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Treatment of Trigger Finger: Randomized Clinical Trial Comparing the Methods of Corticosteroid Injection, Percutaneous Release, and Open Surgery
Edson Sasahara Sato, MEDICAL, DR1; João Baptista Santos, MD2; João Carlos Belloti, MD, PhD3; W. M. Albertoni, MD4; F. Faloppa, MD4; Carlos Henrique Fernandes, MD2
1Discipline of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, UNIFESP - Universidade Federal de São Paulo, São Paulo, Brazil; 2Orthopaedic sugery / Hand Surgery group, Universidade Federal de São Paulo, São Paulo, Brazil; 3Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, Brazil; 4Orthopedic Surgery / Hand Surgery Group, Universidade Federal de São Paulo, São Paulo, Brazil

Objective: This study was designed to evaluate the effectiveness of three methods for treating “trigger finger,” corticosteroid injection, percutaneous pulley release, and conventional open surgery, in terms of cure, relapse, and complication rates.

Methods: One hundred and thirty-seven patients with a total of 150 fingers were randomized and allocated into one of the treatment groups, with treatments allocated into 150 opaque and sealed envelopes. We included patients older than 15 years of age with a “trigger” on any finger of the hand (type II to IV) and used a minimum follow-up time of 6 months. The primary outcome measures were cures, relapses, and failures.

Results: Forty-nine patients were assigned to the conservative group to undergo corticosteroid injections, whereas 45 and 56 were assigned to undergo percutaneous release and outpatient open surgery, respectively. The "trigger" cure rate for patients in the injection method group was 57%, and wherever necessary, two injections were administered, which increased the cure rate to 86%. For the percutaneous and open release methods, remission of the “trigger” was achieved in all cases.

Conclusions: The percutaneous and open surgery methods displayed similar effectiveness and proved superior to the conservative corticosteroid method regarding the trigger cure and relapse rates.

Trial registration: ISRCTN19255926 - 'Trigger finger': comparative analysis of treatment methods by corticosteroid injection, percutaneous release and open surgery. http://www.controlled-trials.com/ISRCTN19255926.

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