Efficacies of Different Managements in Patients With Trigger Finger

Comparing the Effectiveness of Peritendinous Steroid Injection Under Ultrasound Guidance With Percutaneous A1 Pulley Release in Trigger Finger Treatment

The aim of the study is to compare the effectiveness of peritendinous steroid injection under ultrasound guidance and percutaneous A1 pulley release procedures in terms of disease stage, pain, and severity of locking in patients with trigger finger.

Study Overview

• Status: Completed
• Conditions: Trigger Finger
• Intervention / Treatment: Other: The peritendinous Betamethasone group; Procedure: The percutaneous A1 pulley release

Detailed Description

This study was designed as a randomized, controlled, prospective study. Patients who had been experiencing trigger finger symptoms for at least one month and who presented to the Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, affiliated with the Health Sciences University Faculty of Medicine

Patients were randomly divided into two groups: the peritendinous steroid group (n=15) and the percutaneous pulley release group (n=15). In the first group, under ultrasound guidance, a mixture of 1 ml corticosteroid (2 mg+5 mg/ml betamethasone) and 1 ml local anesthetic (20 ml 2% prilocaine) was injected peritendinously between the A1 pulley and the flexor tendon sheath. In the second group, a percutaneous A1 pulley release procedure was performed under ultrasound guidance using a 20 G needle, followed by peritendinous injection of the same mixture of corticosteroid and local anesthetic.

Patients were evaluated four times: before treatment, at 1 week, 1 month, and 3 months after treatment. Modified Quinnel classification, VAS (Visual Analog Scale), and severity of locking scales were used as outcome measures in the study.

• Study Type: Observational
• Enrollment (Actual): 30

Contacts and Locations

Study Locations

• Turkey
  • Ankara, Turkey
    • Gaziler Physical Medicine and Rehabilitation Education and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

older 18 ages

Description

Inclusion Criteria:

• Being over 18 years of age
• Having had trigger finger complaints for more than 1 month
• Not having received any injections for trigger finger diagnosis within the last 1 month
• Signing the informed consent form indicating willingness to participate in the study

Exclusion Criteria:

• Refusing to participate in the study
• Presence of partial or complete tendon rupture in the relevant tendon of the finger to be treated
• Presence of wounds and infection in the area where the procedure will be performed
• Pregnancy status
• History of allergy to the injected medications (local anesthetic, steroid)

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
The peritendinous steroid group; A 1 ml mixture of corticosteroid (2 mg + 5 mg/ml betamethasone) and 1 ml of local anesthetic agent (20 ml 2% prilocaine) was injected peritendinously between the A1 pulley and the flexor tendon sheath at the metacarpophalangeal joint level under ultrasound guidance.	Other: The peritendinous Betamethasone group; USG-guided injection of corticosteroid between the A1 pulley and the flexor tendon sheath.
The percutaneous A1 pulley release group; In the A1 pulley release group, 1 ml of local anesthetic agent (20 ml 2% prilocaine) was injected into the pulley-associated subcutaneous tissue using a 27 G needle under ultrasound guidance. The metacarpophalangeal joint was brought into slight hyperextension. Subsequently, a 20 G 0.9x38mm needle, modified by bending approximately 40-45 degrees from the proximal 1/3 of the needle with the aid of a cap, was used. The needle was advanced in-plane from distal to proximal along the midline, with simultaneous movement towards the palmar surface, aiming to cut or loosen the pulley between the tendon and A1 pulley. The loosening procedure was repeated from the distal to proximal aspect of the pulley until the sensation of resistance at the needle tip disappeared.	Procedure: The percutaneous A1 pulley release; Ultrasound-guided percutaneous pulley release is a procedure aimed at loosening the pulley using various cutting instruments or hypodermic needles under ultrasound guidance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stage of the disease	Modified Quinnel classification Stage 1: Normal movement, no pain.; Stage 2: Normal movement, occasional pain.; Stage 3: Irregular movement (catching without crepitus or locking).; Stage 4: Locking present, actively correctable.; Stage 5: Locking present, passively correctable.	first week, first mount, third month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	The pain associated with movement in the relevant finger was evaluated using the Visual Analog Scale (VAS). Patients were explained that "0" represented no pain at all, "10" represented the most severe pain they had ever experienced in their life, and "5" represented moderate pain. They were asked to indicate a number between 0 and 10 that corresponded to the intensity of pain they were feeling.	first week, first month, third month
severity of triggering	The severity of catching in patients was assessed using a Numeric Rating Scale (NRS) ranging from 0 to 10. Patients were explained that "0" represents no catching at all, while "10" represents catching requiring passive correction of the finger. They were asked to mark a number between 0 and 10 corresponding to the severity of catching they experienced.	first week, first month, third month

Collaborators and Investigators

• Sponsor: Gaziler Physical Medicine and Rehabilitation Education and Research Hospital
• Investigators: Principal Investigator: zeliha gizem mac, MD, university of health sciences, Department of PM&R

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2022
• Primary Completion (Actual): June 30, 2023
• Study Completion (Actual): June 30, 2023

Study Registration Dates

• First Submitted: April 8, 2024
• First Submitted That Met QC Criteria: April 23, 2024
• First Posted (Actual): April 24, 2024

Study Record Updates

• Last Update Posted (Actual): June 6, 2024
• Last Update Submitted That Met QC Criteria: June 5, 2024
• Last Verified: June 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Muscular Diseases; Tendinopathy; Tendon Entrapment; Trigger Finger Disorder; Physiological Effects of Drugs; Anti-Inflammatory Agents; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Anti-Asthmatic Agents; Respiratory System Agents; Betamethasone
• Other Study ID Numbers: 43

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No