SIR 2024
Pain Management/MSK
Sarah Raed Amro, MD (she/her/hers)
Clinical fellow
George Eliot hospital Trust , United Kingdom
Financial relationships: Full list of relationships is listed on the CME information page.
Muataz Kashbour, MD
Radiology Resident
National Cancer instiutte- Misrata, Libya
Disclosure information not submitted.
Mahmoud Shaban Abdelgalil, MBBS
Medical student
Faculty of Medicine, Ain-shams University, Cairo, Egypt., Egypt
Disclosure information not submitted.
Ruaa Qafesha, MD
Medical doctor
faculty of medicine, Al-Quds university, Jerusalem, Palestine, Palestinian Territories
Disclosure information not submitted.
Hatem Eldeeb, MBBS
Medical student
faculty of medicine, Alazhar university, Cairo, Egypt, Egypt
Disclosure information not submitted.
We systematically searched PubMed, Scopus, Embase, and the Cochrane Library to identify relevant studies. Inclusion criteria were studies evaluating ultrasound-guided release of trigger finger (grade 2 and higher) compared to open surgical release. Screening and data extraction were performed with data documented by multiple blinded independent reviewers. A meta-analysis was performed to assess effectiveness, utilizing appropriate statistical methods to address heterogeneity. Primary outcome measures included the "Quick Disability of Arm, Shoulder, and Hand" (QDASH) score, Grip strength, and the Visual Analogue Scale (VAS). Secondary outcome measures included Days of stopping analgesia, full-digit flexion, full-digit extension, days to return to normal activities, pinch strength, and bow strengthening.
Results: Out of the initial pool of 820 studies, five met the inclusion criteria, including 275 patients with 283 trigger digits. The analysis revealed significant differences favoring the ultrasound-guided release group over the surgical group for improvement in QDASH score in the first month (std.MD -0.48, 95% CI [0.75 to -0.2], P=0.0007, I² = 20%). The difference was not statistically significant in the 3-month follow-up period (std.MD -2.25, 95% CI [-0.54 to 0.05], P=0.1, I² = 0%). Additionally, there is a significant difference in the days required for return to normal activities in favor of the ultrasound release approach (MD -13.78, 95% CI -16.68 to 10.89, P=0.00001, I² = 68%). The data displayed heterogeneity, which was resolved through sensitivity analysis that also favored the ultrasound-guided group. In terms of grip strength, days of stopping analgesia, and full-digit extension, no significant differences were observed.
Conclusion: Ultrasound-guided release approach demonstrated significant advantages over the open surgical release approach, leading to improved QDASH score in the first month post-procedure and a quicker return to normal activities. These findings hold substantial clinical importance, as they offer patients a swift, minimally invasive, and highly successful alternative to open surgery, thereby eliminating the associated risks{1}.