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

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.