Trigger finger is clinically characterised by pain and catching during finger movements. Classically, the initial treatment is non-surgical using nonsteroidal anti-inflammatory drugs, splinting and corticosteroid injection, and may require surgical treatment if the conventional treatment fails. Although it is a common condition, there is no consensus about the best surgical treatment approach (by skin incision and direct vision of the hand structures (open); approaches via needle or blade introduced through the skin, with no direct vision of the hand structures (percutaneous); or via a flexible tube with a light camera attached to it (endoscopic).
This Cochrane Review is current to August 2017. We included 14 randomised controlled trials involving 1260 participants, totalling 1361 trigger fingers. Two studies compared open surgery versus steroid injections, five studies compared percutaneous surgery versus steroid injection, one study compared open surgery versus steroid injection plus hyaluronic acid injection, one study compared percutaneous surgery plus steroid injection versus steroid injection, five studies compared percutaneous surgery versus open surgery, one study compared endoscopic surgery versus open surgery and one study compared three types of skin incision to open surgery. The majority of participants were female (about 70%); they were aged between 16 and 88 years; and the mean follow-up of participants after the procedure was eight weeks to 23 months. Due to space constraints, the reporting of all results was limited to the main comparison — open surgery versus steroid injection — because open surgery is the oldest and the most widely used treatment method and considered as standard surgery, whereas steroid injection is the least invasive control treatment method as reported in the studies in this review and is often used as first-line treatment in clinical practice.
Based on two trial (270 participants), compared with the steroid injection procedure:
Resolution of trigger finger (lessening of symptoms with no recurrence):
• 92 out of 100 people had resolution of symptoms with open surgery.
• 61 out of 100 people had resolution of symptoms with steroid injection.
Incidence of pain, assessed as the presence or absence of pain after the procedure was performed (at one week):
• 49% more people had pain with open surgery (33% to 66% more).
• 68 out of 100 people had pain with open surgery.
• 19 out of 100 people had pain with steroid injection.
Recurrence of the trigger finger (from six to 12 months):
• 29% fewer people had recurrence of symptoms with open surgery (60% fewer to 3% more).
• 7 out of 100 people had recurrence of symptoms with open surgery.
• 39 out of 100 people had recurrence of symptoms with steroid injection.
Adverse events including infections, tendon injuries, cutaneous discomfort, flare or fat necrosis at the procedure site, or neovascular events were uncommon in either treatment group.
No study reported hand function or participant-reported treatment success or satisfaction.
Quality of the evidence
Very low quality evidence from two trials means we are uncertain whether open surgery improve resolution of trigger finger in comparison with steroid injection, due the risk of bias in the design of the studies, inconsistencies between studies and the small number of participants in studies. Low-quality evidence from two trials shows that open surgery may result in fewer recurrences of trigger finger compared with steroid injection procedure, although it increases the incidence of pain during the first week after the procedure. Evidence was downgraded to ‘low’ due to the risk of bias in the design and the small number of participants. No studies measured functional improvement or participant satisfaction in the comparison between open surgery and steroid injection. We are uncertain whether there is a difference in the risk of adverse events or neurovascular injury between treatments, as few events occurred in the studies.
Only low and very low-quality evidence was found for other comparisons so we are uncertain if percutaneous surgery has any benefits over steroid injection, or if open surgery is better than steroid plus hyaluronic acid, or if one type of surgery is better than another.