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Comparison of Percutaneous Release, Open Release, and Corticosteroid Injection in the Treatment of Trigger Digits: A Systematic Review and Meta-analysis
Arash Izadpanah, MD, CM, MSc1; Ali Izadpanah, MD, CM, MSc2; Jonathan Kanevsky, BSc3; Eric Belzile, BSc3; Abdul Shararah, PharmD, MD2; Mario Luc, MD, MSc, FRCSC3; Teanoosh Zadeh, MD, FRCSC3
1University of Manitoba, Winnipeg, Canada; 2McGill University Health Centre, Montreal, Canada; 3McGill University, Montreal, Canada

Background: Stenosing flexor tenosynovitis, is a common condition characterized by decreased mobility of the tendon in the tendon sheath. The current standard therapy is corticosteroid injection or open surgical release. Percutaneous release is an emerging therapy of trigger finger. The purpose of this study is to evaluate the efficacy and complications of percutaneous release in comparison to steroid and open surgical treatments.
Method: A literature review of all published data of trigger finger treatments from 1965 to 2010 was performed. The PubMed database of the National Center for Biotechnology Information, National Library of Medicine (Bethesda, Md), Medline, Cochrane review database, and Google Scholar were used to collect reports using the key words "trigger finger", "corticosteroid", "percutaneous release", "surgical release". All articles were reviewed for study design, reports of clinical cases, complications, administered doses, previous therapies, operative time, follow-up, and recurrence rate. Comparison between groups was performed using contingency tables and chi-square tests. We then proceeded with performing meta-analysis based on treatment modality and study designs.
Results: A total of 3,155 trigger-digits were reviewed. Seven studies comprising 790 digits treated with steroid injection, 8 studies comprising 1,056 digits treated by open surgical release, and 11 studies comprising 1,309 digits treated by percutaneous release were reviewed. Procedure time ranged from 2-7 minutes for surgical release and less than 5 minutes for percutaneous release. Using Chi-square analysis we demonstrated a statistically significant difference in rate of success. Open release was associated with highest success rate (94.2%), followed by percutaneous release (91.9%), followed by steroid injection (68.7%). Due to heterogeneity of our studies, we then performed a meta-analysis. Thus, percutenous release had a 94% [90%-98%] chance of success, compared to 92% [81%-98%] in open release group and only 65% [53%-76%] for steroid administration group.
Conclusion: Percutaneous release as a treatment of trigger finger has similar efficacy to open surgical release and is superior to steroid injection. It is associated with a decreased operating time and fewer complications.


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