Abstract
BACKGROUND: Trigger finger (TF) causes pain and impaired hand function. Percutaneous release of the A1 pulley demonstrates a better outcome than steroid injection in the treatment of TF; however, evidence remains limited. Therefore, this study aimed to compare the effect of percutaneous release of the A1 pulley compared to local steroid injection in the treatment of trigger fingers in Nepal. METHODS: A hospital-based randomized clinical trial among 92 patients aged 18 years and above suffering from trigger fingers that were unresponsive to conservative treatment was conducted to evaluate the effect of the percutaneous release of A1 pulley and steroid injection. Quinnell's classification, visual analogue scale (VAS) scoring system and thickness of A1 pulley, as well as the flexor tendon in the affected site, were assessed before and after intervention at six months. Student's t-test, Mann-Whitney U test and chi-square tests were performed to compare the effectiveness of both treatments. RESULT: Percutaneous release of the A1 pulley showed better functional improvement than steroid injection, with a p-value of < 0.001 and medium effect size of 0.43. The pain score was also decreased more in the percutaneous release group than the steroid group (-5.1 ± 1.4 versus - 3.7 ± 1.8), with the group difference of 1.3 (95% CI: 0.6 to 2.0), with a p-value of < 0.001 and a large effect size of 0.87. Nevertheless, steroid injection decreased the thickness of A1 pulley than percutaneous release (-0.34 ± 0.24 versus - 0.21 ± 0.21), with a p-value of 0.011 and a large effect size of 0.5. Furthermore, tendon thickness was decreased more in the steroid group compared with the percutaneous release group (-1.12 ± 0.73 versus - 0.34 ± 0.41), with a p-value of < 0.001 and a huge effect size of 1.31. CONCLUSION: Percutaneous release of A1 pulley illustrated greater improvement in functional mobility with a moderate effect size and pain with a large effect size compared to steroid injection in trigger fingers. A multicenter trial with a larger sample size and involving a diverse participant cohort may enhance the strength of the evidence. TRIAL REGISTRATION: NCT05383040, first registered on 17/05/2022 (https//clinicaltrials.gov/ct2/show/NCT05383040).