Percutaneous A1 Pulley Release VS Steroid Injection for Trigger Digit

   The results of a prospective, randomized trial


The objective of this study was to compare the differences in treatment of trigger finger in the short term (one month) and mid term (6 months).
Two types of treatment were compared; a percutaneous A1 pulley release and the second, a steroid injection.
The objective of this study was to determine whether one treatment was more effective than the other as previous articles and research were inconclusive.

105 digits from 95 patients with a mean age of 56 years were recruited for this study.
The patients were split randomly into two groups; 55 patients were treated surgically and 60 patients were treated by an injection.
All patients were assessed before their procedure and again one month and 6 months post treatment. Assessments included ongoing triggering, pain on movement, active range of movement of the affected digit, rate of recurrence (primary outcome measure) and grip strength.

Results of this study showed at one month post treatment, no recurrences of trigger finger had occurred in either group.
Six months post treatment; there were 6 recurrences of trigger finger, all of which were treated by a steroid injection. All the recurrences occurred between the second and fourth month post injection.

Initially patients who had been treated via surgical release had significantly lower active range of motion of the fingers as well as significantly weaker grip strength. These findings however were not clinically apparent. There were no significant differences in respect to other parameters. However, patients after surgical release experienced significantly less pain on movement of the involved digit, even though range of movement of the fingers was initially restricted.

Patients received statistically significantly less pain on movement of the affected digit following percutaneous A1 pulley release. However two of these patients treated by percutaneous release had incomplete finger flexion up until the final assessment where they had regained full active range of movement.
At 6 months a percutaneous A1 pulley release was considered to be more effective therapy than a steroid injection.
Mike Hayton offers patients at first visit either a steroid injection or surgical release depending upon patients requirements.

Zyluk. A. and Jagielski. G.
Journal of Hand Surgery (European Volume)