Introduction
Stenosing tenosynovitis, or trigger finger, is a commonly treated hand pathology in primary care, orthopedic hand surgery and plastic surgery. Traditionally, trigger finger has been treated in an open fashion using a longitudinal incision at the palm of the hand. The increased trend toward minimally invasive surgical techniques has shifted more light on percutaneous and endoscopic surgical treatment methods. While multiple studies have compared open and percutaneous release, further analysis of endoscopic release is warranted. The purpose of this study is to retrospectively compare endoscopic trigger finger release (ETFR) and open trigger finger release (OTFR) for associated complications and potential risk-factors that may increase the incidence of complications.
Methods
118 patients, comprising 123 cases (191 digits), who failed conservative treatment for trigger finger were admitted to an outpatient surgery center for surgical treatment. 74 cases (128 digits) were treated using OTFR and 49 cases (63 digits) were treated using ETFR. Patient charts were retrospectively reviewed and assessed for major and minor complications. Major complication categories included: need for revision surgery, digital nerve injury, flexor tendon injury, A2 pulley severance, and chronic regional pain syndrome (CRPS). Minor complication categories included: wound complications, tenderness to palpation, persistent swelling, stiffness, clicking/re-triggering, and post-operative injections. Secondary outcomes including procedural time, tourniquet time, and patient reported pain scores using Visual Analog Scale (VAS) were also recorded.
Results
On average, there was no statistical difference in procedural time between groups, however cases treated with OTFR reported having a longer tourniquet time than ETFR (22 and 15 minutes, respectively) (p<0.05). No major complications were reported for ETFR and two major complications (3%) were reported for OTFR; both being post-operative CRPS. Patients who underwent OTFR reported a higher rate of post-operative minor complications (27% vs 8%) compared with ETFR cases (p<0.05). Among minor complications, OTFR cases reported both a significantly higher rate of persistent digit stiffness (19% vs 2%) and incidence of post-operative injections (14% vs 2%) compared with ETFR cases (p<0.05). Both dominant hand injury (85%) and concomitant ipsilateral procedures (85%) were associated with significant increases in complication risk in the OTFR group (p<0.05). When comparing ETFR and OTFR techniques, patients reported significantly less trigger finger-related pain in the ETFR group at 0-4-weeks (2.1 vs. 4.7), 4-8-weeks (1.6 vs. 4) and 8-12-weeks (0.6 vs. 5) (p<0.05).
Conclusions
Our study retrospectively compared two groups of patients receiving either endoscopic or open trigger finger release surgery. Patients in our Open cohort were statistically more likely to encounter minor post-operative complications and report higher post-operative pain levels compared to our Endoscopic cohort. Furthermore, our results suggest that concomitant ipsilateral procedures significantly increases the risk for complication in open trigger finger surgery.