 months, 86% and 99% were successfully treated after corticosteroid
injection and open surgery, respectively. At 12 months, 49% and 99% were considered
successfully treated after corticosteroid injection and open surgery, respectively.
The pain score at latest follow-up was significantly higher in the corticosteroid
injection group. Complications after open surgery were more severe and included 3
superficial infections and 1 iatrogenic nerve lesion. After corticosteroid injection
11 patients experienced a steroid flare and 2 had fat necrosis at the site of injection.
Conclusions
Open surgery is superior to ultrasound-guided corticosteroid injections. Complications
after open surgery are more severe; this must be taken into account when advising
patients with regard to treatment.
Type of study/level of evidence
Therapeutic I.
Key words
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References
- Corticosteroid injection for trigger finger in adults.Cochrane Database Syst Rev. 2009; 1: CD005617
- Flexor tendon entrapment of the digits (trigger finger and trigger thumb).J Occup Environ Med. 2000; 42: 526-545
- Scanning electron microscopic findings of the gliding surface of the A1 pulley in trigger fingers and thumbs.J Hand Surg Eur Vol. 2007; 32: 384-387
- Correlations between clinical presentations of adult trigger digits and histologic aspects of the A1 pulley.J Hand Surg Am. 2009; 34: 1429-1435
- Conservative management of trigger finger.Practitioner. 1980; 224: 187-190
- Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release and open surgery.Rheumatology. 2012; 51: 93-99
- Long-term results of surgical release of trigger finger and trigger thumb in adults.Arch Orthop Trauma Surg. 2009; 129: 1617-1619
- The use of compound F (hydrocortone) in operative and non-operative conditions of the hand.J Bone Joint Surg Am. 1953; 35: 994-1002
- Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review.J Am Acad Orthop Surg. 2007; 15: 166-171
- Corticosteroid injection for trigger finger: blinded or ultrasound-guided injection?.Arch Orthop Trauma Surg. 2015; 135: 125-131
- Impact of corticosteroid injection site on the treatment success rate of trigger finger: a prospective study comparing ultrasound-guided true intra-sheath and true extra-sheath injections.Ultrasound Med Biol. 2016; 42: 2203-2208
- Ultrasound-guided first annular pulley injection for trigger finger.J Ultrasound Med. 2009; 28: 737-743
- Corticosteroid injections for trigger digits: is intrasheath injection necessary?.J Hand Surg Am. 1998; 23: 717-722
- Sonographically guided tendon sheath injections are more accurate than blind injections: implications for trigger finger treatment.J Ultrasound Med. 2011; 30: 197-203
- Corticosteroid injection for idiopathic trigger finger.J Hand Surg Am. 2010; 35: 831-833
- Surgery versus ultrasound-guided steroid injections for trigger finger disease: protocol of a randomized controlled trial.Dan Med J. 2013; 60: A4633
- Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial.J Hand Surg Eur Vol. 2011; 36: 53-56
- A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger.J Hand Surg Am. 2008; 33: 516-522
- Trigger digit release: rates of surgery and complications as indicated by a United States Medicare database.J Hand Surg Eur Vol. 2016; 41: 970-976
- Injection versus surgery in the treatment of trigger finger.J Hand Surg Am. 1997; 22: 138-144
- Outcome of open trigger digit release.J Hand Surg Eur Vol. 2007; 32: 457-459
- Complications of open trigger finger release.J Hand Surg Am. 2010; 35: 594-596
- Steroid injections in the management of trigger fingers.Am J Phys Med Rehabil. 2006; 85: 36-43
- Corticosteroid injection in diabetic patients with trigger finger: a prospective, randomized, controlled double-blinded study.J Bone Joint Surg Am. 2007; 89: 2604-2611
Article info
Publication history
Published online: March 21, 2017
Accepted:
February 17,
2017
Received:
August 16,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
