Trigger finger: injection vs percutaneous vs open release

Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release and open surgery

Sato ES, Gomes Dos Santos JB, Belloti JC, et al. Rheumatology (Oxford, England) 2012 · PMID 22039269 · doi:10.1093/rheumatology/ker315

Question

Which is most effective for trigger finger: steroid injection, percutaneous release or open A1 pulley release?

Design

Three-arm randomised controlled trial with at least six months of follow-up.

Patients

Patients over 15 years with trigger digits (types II-IV).

Intervention

Percutaneous A1 pulley release or open surgical release

Comparison

Corticosteroid injection

Primary outcome

Cure, relapse and failure of triggering

Key result

Percutaneous and open release both resolved triggering in all cases and were similarly effective, while steroid injection had lower cure rates even when a second injection was allowed.

Limitations

Single centre with relatively short follow-up; injections were limited to two, whereas practice sometimes allows more.

Impact on practice

Supports steroid injection as a reasonable first step with surgical A1 pulley release for failure or recurrence, and shows percutaneous release is a valid alternative to open release in the fingers.