Percutaneous Release vs Steroid Injection for Trigger Finger

NCT05383040 | Completed DMC

• 1 other identifier: Trigger finger
• Study Type: interventional
• Target: 112
• Locations: 1 country
• Sites: 1

Brief Summary

Trigger fingers (TF) is the common cause of pain and disturbed function of hand. Many studies show that percutaneous release of A1 pulley has better outcome than the steroid injection. However, over the past many years, steroid injection has been considered as the choice of treatment after the failure of conservative treatment methods. The aim of this study is to assess the effect of percutaneous release of A1 pulley compared with the local Steroid injection in the treatment of trigger fingers. This study is based on a randomized clinical trial to compare the effect of the percutaneous release of A1 pulley with steroid injection in trigger fingers. A total of 112 participants aged 18 years and above suffering from trigger fingers with failed conservative treatment will be intervened randomly (56 participants in injection group and 56 participants in percutaneous release group). The Quinnell's classification, VAS scoring system and active range of movement in the affected site will be assessed at the baseline and the same criteria will be at one month and three month as end line assessment. Statistical analyses will be performed using independent t-test and Mann Whitney U test to compare between the two means. The outcome of this study will help to guide the physicians to choose the better therapeutic approach among the patients suffering from trigger fingers.

Conditions

Trigger Finger

Keywords

Trigger fingers; Trigger digits; Steroid injection; Percutaneous release

Outcome Measures

Primary Outcomes (2)

• Functional mobility improvement

  Compare the effects of percutaneous release versus steroid injection on functional mobility at baseline, one month and three months.

  3 months

• Pain reduction

  Compare the effects of percutaneous release versus steroid injection on pain reduction at baseline, one month and three months.

  3 months

Secondary Outcomes (2)

• Decrease in the thickness of the A1 pulley

  3 months

• Recurrence of problem within 3 months

  3 months

Study Arms (2)

percutaneous release

EXPERIMENTAL

Percutaneous release of A1 pulley release will be performed in the well-managed operation theater set up, using an 18 gauge hypodermic needle, after preparation of the skin and injection of 1ml 2% plain lidocaine. The proper location of the pulley will be defined using surface landmarks in each digit after waiting a few minutes to allow the anesthetic to take effect the 18 gauge needle will be longitudinally moved to keep the level of the needle parallel with the tendon grating sensation will be elucidated confirming the cut of pulley until there is no grating sensation felt and improvement of symptoms. A sterile dressing will be placed.

Procedure: Percutaneous release

Steroid injection

NO INTERVENTION

The steroid injection mixed with 1 ml of methyl prednisone (40mg) with 0.5 ml of 2% plain lidocaine will be inserted into the flexor tendon sheath over the A1 pulley, which will also be performed in the operation theater for patient safety.

Interventions

Percutaneous release PROCEDURE

Percutaneous release of A1 pulley release will be performed in the well-managed operation theater set up, using an 18 gauge hypodermic needle, after preparation of the skin and injection of 1ml 2% plain lidocaine. The proper location of the pulley will be defined using surface landmarks in each digit after waiting a few minutes to allow the anesthetic to take effect the 18 gauge needle will be longitudinally moved to keep the level of the needle parallel with the tendon grating sensation will be elucidated confirming the cut of pulley until there is no grating sensation felt and improvement of symptoms. A sterile dressing will be placed.

percutaneous release

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Participants aged 18 years and above
• Duration of symptoms :≥ 3 months
• Triggering in any of the digits of hand
• Trigger finger type II-IV based on Quinnell classification

You may not qualify if:

• There is prior treatment for trigger finger, or Trigger thumb
• There had been previous surgery or other hand pathology such as rheumatoid arthritis, osteoarthritis, Dupuytren's contracture and diabetic mellitus.

Sponsors & Collaborators

• Armed Police Force Hospital, Nepal: lead

Study Sites (1)

Armed Police Force Hospital

Kathmandu, Bagmati, +9779851147339, Nepal

Location

Related Publications (25)

• Moore JS. Flexor tendon entrapment of the digits (trigger finger and trigger thumb). J Occup Environ Med. 2000 May;42(5):526-45. doi: 10.1097/00043764-200005000-00012.

  PMID: 10824306 RESULT

• Maneerit J, Sriworakun C, Budhraja N, Nagavajara P. Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone. J Hand Surg Br. 2003 Dec;28(6):586-9. doi: 10.1016/s0266-7681(03)00172-4.

  PMID: 14599834 RESULT

• Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008 Jun;1(2):92-6. doi: 10.1007/s12178-007-9012-1.

  PMID: 19468879 RESULT

• Mineoka Y, Ishii M, Hashimoto Y, Yuge H, Toyoda M, Nakamura N, Katsumi Y, Fukui M. Trigger finger is associated with risk of incident cardiovascular disease in individuals with type 2 diabetes: a retrospective cohort study. BMJ Open Diabetes Res Care. 2021 Apr;9(1):e002070. doi: 10.1136/bmjdrc-2020-002070.

  PMID: 33832915 RESULT

• David M, Rangaraju M, Raine A. Acquired triggering of the fingers and thumb in adults. BMJ. 2017 Nov 30;359:j5285. doi: 10.1136/bmj.j5285. No abstract available.

  PMID: 29191846 RESULT

• Lunsford D, Valdes K, Hengy S. Conservative management of trigger finger: A systematic review. J Hand Ther. 2019 Apr-Jun;32(2):212-221. doi: 10.1016/j.jht.2017.10.016. Epub 2017 Dec 28.

  PMID: 29290504 RESULT

• Takahashi M, Sato R, Kondo K, Sairyo K. Morphological alterations of the tendon and pulley on ultrasound after intrasynovial injection of betamethasone for trigger digit. Ultrasonography. 2018 Apr;37(2):134-139. doi: 10.14366/usg.17038. Epub 2017 Jul 25.

  PMID: 28870061 RESULT

• Pan M, Sheng S, Fan Z, Lu H, Yang H, Yan F, E Z. Ultrasound-Guided Percutaneous Release of A1 Pulley by Using a Needle Knife: A Prospective Study of 41 Cases. Front Pharmacol. 2019 Mar 26;10:267. doi: 10.3389/fphar.2019.00267. eCollection 2019.

  PMID: 30971922 RESULT

• Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. J Ultrasound Med. 2019 Dec;38(12):3141-3154. doi: 10.1002/jum.15025. Epub 2019 May 20.

  PMID: 31106876 RESULT

• LORTHIOIR J Jr. Surgical treatment of trigger-finger by a subcutaneous method. J Bone Joint Surg Am. 1958 Jul;40-A(4):793-5. No abstract available.

  PMID: 13549516 RESULT

• Blumberg N, Arbel R, Dekel S. Percutaneous release of trigger digits. J Hand Surg Br. 2001 Jun;26(3):256-7. doi: 10.1054/jhsb.2001.0569.

  PMID: 11386779 RESULT

• Park MJ, Oh I, Ha KI. A1 pulley release of locked trigger digit by percutaneous technique. J Hand Surg Br. 2004 Oct;29(5):502-5. doi: 10.1016/j.jhsb.2004.03.015.

  PMID: 15336757 RESULT

• Ragoowansi R, Acornley A, Khoo CT. Percutaneous trigger finger release: the 'lift-cut' technique. Br J Plast Surg. 2005 Sep;58(6):817-21. doi: 10.1016/j.bjps.2005.04.003.

  PMID: 15936736 RESULT

• Eastwood DM, Gupta KJ, Johnson DP. Percutaneous release of the trigger finger: an office procedure. J Hand Surg Am. 1992 Jan;17(1):114-7. doi: 10.1016/0363-5023(92)90125-9.

  PMID: 1538091 RESULT

• Lyu SR. Closed division of the flexor tendon sheath for trigger finger. J Bone Joint Surg Br. 1992 May;74(3):418-20. doi: 10.1302/0301-620X.74B3.1587893.

  PMID: 1587893 RESULT

• Bain GI, Turnbull J, Charles MN, Roth JH, Richards RS. Percutaneous A1 pulley release: a cadaveric study. J Hand Surg Am. 1995 Sep;20(5):781-4; discussion 785-6. doi: 10.1016/S0363-5023(05)80430-7.

  PMID: 8522744 RESULT

• HOWARD LD Jr, PRATT DR, BUNNELL S. The use of compound F (hydrocortone) in operative and non-operative conditions of the hand. J Bone Joint Surg Am. 1953 Oct;35-A(4):994-1002. No abstract available.

  PMID: 13108902 RESULT

• Dala-Ali BM, Nakhdjevani A, Lloyd MA, Schreuder FB. The efficacy of steroid injection in the treatment of trigger finger. Clin Orthop Surg. 2012 Dec;4(4):263-8. doi: 10.4055/cios.2012.4.4.263. Epub 2012 Nov 16.

  PMID: 23205235 RESULT

• Wang J, Zhao JG, Liang CC. Percutaneous release, open surgery, or corticosteroid injection, which is the best treatment method for trigger digits? Clin Orthop Relat Res. 2013 Jun;471(6):1879-86. doi: 10.1007/s11999-012-2716-6. Epub 2012 Dec 4.

  PMID: 23208122 RESULT

• Quinnell RC. Conservative management of trigger finger. Practitioner. 1980 Feb;224(1340):187-90. No abstract available.

  PMID: 7367373 RESULT

• Sato ES, Gomes Dos Santos JB, Belloti JC, Albertoni WM, Faloppa F. Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release and open surgery. Rheumatology (Oxford). 2012 Jan;51(1):93-9. doi: 10.1093/rheumatology/ker315. Epub 2011 Oct 29.

  PMID: 22039269 RESULT

• Sahu R, Gupta P. Experience of Percutaneous Trigger Finger Release under Local Anesthesia in the Medical College of Mullana, Ambala, Haryana. Ann Med Health Sci Res. 2014 Sep;4(5):806-9. doi: 10.4103/2141-9248.141558.

  PMID: 25328798 RESULT

• Ha KI, Park MJ, Ha CW. Percutaneous release of trigger digits. J Bone Joint Surg Br. 2001 Jan;83(1):75-7. doi: 10.1302/0301-620x.83b1.11247.

  PMID: 11245542 RESULT

• Saldana MJ. Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg. 2001 Jul-Aug;9(4):246-52. doi: 10.5435/00124635-200107000-00004.

  PMID: 11476534 RESULT

• Karki M, Sharma R, Sunuwar DR, Gupta RS, Singh DR, Lama S, Bhandari KK, Tamang RK, Chaudhary NK. Effect of percutaneous release versus steroid injection among adults with trigger fingers: a randomized clinical trial. BMC Musculoskelet Disord. 2025 Oct 1;26(1):885. doi: 10.1186/s12891-025-08981-6.

  PMID: 41029287 DERIVED

MeSH Terms

Conditions

Trigger Finger Disorder

Condition Hierarchy (Ancestors)

Tendon Entrapment; Tendinopathy; Muscular Diseases; Musculoskeletal Diseases

Study Officials

• Mandeep Karki, MS

  Nepal Orthopedic Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dietitian/Researcher

Model Details: A hospital-based randomized clinical trial study will be carried out to compare the effect of percutaneous release of A1 pulley with steroid injection in the treatment for trigger finger.

Study Record Dates

• First Submitted: May 17, 2022
• First Posted: May 19, 2022
• Study Start: June 1, 2022
• Primary Completion: November 2, 2022
• Study Completion: November 2, 2022
• Last Updated: February 27, 2023

Record last verified: 2023-02

Data Sharing

• IPD Sharing: Will not share

Locations

NE (1)