Percutaneous release of trigger thumb: do we really need steroid?

Abstract

We would like to comment on the article by Cebesoy et al. entitled “Percutaneous release of the trigger thumb: is it safe, cheap and effective?” [2]. First, we would like to congratulate the authors for their contribution to the relevant literature. We know that percutaneous A1 pulley release is being increasingly used as an alternative to open surgical release and conservative treatment of the trigger digit. However, most hand surgeons are hesitant to release the A1 pulley of thumb percutaneously due to the close proximity to the digital nerve. That is why most surgeons choose open surgery or steroid injection alone for the trigger thumb. In the authors’ study, 84% of trigger thumbs (21 of 25) were cured by percutaneous release of the A1 pulley with steroid injection [2]. In a recent valuable study, authors found that a percutaneous trigger digit release resulted in high percentage of successful releases of A1 with no steroid injection [1, 3, 4]. In another study, steroids are found to be a highly effective treatment of trigger digits [5]. In the authors’ study, was this high success rate related more to percutaneous release or more related with steroid injection? And what is the contribution of steroid injection to this procedure? The authors’ study is extremely valuable, but if they had an isolated control group consisting of patients treated by percutaneous release of A1 pulley or by steroid injection group, then the comparison and distinction would be much easier. We agree with the authors: percutaneous release is a safe and effective technique which provides significant cost savings. But do we need to increase this cost by using steroids?