Trigger finger, also known as trigger digit or stenosing tenovaginitis, is caused by a size mismatch between the flexor tendon and the A1 pulley, which is generally characterized by pain, swelling, the limitation of finger range of motion and a symptomatic locking or clicking sensation. Conservative treatment options include the application of non-steroidal anti-inflammatory drugs (NSAID), physiotherapy, electrotherapy, splinting and corticosteroid injection but not always effective with regard to frequent recurrence. Open surgical release of the A1 pulley remains the gold standard of treating symptomatic trigger finger. While percutaneous release is a minimal invasive alternative and gaining popularity for the index, middle ring and little fingers, investigations for the surgical efficacy on thumb is few and far between. Investigators believe that a carefully conducted operation with proper positioning of the thumb, wide-awake approach and meticulous technique can achieve similar efficacy and safety in terms of possibly less intraoperative pain, imperceptible scar and early return to daily activities and routine work. The hypothesis of this study is that by using a proper positioning of thumb, wide awake approach and meticulous technique in conducting percutaneous release of trigger thumb can achieve similar efficacy and safety compared to that of open release surgical method. Moreover, percutaneous release of trigger thumb can generate less intraoperative pain, imperceptible scar and promote early return to routine work. Hence, the objective of this study is to investigate and compare the safety, effectiveness and outcome of percutaneous release versus traditional open release for trigger thumbs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
Open surgical release of the A1 pulley is the gold standard of treating symptomatic trigger finger
Percutaneous release is a minimal invasive alternative surgical procedure
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong
Hong Kong, Hong Kong
Total volume of local anaesthetics injected
The total volume of local anaesthetics injected during operation
Time frame: Intra-operative
Duration of surgery (in minutes)
The time (in minutes) needed for operation
Time frame: Intra-operative
Surgical site pain
Visual analogue scale (VAS) was used to evaluate the pain at surgical site (0=no pain and 10=greatest pain)
Time frame: Intra-operative
Active and passive range of motion (ROM) of interphalangeal joint (IPJ) and metacarpal-phalangeal joint (MPJ)
Pre-operative active and passive ROM of IPJ and MPJ was measured to determine the joint stiffness
Time frame: Pre-operative
Active and passive range of motion (ROM) of interphalangeal joint (IPJ) and metacarpal-phalangeal joint (MPJ)
Active and passive ROM of IPJ and MPJ was measured post-operatively to determine the joint stiffness
Time frame: Post-op Day 7
Active and passive range of motion (ROM) of interphalangeal joint (IPJ) and metacarpal-phalangeal joint (MPJ)
Active and passive ROM of IPJ and MPJ was measured post-operatively to determine the joint stiffness
Time frame: Post-op Day 28
Active and passive range of motion (ROM) of interphalangeal joint (IPJ) and metacarpal-phalangeal joint (MPJ)
Active and passive ROM of IPJ and MPJ was measured post-operatively to determine the joint stiffness
Time frame: Post-op Day 90
Pre-operative Kapandji score
Kapandji score is a tool useful for assessing the opposition of the thumb, based on where on their hand the patient is able to touch with the tip of their thumb.
Time frame: Pre-operative
Post-operative Kapandi score
Kapandji score is a tool useful for assessing the opposition of the thumb, based on where on their hand the patient is able to touch with the tip of their thumb.
Time frame: Post-op Day 7
Post-operative Kapandi score
Kapandji score is a tool useful for assessing the opposition of the thumb, based on where on their hand the patient is able to touch with the tip of their thumb.
Time frame: Post-op Day 28
Post-operative Kapandi score
Kapandji score is a tool useful for assessing the opposition of the thumb, based on where on their hand the patient is able to touch with the tip of their thumb.
Time frame: Post-op Day 90
Pre-operative Disabilities of the Arm, Shoulder and Hand (DASH) scores, including total, function, symptoms and work
The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100.
Time frame: Pre-operative
Post-operative Disabilities of the Arm, Shoulder and Hand (DASH) scores, including total, function, symptoms and work
The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100.
Time frame: Post-op Day 7
Post-operative Disabilities of the Arm, Shoulder and Hand (DASH) scores, including total, function, symptoms and work
The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100.
Time frame: Post-op Day 28
Post-operative Disabilities of the Arm, Shoulder and Hand (DASH) scores, including total, function, symptoms and work
The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100.
Time frame: Post-op Day 90
Pre-operative pain at rest
Visual analogue scale (VAS) was used to evaluate the pain at rest (0=no pain, 10=greatest pain)
Time frame: Pre-opeartively
Post-operative pain at rest
Visual analogue scale (VAS) was used to evaluate the pain at rest (0=no pain, 10=greatest pain)
Time frame: Post-op Day 7
Post-operative pain at rest
Visual analogue scale (VAS) was used to evaluate the pain at rest (0=no pain, 10=greatest pain)
Time frame: Post-op Day 28
Post-operative pain at rest
Visual analogue scale (VAS) was used to evaluate the pain at rest (0=no pain, 10=greatest pain)
Time frame: Post-op Day 90
Pre-operative pain on exertion
Visual analogue scale (VAS) was used to evaluate the pain on exertion (0=no pain, 10=greatest pain)
Time frame: Pre-operative
Post-operative pain on exertion
Visual analogue scale (VAS) was used to evaluate the pain on exertion (0=no pain, 10=greatest pain)
Time frame: Post-op Day 7
Post-operative pain on exertion
Visual analogue scale (VAS) was used to evaluate the pain on exertion (0=no pain, 10=greatest pain)
Time frame: Post-op Day 28
Post-operative pain on exertion
Visual analogue scale (VAS) was used to evaluate the pain on exertion (0=no pain, 10=greatest pain)
Time frame: Post-op Day 90
Satisfaction level after surgery
Subjects' satisfaction was evaluated (1=totally not satisfied; 10=totally satisfied) after surgery
Time frame: Post-op Day 7
Satisfaction level after surgery
Subjects' satisfaction was evaluated (1=totally not satisfied; 10=totally satisfied) after surgery
Time frame: Post-op Day 28
Satisfaction level after surgery
Subjects' satisfaction was evaluated (1=totally not satisfied; 10=totally satisfied) after surgery
Time frame: Post-op Day 91
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