Open Surgery Versus Ultrasound-Guided Corticosteroid Injection for Trigger Finger: A Randomized Controlled Trial With 1-Year Follow-up.
OBJECTIVE
Trigger finger is a common condition with a lifetime prevalence of 2%. Corticosteroid injection is a treatment often considered as a first-line intervention with reported cure rates between 60% and 90% in observational cohorts. Nevertheless, open surgery remains the most effective treatment with reported cure rates near 100%. Head-to-head trials on these treatments are limited. We investigated the efficacy of open surgery compared with ultrasound-guided corticosteroid injections.


METHODS
The study was performed as a single-center, randomized, controlled trial with a 1-year follow-up. A total of 165 patients received either open surgery (n = 81) or ultrasound-guided corticosteroid injection (n = 84). Follow-up was conducted at 3 and 12 months. If the finger had normal movement or normal movement with discomfort at latest follow-up, the outcome was considered a success. Secondary outcomes were postprocedural pain and complications.


RESULTS
The groups were similar at baseline except for lower alcohol consumption in the open surgery group. At 3 months, 86% and 99% were successfully treated after corticosteroid injection and open surgery, respectively. At 12 months, 49% and 99% were considered successfully treated after corticosteroid injection and open surgery, respectively. The pain score at latest follow-up was significantly higher in the corticosteroid injection group. Complications after open surgery were more severe and included 3 superficial infections and 1 iatrogenic nerve lesion. After corticosteroid injection 11 patients experienced a steroid flare and 2 had fat necrosis at the site of injection.


CONCLUSIONS
Open surgery is superior to ultrasound-guided corticosteroid injections. Complications after open surgery are more severe; this must be taken into account when advising patients with regard to treatment.


METHODS
Therapeutic I.
Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark.
Rehne L
RL
Hansen
Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark.
Morten
M
Søndergaard
Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark; Interdisciplinary Research Unit, Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark. Electronic address: jeplan@rm.dk.
Jeppe
J
Lange
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D052582:Trigger Finger Disorder / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D018084:Ultrasonography, Interventional
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide
Corticosteroid injections; randomized controlled trial; surgery; trigger finger; ultrasound