Recurrent Diabetic Trigger Finger. Percutaneous or Open Release as Surgical Treatment is More Effective in Long-term Outcomes?

Stenosing Tenosynovitis is a common complication in diabetic patients. The release of the A1 pulley is the final treatment (open or percutaneous). The functional outcomes and complication rates of two methods (open versus percutaneous release) for recurrent trigger finger in diabetic patients are compared in this study.

Materials and Methods: 114 patients with diabetes mellitus and an average age of 48 years (range 28-64 yrs old) were treated for recurrent trigger finger. The modified Quinnell grading system was used as a selection criterion for the classification of trigger digit. The patients were divided in two groups randomly. Group A, included 52 patients who were treated with open release of A1 pulley and group B included 62 patients who were treated with percutaneous release using the tip of an 18-gauge or knife (Ophtalmic Corneal/ Scleral knife 19 Gauge).

Results: The median follow-up was 12 months (range from 10-14 months). The results were based on the Visual Analogue Scale (VAS), Quick Dash, and Gilberts & Wereldasma Questionnaire. At 3 months, the results seemed to be better in group B, while there was no statistical difference at six months and at one year postoperatively.

Conclusions: In long-term postoperative follow-up, both surgical approaches (open and percutaneous release) produced comparable therapeutic efficacy. The advantages though of the percutaneous release over the classic open method in short-term outcomes are: 1) low cost, 2) less complication rates and 3) immediate functional recovery.