Comparing Open to Percutaneous A1 Trigger Finger Release

Trigger finger occurs when a finger gets stuck in a flexed or bent position then releases into a straight position with a snap-like motion. Caused by the narrowing of the sheath that surrounds the tendon in the affected finger, the treatment often ends up being surgical. An open trigger release is considered the gold standard as it has a high success rate with little complications. It involves creating an incision to openly release the affected tendon.

Percutaneous trigger release is another option that is becoming increasingly more popular in recent years with proponents claiming that it is a much simpler procedure that often results in a less painful and faster recovery. It involves using a hypodermic needle or specially designed scalpel to release the affected tendon without an open incision. Percutaneous release can be done in an office setting, thus minimizing cost.

The research investigating effectiveness and complications associated with open A1 pulley release surgery treating trigger finger indicates success rates varying from a 60 per cent to 100 per cent rate of symptom resolution. Adverse effects with open trigger finger release may include infection, nerve injury, slow range of motion recovery or bowstringing. Research has looked at the rate of adverse effects with findings ranging from less than one per cent to five per cent. One study identified adverse effects occurring in 30 per cent of patients, but this particular study included swelling and pain as adverse effects.

Percutaneous A1 pulley release has also been the subject of research investigating effectiveness and rate of complication, though the research is not as strong as with A1 pulley release. Excluding the research of percutaneous release on thumbs, which is a procedure much more difficult to perform, and excluding cadaver studies, the success rates vary from 91 per cent 100 per cent. Complications of percutaneous release may include risk of incomplete release, superficial tendon abrasions, and neurovascular damage. Risk of these complications ranged from zero percent to 60 per cent, with the 60 per cent being primarily superficial tendon abrasions.

Comparing outcomes of open versus percutaneous A1 pulley release surgery shows that those undergoing percutaneous repair reported post-operative pain lasting only three days compared to almost six days for open repair. Return to work was four days for the percutaneous repair compared to seven and a half days for the open repair. According to these comparative studies, there was no difference between the two groups with regards to failure or complication rate.

Overall, percutaneous repair for trigger finger is promising in being both highly effective and economical, though strong research is lacking. As new techniques, such as ultrasound guided releases, and new equipment, such as specially designed scalpels, are introduced, randomized trials comparing these methods are warranted.