Ultrasound-Guided Percutaneous Versus Open A1 Pulley Release for Trigger Finger: A Randomized Controlled Trial
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Ethical Approval
2.2. Patient Selection
- Age ≥ 18 years.
- Diagnosis of according to Green’s classification stage 2–4 trigger finger.
- Symptoms lasting ≥3 months.
- No prior treatment (including corticosteroid injections, splinting, physiotherapy, or surgery) for the affected finger.
- According to Green’s classification stage 1 trigger finger.
- Previous surgery for trigger finger in the same region.
- Rheumatoid arthritis, osteoarthritis, or De Quervain’s tenosynovitis, Dupuytren’s disease.
- Bony deformities.
- Pregnancy.
2.3. Preoperative Evaluation
2.4. Surgical Techniques Open Release
2.5. Ultrasound-Guided Percutaneous Release
2.6. Postoperative Follow-Up
2.7. Statistical Analysis
3. Results
3.1. Functional Scores
- QuickDASH scores were significantly higher in the UGPR group on postoperative day 3 and at the first month (p < 0.05), but scores were comparable between groups at 6 and 12 months (Table 2).
- VAS and Nirschl Phase Rating Scale (NPRS) scores followed a similar trend: higher in the early period in the UGPR group, but no significant difference at the final follow-up (p > 0.05) (Table 2).
3.2. Grip Strength
- At 12 months, the pinch strength values measured with a digital pinchmeter were significantly higher in the UGPR group compared to the open surgery group (p < 0.05), indicating better long-term functional recovery (Table 3).
- Ultrasonographic Measurements.
- The increase in flexor tendon thickness at the metacarpophalangeal (MCP) joint level was significantly greater in the open surgery group (p < 0.05).
- No significant difference was observed between groups in A1 pulley thickness at 12 months (Table 4).
3.3. Complications
- A total of 6 patients (4.1%) experienced complications: 5 in the open surgery group and 1 in the UGPR group. Complications such as incomplete release occurred in 1 patient from the UGPR group. Additionally, revision surgery was required in 4 patients of the UGPR group due to persistent or recurrent triggering, which we reported separately from complications, but this difference did not reach statistical significance (p > 0.05).
- In the UGPR group, four complications/revisions were observed, while none occurred in the open surgery group. One stage 3 thumb case developed a flexor tendon rupture, identified at the first postoperative week, which required surgical repair. Two stage 3 patients experienced recurrent pain and tenosynovitis; one was managed with re-operation using open release, and the other with conservative treatment including steroid injection and physiotherapy. In one patient, digital artery and nerve injury occurred intraoperatively. All patients recovered satisfactorily, although mild residual paresthesia persisted in the neurovascular injury case. No revisions or major complications were noted in the open group.
4. Discussion
5. Limitations
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
UGPR | Ultrasound-guided percutaneous release |
kg | Kilograms |
ASHT | American Society of Hand Therapists |
NPRS | Nirschl Phase Rating Scale |
VAS | Visual Analog Scale |
QuickDASH | Quick Disabilities of the Arm, Shoulder, and Hand |
USG | Ultrasonographic |
MCP | Metacarpophalangeal |
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Method | ||||
---|---|---|---|---|
All Patients | USG (n = 75) | Open (n = 71) | p-Value | |
Age † | 58.3 ± 9.6 | 57.4 ± 10.1 | 59.2 ± 9.0 | 0.246 * |
Sex ‡ | ||||
Male | 37 (25.3) | 18 (24.0) | 19 (26.8) | 0.847 ** |
Female | 109 (74.7) | 57 (76.0) | 52 (73.2) | |
Finger ‡ | ||||
1 Finger | 67 (45.9) | 44 (58.7) | 23 (32.4) | 0.030 ** |
2 Finger | 11 (7.5) | 5 (6.7) | 6 (8.5) | |
3 Finger | 25 (17.1) | 9 (12.0) | 16 (22.5) | |
4 Finger | 38 (26.0) | 15 (20.0) | 23 (32.4) | |
5 Finger | 5 (3.4) | 2 (2.7) | 3 (4.2) | |
Hand Direction ‡ | ||||
Left | 54 (37.0) | 29 (38.7) | 25 (35.2) | 0.794 ** |
Right | 92 (63.0) | 46 (61.3) | 46 (64.8) | |
Green Classification ‡ | ||||
Stage 2 | 91 (62.3) | 52 (69.3) | 39 (54.9) | 0.212 ** |
Stage 3 | 51 (34.9) | 21 (28.0) | 30 (42.3) | |
Stage 4 | 4 (2.7) | 2 (2.7) | 2 (2.8) | |
Complication + ‡ | 6 (4.1) | 1 (1.3) | 5 (7.0) | 0.109 ** |
Revision, + ‡ | 4 (2.7) | 4 (5.3) | 0 (0.0) | 0.120 ** |
Method | ||||
USG (n = 75) | Open (n = 71) | p-Value | ||
VAS | ||||
0 | 6.0 [4.0–8.0] | 6.0 [4.0–8.0] | 0.409 | |
3 | 6.0 [4.0–9.0] | 4.0 [3.0–7.0] | <0.001 | |
1 Month | 2.0 [0.0–5.0] | 2.0 [0.0–4.0] | 0.053 | |
6 Month | 0.0 [0.0–3.0] | 0.0 [0.0–2.0] | 0.420 | |
12 Month | 0.0 [0.0–1.0] | 0.0 [0.0–1.0] | 0.561 | |
p-value ** | <0.001 | <0.001 |
Method | |||
---|---|---|---|
USG (n = 75) | Open (n = 71) | p-Value | |
DASH | |||
0 | 38.6 [25.0–61.3] | 40.9 [25.0–61.3] | 0.710 |
3 | 40.9 [25.0–61.3] | 34.0 [20.4–59.0] | <0.001 |
1 Month | 7.9 [4.5–43.1] | 4.5 [2.2–11.3] | <0.001 |
6 Month | 2.2 [0.0–4.5] | 2.2 [0.0–4.5] | 0.409 |
12 Month | 0.0 [0.0–9.0] | 0.0 [0.0–2.2] | 0.297 |
p-value ** | <0.001 | <0.001 | |
Method | |||
USG (n = 75) | Open (n = 71) | p-Value | |
NİRSCHL | |||
0 | 4.0 [2.0–6.0] | 4.0 [2.0–6.0] | 0.499 |
3 | 5.0 [3.0–7.0] | 3.0 [2.0–5.0] | <0.001 |
1 Month | 2.0 [0.0–5.0] | 2.0 [0.0–5.0] | 0.081 |
6 Month | 0.0 [0.0–2.0] | 0.0 [0.0–2.0] | 0.409 |
12 Month | 0.0 [0.0–1.0] | 0.0 [0.0–1.0] | 0.650 |
p-value ** | <0.001 | <0.001 |
Method | |||
---|---|---|---|
USG (n = 75) | Open (n = 71) | p-Value * | |
Pinchmetre | |||
0 | 4.2 [0.8–7.4] | 3.3 [0.6–7.1] | 0.059 |
12 Month | 5.2 [1.1–9.1] | 4.0 [1.1–9.3] | 0.008 |
p-value ** | <0.001 | <0.001 |
Method | |||
---|---|---|---|
USG (n = 75) | Open (n = 71) | p-Value * | |
Pulley Thickness | |||
0 | 1.4 [1.1–1.8] | 1.3 [0.9–1.7] | <0.053 |
12 Month | 0.4 [0.2–0.9] | - | - |
p-value ** | <0.001 | - | |
Δ Pulley thickness | −66.67 [−84.09–−40] | - | - |
Method | |||
USG (n = 75) | Open (n = 71) | p-Value * | |
MCP fleksör Tend | |||
0 | 3.4 [2.7–5.0] | 3.1 [2.6–4.1] | <0.001 |
12 Month | 3.8 [2.8–6.3] | 3.6 [2.8–4.5] | 0.086 |
p-value ** | <0.001 | <0.001 | |
Δ MCP flexor tendon | 7.14 [−21.62–85.29] | 12.43 [−3.23–22.92] | <0.001 |
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Öner, S.K.; Demirkiran, N.D.; Dulgeroglu, T.C.; Kuyubasi, S.N.; Kozlu, S.; Yılmaz, S. Ultrasound-Guided Percutaneous Versus Open A1 Pulley Release for Trigger Finger: A Randomized Controlled Trial. J. Clin. Med. 2025, 14, 7064. https://doi.org/10.3390/jcm14197064
Öner SK, Demirkiran ND, Dulgeroglu TC, Kuyubasi SN, Kozlu S, Yılmaz S. Ultrasound-Guided Percutaneous Versus Open A1 Pulley Release for Trigger Finger: A Randomized Controlled Trial. Journal of Clinical Medicine. 2025; 14(19):7064. https://doi.org/10.3390/jcm14197064
Chicago/Turabian StyleÖner, Süleyman Kaan, Nihat Demirhan Demirkiran, Turan Cihan Dulgeroglu, Sabit Numan Kuyubasi, Suleyman Kozlu, and Selçuk Yılmaz. 2025. "Ultrasound-Guided Percutaneous Versus Open A1 Pulley Release for Trigger Finger: A Randomized Controlled Trial" Journal of Clinical Medicine 14, no. 19: 7064. https://doi.org/10.3390/jcm14197064
APA StyleÖner, S. K., Demirkiran, N. D., Dulgeroglu, T. C., Kuyubasi, S. N., Kozlu, S., & Yılmaz, S. (2025). Ultrasound-Guided Percutaneous Versus Open A1 Pulley Release for Trigger Finger: A Randomized Controlled Trial. Journal of Clinical Medicine, 14(19), 7064. https://doi.org/10.3390/jcm14197064