Early Postoperative Function After Open Versus Ultrasound-Guided Trigger Finger Release

Massachusetts General Hospital60 enrolled

Overview

Clinical outcomes after open trigger finger release are excellent. Minimally invasive techiques with ultrasound guidance theoretically offer advantages for faster recovery but this technique has not been compared prospectively with the standard of care (open trigger release). This study aims to prospectively analyze patient-reported outcomes in patients undergoing open vs. ultrasound-guided trigger finger release.

Trigger finger is initially treated conservatively. Conservative treatment options include modification of activities, painkiller administration, splinting, and corticosteroid injections (1). Open or minimally invasive surgical treatment can be considered if conservative treatment fails. Minimally invasive surgery options consist of ultrasound-guided or blind percutaneous trigger finger release. Many studies have reported good clinical outcomes after ultrasound-guided trigger finger release, including low rates of catching or locking recurrence rates, high QuickDASH scores and high patient satisfaction (2-4). Postoperative clinical outcomes of open surgery have been widely compared to percutaneous surgery (5-8). However, the comparison of postoperative results between ultrasound-guided and open trigger finger release has been scarcely reported. Nikolaou et al. reported that ultrasound-guided trigger finger release resulted in a significantly sooner return to normal activities and better patient-reported cosmetic outcomes than open trigger finger release (9). Success rates and mean QuickDASH scores did not differ significantly between these groups in this cohort. The potential benefits of ultrasound-guided trigger finger release compared to open trigger finger release have yet to be investigated. This study aims to prospectively analyze patient-reported outcomes in patients undergoing open vs. ultrasound-guided trigger finger release.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Trigger Finger

Interventions

UltraGuideTFR (Sonex Health, MN, USA)DEVICE

SonexHealth percutaneous trigger finger release device used in ultrasound-guided release cohort

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * undergoing trigger finger release for the index through small fingers due to symptoms refractory to conservative treatment and elected for surgical intervention through shared decision-making * English-speaking adults (≥18 years of age) * Patients with inflammatory arthritis were included if their diagnosis had been established ≥5 years prior without exacerbations in the past 5 years. Those on immunomodulatory therapy were required to have been on a stable regimen for ≥5 years without flare-ups. Exclusion Criteria: * prior surgery on the affected finger * corticosteroid injection in the affected hand within 6 weeks * additional hand or wrist pathology requiring concurrent surgery * symptomatic trigger finger in the contralateral extremity * prior surgical pulley release in either hand within 6 months of enrollment * Systemic inflammatory disease (e.g., rheumatoid arthritis, lupus) not controlled * inflammatory arthritis if diagnosis established \<5 years, exacerbation within the past 5 years, or modifications to immunomodulatory therapy within 5 years of enrollment * Amyloidosis * Diabetes not controlled by a stable dose of medication over the past three months * Pregnant or planning pregnancy in the next 6 months * Workers' compensation subjects * Inability to provide a legally acceptable Informed Consent Form and/or comply with all follow-up requirements, including patients who do not speak English * other medical, social, or psychological conditions that, in the opinion of the investigator, preclude them from receiving the pre-treatment, required treatment, and post-treatment procedures and evaluations. * Trigger Thumb

Locations (2)

Brigham and Women's Hospital

Boston, Massachusetts, United States

Massachusetts General Hospital

Boston, Massachusetts, United States

Outcomes

Primary Outcomes

Activities of Daily Living (Study-specific questionnaire)

Study-specific survey of limitations with Activities of Daily Living. Responses for questions on the study-specific survey for limitations with ADLS utilized a Likert scale with 1 representing no difficulty with the task and 5 being unable to perform the task due to limitations from trigger finger symptoms. Likert scale responses for the 12 ADLs on the survey were summated for final scores ranging from 14 (no difficulty with any ADLs) to 70 (unable to perform any ADLs). These were standardized to a 100-point scale to facilitate clinical interpretation of outcomes. A score of 0 represented no functional limitations with ADLs and a score of 100 represented inability to perform any ADL on the survey.

Time frame: From enrollment to final follow-up at 6 months

Pain on the Visual Analogue Scale

VAS pain score on a scale from 1 to 10 with a score of 1 representating no pain and score or 10 representing maximal pain.

Time frame: From enrollment to final follow-up at 6 months

Secondary Outcomes

Timing of Return to work

Timing of return to work in days as reported by patient. Minimum value is 0 days, meaning patient reported returning to work on the day of the procedure. No maximum value applicable.

Time frame: From 2 days post-procedure to final follow-up at 6 months

Patient satisfaction with procedure

Patient reported satisfaction with procedure. Response of either yes or no to the following question: Are you satisfied with the procedure, and would you choose to have it again for a similar problem?

Time frame: Single evaluation at final follow-up 6 months post-procedure

Data from ClinicalTrials.gov

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