Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial

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Abstract
This study compared the results of percutaneous A1 pulley release and steroid injection in 105 trigger digits in 95 patients. The patients were randomly assigned to either surgery (43 patients, 46 digits) or steroid injection (52 patients, 59 digits). The results were assessed at 1 and 6 months and the measurements included rate of recurrence (primary outcome measure), pain on movement, active range of movement of the affected digit and grip strength. No recurrences were seen at 1 month. At the 1 month assessment, patients after steroid injection achieved greater active range of movement of the fingers (270° vs 264°) and stronger grip (99% vs 85%) than those treated by percutaneous release. At the 6 month assessment six recurrences (11%) occurred in the steroid injection group and none in the percutaneous release group (P = 0.005). Patients after percutaneous release had less pain on movement of the involved digit (VAS 0.4 vs 1.3), but still had lower AROM of the fingers (265° vs 270° after steroid injection). We conclude that percutaneous A1 pulley release is more effective medium-term therapy for trigger digit than steroid injection, because of lower risk of recurrence.

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