Material and Methods
Study Population:
Patients diagnosed with trigger finger, aged 18 years or older, and classified under
Quinell's grade 2, 3, or 4, were included in the study [ ]. Recruitment took place at the
Outpatient Orthopedic Department of the Police General Hospital between October 2023 and
January 2024. Exclusion criteria encompassed individuals with a history of prior hand
surgery, Dupuytren's disease, type 1 diabetes, previous phalangeal fractures, recent steroid
injection within the last month, and autoimmune diseases.
Group allocation and Randomization:
Patients were enrolled and randomized into two groups, percutaneous A1 pulley release with
steroid injection (Group A) and percutaneous A1 pulley release alone (Group B), by utilizing
computer generate randomization and the results were put in opaque sealed envelopes. Informed
consent was obtained from all participants, and surgeries were performed by the same surgeon
(WJ).
Surgical Technique:
The surgical procedure followed Eastwood's method [ ], involving the following steps:
Preparation of the sterile field.
Injection of 1% lidocaine with epinephrine at the surgical site.
Insertion of an 18-gauge needle following the tract from the previous injection.
Patient extension of the finger to bring flexor tendons close to the skin, moving the
neurovascular structures away.
Slow penetration of the needle until it is over the A1 pulley.
Gentle flexion of the finger while observing the needle tip to prevent penetrating the
flexor tendon.
Rotation of the needle bevel into a longitudinal orientation to the flexor tendon.
Release of the A1 pulley by moving the needle upward and downward parallel to the flexor
tendon until complete release is achieved.
Withdrawal of the needle while hyperextending the finger.
Flexion and extension of the finger to check for triggering.
Injection of triamcinolone (40mg/ml) 1 ml in the study group.
Closure of the wound with a small elastic dressing.
Postoperative Protocols:
Both groups received identical postoperative protocols, including the same medications
(Augmentin, Naproxen, Tolperisone) for 7 days. Patients were encouraged for early finger
range of motion without restriction.
Outcome Measures:
The primary outcome measure was pain score assessed by the VAS. Secondary outcomes included
quality of life measured by the qDASH score, patient satisfaction, and surgical
complications.
Follow-Up:
All cases underwent follow-up via telephone on postoperative days 1 to 6, in the clinic
during the first and second weeks, and at 1 to 2 months postoperative.
Statistical analysis In this study, all data calculations were conducted using Stata software
(version 17.0). Group comparisons involved the application of Pearson's chi-squared test or
Continuity Correction chi-squared test for categorical variables, and the student's t-test
was employed for continuous variables. Statistically significant differences were defined as
those with a P-value < 0.05.
