[x_section bg_color=”#1e73be” style=”margin: 0px 0px 0px 0px; padding: 45px 0px 45px 0px; “][x_row inner_container=”true” marginless_columns=”false” bg_color=”” style=”margin: 0px auto 0px auto; padding: 0px 0px 0px 0px; “][x_column bg_color=”” type=”1/1″ style=”padding: 0px 0px 0px 0px; “][x_raw_content][/x_raw_content][/x_column][/x_row][/x_section][x_section style=”margin: 0px 0px 0px 0px; padding: 0px 0px 0px 0px; “][x_row inner_container=”true” marginless_columns=”false” bg_color=”” style=”margin: 0px auto 0px auto; padding: 0px 0px 0px 0px; “][x_column bg_color=”#ffffff” type=”2/3″ class=”left-text ” style=”padding: 0px 0px 0px 0px; “][x_gap size=”20px”][x_custom_headline level=”h2″ looks_like=”h3″ accent=”false”]TRIGGER Trial[/x_custom_headline][x_text] 

Trigger finger is one of the most common conditions seen by hand surgeons. Different non-operative treatments (e.g. physiotherapy, splinting and NSAIDs) have been described with little evidence to support the usage. The mainstay of non-operative treatment remains intermediate-acting steroid injection with or without a local anesthetic added. Operative management is by release of the A1 pulley, either percutaneously or with open surgery.

A recent systematic review showed moderate evidence that steroid injections are an effective initial treatment for trigger fingers. However, this evidence is based on two small studies of poor quality with a short follow-up of just four months. There is high quality evidence that trigger digits can be managed safely by open or percutaneous surgical release, but there are only 3 RCTs with several shortcomings comparing steroid injection with surgery.

We propose a large, international, multicenter, randomized controlled trial to compare steroid injection and surgery in treating trigger fingers with follow-up of one year. At the end of this study we should be able to make an evidence-based recommendation on how to treat a patient with a trigger finger.

Population: Adults with ≥ 1 trigger fingers

Intervention: Surgical release using surgeon’s preferred technique (open or percutaneous)

Control: ≥ 1 injections with steroid injection (steroid of choice, with or without local anesthetic added)

Outcome:

  • Primary outcome: resolution of triggering
  • Secondary outcome: level of pain, hand function (PROM), costs and complications
  • Subgroup analysis: type of surgery, type of injection, thumb vs long digits, diabetes, rheumatoid arthritis
  • Follow-up: 6 and 12 months

[/x_text][x_custom_headline level=”h2″ looks_like=”h3″ accent=”false”]Getting involved[/x_custom_headline][x_text]Thank you to all of the collaborators involved in the TRIGGER Survey. The study is finished and data is being analysed. It was presented on Friday 15th June at FESSH.[/x_text][x_gap size=”50px”][/x_column][x_column bg_color=”” type=”1/3″ style=”padding: 0px 0px 0px 0px; “][x_gap size=”20px”][x_image type=”none” src=”” alt=”” link=”false” href=”#” title=”” target=”” info=”none” info_place=”top” info_trigger=”hover” info_content=””][x_gap size=”20px”][x_accordion][x_accordion_item title=”Status” open=”true”][icon_list] [icon_list_item type=”square”]Clinician survey [/icon_list_item] [icon_list_item type=”square-o”]University ethics approval [/icon_list_item][icon_list_item type=”square-o”]Data collection [/icon_list_item] [icon_list_item type=”square-o”]Data analysis[/icon_list_item] [icon_list_item type=”square-o”]Manuscript submission [/icon_list_item][icon_list_item type=”square-o”]Publication [/icon_list_item][/icon_list] [/x_accordion_item][x_accordion_item title=”Steering group” open=”false”]Anita Dijksterhuis
Plastic Surgery Trainee
Jeroen Bosch Hospital
The Netherlands

Brigitte van der Heijden
Consultant Hand Surgeon
Jeroen Bosch Hospital
The Netherlands

Jan Debeij
The Netherlands

Henk Coert
The Netherlands

Richard Pinder
Consultant Hand Surgeon
Hull, UK

Jeremy Rodrigues
NIHR Academic Clinical Fellow in Plastic Surgery
NDORMS
University of Oxford, UK

Matthew D. Gardiner
Kennedy Institute of Rheumatology
University of Oxford, UK

Zaf Naqui
Manchester, UK

Abhilash Jain
NDORMS
University of Oxford, UK[/x_accordion_item][x_accordion_item title=”Collaborators” open=”false”]Collaborators will be listed here in due course.[/x_accordion_item][x_accordion_item title=”Trials Unit” open=”false”]SITU, NDORMS, University of Oxford[/x_accordion_item][x_accordion_item title=”Funding” open=”false”]£20K BAPRAS Pump Priming Award for Clinical Trials[/x_accordion_item][x_accordion_item title=”Downloads” open=”false”]No downloads available.[/x_accordion_item][x_accordion_item title=”Contact” open=”true”]triggertrial@gmail.com[/x_accordion_item][/x_accordion][/x_column][/x_row][/x_section][x_section bg_color=”#ffffff” style=”margin: 0px 0px 0px 0px; padding: 45px 0px 45px 0px; “][x_row inner_container=”true” marginless_columns=”false” bg_color=”#ffffff” style=”margin: 0px auto 0px auto; padding: 0px 0px 0px 0px; “][x_column bg_color=”#ffffff” type=”2/3″ style=”padding: 0px 0px 0px 0px; “][x_custom_headline level=”h2″ looks_like=”h3″ accent=”false”]Trigger Finger Webinar[/x_custom_headline][x_text]Date: Wednesday 21st February
Time: 1900-2100 GMT (London)
Location: Zoom webinar service
Thank you to those that attended. Certificates will be sent shortly.
[/x_text][x_text]Who should attend?

  • Clinicians who treat trigger finger and would like to find out about the current evidence.
  • Clinicians interested in designing a randomised controlled trial relating to the treatment of trigger finger.

Learning objectives

Programme – Starts 1900 GMT (London time)

1900 Welcome and introduction to the webinar. Mr Richard Pinder MD FRCS(Plast) DipHandSurg, Hull, UK
1910 Trigger fingers: how do you treat them? Emmi Friedman MD EPOBRAS, Jeroen Bosch Hospital, Den Bosch, The Netherlands
1920 Discussion
1930 BEST Guidelines for trigger finger. Jeremy Rodrigues MD PhD, University of Oxford, UK
1940 Discussion
2000 Power of research collaboratives. Matt Gardiner MD PhD FRCS(Plast), Oxford, UK
2020 Introducing the TRIGGER Trial. Anita Dijksterhuis MD, UMC Utrecht, The Netherlands
2030 Discussion and brainstorming RCT
2100 Close

Certificates of attendance will be emailed to those at the close of the meeting.[/x_text][/x_column][x_column bg_color=”” type=”1/3″ style=”padding: 0px 0px 0px 0px; “] [/x_column][/x_row][x_row inner_container=”true” marginless_columns=”false” bg_color=”” style=”margin: 0px auto 0px auto; padding: 0px 0px 0px 0px; “][x_column bg_color=”#ffffff” type=”2/3″ style=”padding: 0px 0px 0px 0px; “][x_custom_headline level=”h2″ looks_like=”h3″ accent=”false”]The Trigger Webinar Panel[/x_custom_headline][/x_column][x_column bg_color=”” type=”1/3″ style=”padding: 0px 0px 0px 0px; “][x_gap size=”50px”][/x_column][/x_row][x_row inner_container=”true” marginless_columns=”false” bg_color=”” style=”margin: 0px auto 0px auto; padding: 0px 0px 0px 0px; “][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “][x_image type=”circle” src=”https://reconstructivesurgerytrials.net/wp-content/uploads/2018/02/Pinder-e1519085067233.jpg” alt=”” link=”false” href=”#” title=”” target=”” info=”none” info_place=”top” info_trigger=”hover” info_content=””][x_text]Richard Pinder[/x_text][/x_column][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “][x_image type=”circle” src=”https://reconstructivesurgerytrials.net/wp-content/uploads/2018/02/2018-02-21-PHOTO-00000545-e1519236101382.jpg” alt=”” link=”false” href=”#” title=”” target=”” info=”none” info_place=”top” info_trigger=”hover” info_content=””][x_text]Emmi Friedeman[/x_text][/x_column][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “][x_image type=”circle” src=”https://reconstructivesurgerytrials.net/wp-content/uploads/2017/04/Gardiner.jpeg” alt=”” link=”false” href=”#” title=”” target=”” info=”none” info_place=”top” info_trigger=”hover” info_content=””][x_text]Matt Gardiner[/x_text][/x_column][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “][x_image type=”circle” src=”https://reconstructivesurgerytrials.net/wp-content/uploads/2017/04/Rodrigues.jpg” alt=”” link=”false” href=”#” title=”” target=”” info=”none” info_place=”top” info_trigger=”hover” info_content=””][x_text]Jeremy Rodrigues[/x_text][/x_column][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “][x_image type=”circle” src=”https://reconstructivesurgerytrials.net/wp-content/uploads/2018/02/Dijksterhuis.jpg” alt=”” link=”false” href=”#” title=”” target=”” info=”none” info_place=”top” info_trigger=”hover” info_content=””][x_text]Anita Dijksterhuis[/x_text][/x_column][/x_row][x_row inner_container=”true” marginless_columns=”false” bg_color=”” style=”margin: 0px auto 0px auto; padding: 0px 0px 0px 0px; “][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “][x_image type=”circle” src=”https://reconstructivesurgerytrials.net/wp-content/uploads/2018/02/TD–e1519236234806.jpeg” alt=”” link=”false” href=”#” title=”” target=”” info=”none” info_place=”top” info_trigger=”hover” info_content=””][x_text]Tim Davis[/x_text][/x_column][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “][x_image type=”circle” src=”https://reconstructivesurgerytrials.net/wp-content/uploads/2015/11/Abhi-photo-e1447227924381.jpg” alt=”” link=”false” href=”#” title=”” target=”” info=”none” info_place=”top” info_trigger=”hover” info_content=””][x_text]Abhi Jain[/x_text][/x_column][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “] [/x_column][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “] [/x_column][x_column bg_color=”” type=”1/5″ style=”padding: 0px 0px 0px 0px; “] [/x_column][/x_row][/x_section]