Outcomes of corticosteroid injection and percutaneous release in treatment of trigger finger at tertiary hospital of Eastern Nepal.

Introduction: Trigger finger or stenosing tenosynovitis is a common cause of painful fingers and thumb that result in painful triggering, snapping or locking of fingers on flexion and extension of involved digit. Available treatment options for this condition are NSAID, splints, intralesional steroid injection, percutaneous release and open release of tendon sheath. Objectives: To study the clinical and functional outcomes and complications of corticosteroid injection and percutaneous release in management of trigger finger. Methodology: In this prospective study, sixty patients who presented with Grade 2 to Grade 3 trigger finger were placed into two groups. Group A(30 patients) were treated with intralesional steroid (40 mg of methylprednisolone) injection. Group B (30 patients) underwent percutaneous surgical release of affected tendon sheath. Both group of patients were treated in outpatient department. Patients of both groups were then asked to follow on scheduled time interval of two-week, six-week, three-months and six-months of period and their progress were recorded. Results: The baseline VAS score before intervention in group A (5.82) and group B (6.12) was statistically significant. In group B there was significant improvement of VAS score till 6 months of follow up. However, in group A there was significant improvement of VAS score by 3 months of follow-up, but by end of 6 months it again raised to 2.14. Yet it was far better than baseline VAS score. Conclusion: In our study both corticosteroid injection and percutaneous trigger finger release were found to be much effective in management of trigger finger.

A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

Percutaneous release of the A1 pulley has been introduced as a therapeutic approach for trigger fingers and is suggested as an effective and safe alternative, where conservative treatments fail. The aim of the current study was to determine if percutaneous release with a 15° stab knife can effectively result in acceptable efficacy and lower complication rate. Methods In the present study, the percutaneous release of the A1 pulley was evaluated by percutaneous release using a 15° stab knife in 20 fresh-frozen cadaver hands (10 cadavers). One hundred fingers were finally included in the present study. The success rate of A1 pulley release as well as the complications of this method including digital vascular injury, A2 pulley injury, and superficial flexor tendon injury was evaluated, and finally, the data were analyzed by the SPSS software. Results The results showed a success rate of 75% for A1 pulley release in four fingers, followed by eleven fingers (90%) and eighty-five fingers (100%). Therefore, the A1 pulley was found to be completely released in eighty-five fingers (100%). Overall, the mean of A1 pulley release for these fingers was determined as 97.9%, indicating that percutaneous trigger finger release can be an effective technique using a 15° stab knife. Furthermore, our findings revealed no significant difference in the amount of A1 pulley release in each of the fingers in the right and left hands. Additionally, 17 fingers developed superficial scrape in flexor tendons, while 83 fingers showed no flexor tendons injuries and no other injuries (i.e., vascular, digital nerve, and A2 pulley injuries). Conclusions Percutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.

Randomized Controlled Trial on Combined Percutaneous Release and Steroid Injection Versus Percutaneous Release Alone for Trigger Finger in Adults

Introduction. Trigger finger is one of the most common causes of hand pain and disability. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Many authors have noted that percutaneous release is convenient and cost-effective with a low complication rate. Only few studies have published results on combination of percutaneous release and steroid injection. Objective. To compare the differences of outcomes in adults with trigger finger treated with combination of percutaneous release and corticosteroid injection to those treated with percutaneous release alone Methods. We included all patients older than 18 years old in the UP-PGH Department of Orthopedics with a diagnosis of trigger finger who have consented to participate in this study. They were randomized into two treatment groups. One group was treated with percutaneous release only and the other group was treated with combined percutaneous release and corticosteroid injection. Outcomes measured were total active motion (TAM), postoperative pain, time to return-to-work, patient satisfaction, and complications. Results. Post-procedure, both groups showed significant improvement in motion of the fingers (p = 0.034) and pain relief (p = 0.001). TAM scores of the combination group were better compared to the control at all time intervals (p = 0.03, 0.008, 0.004, 0.019) and better pain VAS scores in the 1st week (p = 0.009). Patients who received the combination treatment showed a trend toward better patient satisfaction, shorter duration of post-release pain and earlier return-to-work. Conclusion. The addition of corticosteroid injections to percutaneous release of trigger finger significantly improves TAM and pain VAS scores.