The efficacy of percutaneous A1 pulley release for trigger finger treatment

Abstract

Background : Percutaneous soft tissue release is an alternative treatment of trigger fingers after it has failed conservative treatment. This technique is, convenient, safe, taking short surgical time, and can be performed on out patients without requiring any special instrument and well tolerated by patients. But because of its limited surgical exposure, some surgeons have questions on the completeness of soft tissue releasing, its outcomes, recurrent rate and adverse effects. We study recurrent rate and efficacy of percutaneous soft tissue release in comparison to open soft tissue release including post-operative pain, complications of the technique and time to return to work.

Material and Method : A randomized control trial study was performed on 62 fingers at Chainat Hospital and the Department of Orthopedics, King Chulalongkorn Memorial Hospital from May 2004 to October 2005. Demo-graphic data were described as descriptive. The mean and SD of pain VAS before and after operation were computed with 95 % confidence interval. The statistical analysis was summarized by unpaired T-test. The patient's global assessment and satisfaction index were analyzed by Mann-Whitney test. The frequencies of recurrence of snapping and adverse events were presented with descriptive statistics and Chi-square test.

Results : No statistic significantly difference of recurrent rate and efficacy Conclusion including average VAS pain and snapping between open group and percutaneous group (p>0.05). The average VAS pain score between the two groups in the time both before and after surgery (before surgery: open group and percutaneous group=4.043 ± 2.072 and 3.408 + 1.616, respectively (P=0.191); week 1 post-operative= 1.560 ± 1.196and1.783 ± 1.020, respectively (p=0.44); week 12 postoperative=0.291 + 0.64 and 0.291 +0.988, respectively (P=0.26). All cases had clinical improvement of snapping movement after surgery and no significant difference (P=0.150). For secondary outcomes, there were no statistically significant difference in patient's global assessment and satisfaction index between both groups (P-0.686 and 0.172, respectively). However there were strongly statistically significant difference in number of paracetamol used, time to return to work and evidence of surgical site morbidity (P<0.001).

 Conclusion : This study demonstrates that efficacy and recurrent rate of Clinical relevance percutaneous soft tissue release has no statistically significant difference in comparison with conventional open soft tissue release. Nevertheless, it has superiority over the conventional in terms of complication of the technique and time to return to work.

 Clinical relevance : The percutaneous soft tissue release of A1 pulley in trigger finger is an effective treatment with iow recurrent rate. This technique is convenient, safe and minimaliy invasive procedure. Patients can return to work quickly and have fewer surgical wound problems and absence of surgical scar.