Stenosing Tenosynovitis, Steroid Versus Open Release Versus Percutaneous Release: A Systematic Review and Meta-Analysis

Purpose
Stenosing tenosynovitis, frequently referred to as trigger finger, is a common condition
characterized by decreased mobility of the tendon in the tendon sheath. The current standard
therapy is corticosteroid injection or open surgical release. Percutaneous release is an emerging
therapy of trigger finger. The purpose of this study is to evaluate the efficacy and complications
of percutaneous release compared to steroid and surgical therapy.

Method
A Medline search was performed for all relevant articles describing the use of corticosteroid,
surgical, or percutaneous therapy of trigger finger. This study includes all published data of
trigger finger treatment from 1965 to January 2011. The PubMed database of the National Center
for Biotechnology Information, National Library of Medicine (Bethesda, Md) was used to collect
reports using the key words “trigger finger”, “corticosteroid”, “percutaneous release”, “surgical
release”. All articles were reviewed for reports of clinical cases, complications, doses, number of
digits and patients, previous therapy, operation time, outcome measure, success, follow-up, and
study design. The difference of success rates between steroid injection, open surgical release, and
percutaneous release was described using contingency tables. Statistical analysis using chi-square
was performed.

Results
A total of 3155 trigger-digits were reviewed. Seven studies comprising 790 digits treated with
steroid injection, 8 studies comprising 1056 digits treated by open surgical release, and 11 studies
comprising 1309 digits treated by percutaneous release were reviewed. The most common
complications encountered across all three procedures were recurrence (0.3%) and infection
(0.1%). Percutaneous release had a 5% complication rate while surgical release had a 10%
complication rate. Procedure time ranged from 2-7 minutes for surgical release and less than 5
minutes for percutaneous release. There was a statistically significant difference in rate of success
following three different treatment modalities; steroid injection (68.7%) versus open release (94.2%) versus
percutaneous release (91.9%); p<0.0001.

Conclusion
Percutaneous release as a treatment of trigger finger has similar efficacy to open surgical release
and is superior to steroid injection. Although, percutaneous release is slightly less successful than
surgical release it is associated with a decreased operating time and fewer complications.