Journal of Clinical and Diagnostic Research. 2018 Jul, Vol-12(7): RC05-RC08 5 5 DOI: 10.7860/JCDR/2018/34100.11771 Original Article Orthopedics Section Trigger Finger: A Prospective Randomised Control Trial Comparing Percutaneous Release versus Open Release INTRODUCTION Stenosing Tenosynovitis (ST)/tenovaginitis of the finger, also known as TF, is one of the common presentation of patients to an orthopaedic surgeon. If not managed appropriately, it causes pain, discomfort and varying degrees of disability in hand function. Patients with TFs initially presents with pain localised to the metacarpophalangeal or proximal interphalangeal joints and later with locking or clicking, which may sometime progress to contracture of the proximal interphalangeal joint of the particular finger. The common causes are enlargement of the tendon from swelling or thickening of the tenosynovium, thickening of the fibrous flexor sheath or fibrocartilaginous metaplasia of the 1 st Annular (A1) pulley. This causes a mismatch between the flexor sheath and the flexor tendon [1-3]. TF more commonly affects the thumb, ring or middle fingers. It is more commonly seen in adult female population (~F:M=4:1), in their 5 th and 6 th decades of life [4]. Although, there are many acceptable methods available, most of the TF cases are treated with conservative management as oral pain relievers, oral steroid or local steroid injection however, some of them undergo operative management i.e., surgical transection of A1 pulley either by the percutaneous or open method. The current recommendation for TF Types II-IIIb [4] is still by local steroid injection with reported 60% success rate after one injection in the study by Lambert MA et al., [5] and 72% success rate in the study by Baumgarten KM et al., [6] after injection and immobilisation. However, it was noted that surgical treatment for TF is recommended if conservative treatment failed, in Type IV TF, or if TF was secondary to diabetes mellitus, gout, rheumatoid arthritis, and other connective tissue disorders [7-9]. For the open technique, to release the A1 pulley the surgeon first makes a transverse incision on the skin between the distal palmar crease and proximal digital crease, then A1 pulley is directly visualised and transected. The success rates were reported to be 83% to 97% and recurrence rate was 3% [10- 12]. Several percutaneous methods to release A1 pulley have been advocated since 1958. Authors [11,12] have advised to release the A1 pulley using a hypodermic needle with varying rates of success from 89% to 100%. Yet other study [13] comparing the long-term results of open surgery and percutaneous for TF have reported excellent long-term results for percutaneous release as compared to open release techniques in terms of residual pain, stiffness, recurrence of triggering, nerve injury and patient satisfaction. Other studies [12,14-18] have concluded that percutaneous release is safe, effective, less painful, quicker procedure, and has significantly better results in rehabilitation when compared to open release. The study by King EB and Delarosa T [18] found no significant difference for all the variables evaluated in terms of recurrence of triggering, postoperative pain, time to recovery of motor function, time to recovery of full range of motion and patient satisfaction with regards to the procedure done and amount of scar formation, functional recovery and complications such as infection and digital nerve injury. Though recent literature [19-23] shows comparable success and complication rates for both the percutaneous and open release techniques, percutaneous release is still less preferred and less NIRAJ RANJEET 1 , KRISHNA SAPKOTA 2 , PABIN THAPA 3 , PRATYENTA RAJ ONTA 4 , KRISHNA WAHEGOANKAR 5 , UPENDRA JUNG THAPA 6 , HIMANSHU SHAH 7 Keywords: Open release technique, Percutaneous release group, Stenosing tenosynovitis ABSTRACT Introduction: Trigger Finger (TF) is frequently encountered problem by an orthopaedic surgeon which, if not managed, causes pain, discomfort and disability in hand function. Patient presents with pain at Metacarpo-phalangeal (MCP) or Proximal Inter-phalangeal (PIP) joint or clicking of the thumb, ring or long fingers. It is commonly caused by mismatch between the flexor sheath and the flexor tendon, which may be because of enlargement of the tendon or thickening of the fibrous flexor sheath of the first annular pulley. Aim: To compare percutaneous release with that of open surgery in terms of its effectiveness in releasing the A1 pulley and their complications and also to determine if the results are comparable with those observed in other studies. Materials and Methods: From January to December 2016, 56 patients presented to Manipal Teaching Hospital, Kaski, Nepal, with diagnosis of TF, were blindly randomised to two groups with 28 patients and 30 fingers each. One group was treated with percutaneous release while the other group was treated with open release. All the patients were followed up in OPD on two days, two weeks and eight weeks and were evaluated for postoperative pain, presence of infection, persistence or recurrence of triggering, presence of digital nerve injury and finger range of motion. Results: There was no statistical difference between the two groups with regard to the above parameters. Although, there was a trend to earlier return to full activities of daily living and full range of motion in the percutaneous group and also the complication rates were low and without any surgical scar, the difference was insignificant compared to the open release group. Conclusion: The present study recommend that both the open and percutaneous release is equally effective in treating TFs. Depending on the surgeon’s preference and experience the surgeon may opt to choose any of the surgical procedure for his patients.