Background

Trigger finger is a common condition resulting in the inability to freely extend the finger, and has been associated with carpal tunnel syndrome, diabetes mellitus and rheumatoid arthritis. Typically trigger finger is managed nonoperatively and can be treated with anti-inflammatory medication, splinting and corticosteroid injections. In cases where patients have continued symptoms then surgical release is recommended, but traditional surgical management has a published complication rate of 3 to 28% (Bonnici & Spencer, 1988; Hodgkinson et al, 1988; Thorp, 1988; Turowski et al, 1997).

Study Results

Bain and Wallwork (1998) published a study using a technique described by Eastwood (1992), and retrospectively reviewed the charts of all of the patients in their clinic who had a trigger finger release using this percutaneous approach. The study reviewed the results of 26 patients. Some of these patients had multiple fingers involved, so the study examined the results of 31 trigger finger release procedures (9 middle, 16 ring and 6 little fingers). In this study, patients with trigger thumb were treated with open surgical release.

The technique involved using a 14-guage needle and was performed using landmark guidance. The needle was advanced to the A1 pulley and manipulated to release the tendon. There were no significant complications reported in this study, including no digital nerve injuries, cases of infection, or no clinical evidence of tendon injury or bowstringing. At follow up ranging from 1-week to 6-months, only 1 patient had persistent patients that required an open surgical release with a 97% success rate.

Conclusion

Many different techniques for percutaneous release have been reported since this approach has been first described by Lorthioir in 1958. The technique using a needle and palpation to perform the procedure was first described in 1992 by Eastwood. Multiple clinical studies have demonstrated that percutaneous release is effective and safe with no reported significant neurovascular complications (Eastwood et al, 1992; Lorthioir, 1958; Lyu, 1998; Patel & Moradia, 1997; Tanaka et al, 1990).

What treatment options do you have with trigger finger?

The management of trigger finger has 3 main options: nonoperative care, open release or percutaneous release.

What are the advantages of the percutaneous appraoch?

Bain and Wallwork noted that advantages of the percutaneous release is that it can be performed in the outpatient setting, uses local anesthetic and can be performed in several minutes. The makes the percutaneous technique more convenient and potentially offers significant cost savings for the patient.

This study reported a 97% success rate with the percutaneous release without significant complications.

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