Surgery for trigger finger

Haroldo Junior Fiorini; Marcel Jun Tamaoki; Mário Lenza; Joao Baptista Gomes dos Santos; Flávio Faloppa; Joao carlos Belloti

doi:10.1002/14651858.CD009860.pub2

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Figure 1

Study flow diagram.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Open surgery versus steroid injection, Outcome 1 Resolution of trigger finger.

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Analysis 1.2

Comparison 1 Open surgery versus steroid injection, Outcome 2 Pain on the palm of the hand.

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Analysis 1.3

Comparison 1 Open surgery versus steroid injection, Outcome 3 Pain (1 to 10 scale).

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Analysis 1.4

Comparison 1 Open surgery versus steroid injection, Outcome 4 Frequency of recurrence.

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Analysis 1.5

Comparison 1 Open surgery versus steroid injection, Outcome 5 Adverse events.

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Analysis 1.6

Comparison 1 Open surgery versus steroid injection, Outcome 6 Neurovascular injury.

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Analysis 1.7

Comparison 1 Open surgery versus steroid injection, Outcome 7 Subgroup analyses for resolution.

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Analysis 1.8

Comparison 1 Open surgery versus steroid injection, Outcome 8 Subgroup analyses for recurrence.

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Analysis 2.1

Comparison 2 Percutaneous surgery versus steroid injection, Outcome 1 Resolution of trigger finger.

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Analysis 2.2

Comparison 2 Percutaneous surgery versus steroid injection, Outcome 2 Pain (VAS: 0 to 10 scale).

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Analysis 2.3

Comparison 2 Percutaneous surgery versus steroid injection, Outcome 3 Pain on the palm of the hand.

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Analysis 2.4

Comparison 2 Percutaneous surgery versus steroid injection, Outcome 4 Frequency of recurrence.

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Analysis 2.5

Comparison 2 Percutaneous surgery versus steroid injection, Outcome 5 Adverse events.

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Analysis 2.6

Comparison 2 Percutaneous surgery versus steroid injection, Outcome 6 Neurovascular injury.

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Analysis 2.7

Comparison 2 Percutaneous surgery versus steroid injection, Outcome 7 Subgroup analyses for resolution.

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Analysis 2.8

Comparison 2 Percutaneous surgery versus steroid injection, Outcome 8 Subgroup analyses for recurrence.

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Analysis 3.1

Comparison 3 Open surgery versus steroid injection plus hyaluronic acid injection guided by ultrasound, Outcome 1 Resolution of trigger finger.

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Analysis 3.2

Comparison 3 Open surgery versus steroid injection plus hyaluronic acid injection guided by ultrasound, Outcome 2 Frequency of recurrence.

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Analysis 3.3

Comparison 3 Open surgery versus steroid injection plus hyaluronic acid injection guided by ultrasound, Outcome 3 Adverse events.

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Analysis 4.1

Comparison 4 Percutaneous surgery plus steroid injection versus steroid injection, Outcome 1 Resolution of trigger finger.

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Analysis 4.2

Comparison 4 Percutaneous surgery plus steroid injection versus steroid injection, Outcome 2 Adverse events.

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Analysis 4.3

Comparison 4 Percutaneous surgery plus steroid injection versus steroid injection, Outcome 3 Neurovascular injury.

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Analysis 5.1

Comparison 5 Percutaneous surgery versus open surgery, Outcome 1 Resolution of trigger finger.

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Analysis 5.2

Comparison 5 Percutaneous surgery versus open surgery, Outcome 2 Pain (1 to 6 scale).

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Analysis 5.3

Comparison 5 Percutaneous surgery versus open surgery, Outcome 3 Pain on the palm of the hand.

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Analysis 5.4

Comparison 5 Percutaneous surgery versus open surgery, Outcome 4 Frequency of recurrence.

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Analysis 5.5

Comparison 5 Percutaneous surgery versus open surgery, Outcome 5 Adverse events.

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Analysis 5.6

Comparison 5 Percutaneous surgery versus open surgery, Outcome 6 Subgroup analyses for resolution.

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Analysis 5.7

Comparison 5 Percutaneous surgery versus open surgery, Outcome 7 Subgroup analyses for recurrence.

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Analysis 6.1

Comparison 6 Endoscopic surgery versus open surgery, Outcome 1 Resolution of trigger finger.

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Analysis 6.2

Comparison 6 Endoscopic surgery versus open surgery, Outcome 2 Adverse events.

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Analysis 6.3

Comparison 6 Endoscopic surgery versus open surgery, Outcome 3 Neurovascular injury.

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Analysis 7.1

Comparison 7 Open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease versus open surgery by longitudinal incision of the skin, Outcome 1 DASH score.

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Analysis 8.1

Comparison 8 Open surgery by transverse incision of the skin in the distal palmar crease versus open surgery by longitudinal incision of the skin, Outcome 1 DASH score.

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Analysis 9.1

Comparison 9 Open surgery by transverse incision of the skin in the distal palmar crease versus open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease, Outcome 1 DASH score.

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Summary of findings for the main comparison. Open surgery versus steroid injection for treating trigger finger

Open surgery versus steroid injection for treating trigger finger
Patient or population: patients with trigger finger Settings: hospital Intervention: open surgery Comparison: steroid injection
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Steroid injection	Open surgery
Resolution of symptoms (after one or more injections) Follow‐up: 6 to 12 months	615 per 1000	911 per 1000 (486 to 1000)	RR 1.48 (0.79 to 2.76)	270 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^1,2,3	Absolute difference: 28% more had resolution of symptoms with open surgery (2% fewer to 58% more); relative change: 48% more (21% fewer to 176% more). The NNTH n/a⁴.
Pain Proportion with pain on the palm of the hand Follow‐up: 1 week	184 per 1000	678 per 1000 (366 to 1000)	RR 3.69 (1.99 to 6.85)	105 (1 RCT)	⊕⊕⊝⊝ LOW ^1,3	Absolute risk difference: 49% more people had pain with surgery (33% to 66% more), and the relative percent change translates to worsening of 269% (585% to 99% worse). The NNTH was 3 (95% CI 1 to 5).
Function Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Participant global assessment of success Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Recurrence Follow‐up: range 6 to 12 months	385 per 1000	65 per 1000 (35 to 127)	RR 0.17 (0.09 to 0.33)	270 (2 RCTs)	⊕⊕⊝⊝ LOW ^1,3	Absolute risk difference: 29% fewer people had recurrence with open surgery (60% fewer to 3% more), and the relative percent change translates to improvement of 83% (67% to 91% better). NNTB 4 (95% CI 3 to 4).
Adverse events (infection, tendon or pulley injury, flare, cutaneous discomfort, fat necrosis) Follow‐up: range 6 to 12 months	131 per 1000	133 per 1000 (75 to 241)	RR 1.02 (0.57 to 1.84)	270 (2 RCTs)	⊕⊕⊝⊝ LOW ^1,3	Absolute risk difference: 0% (3% fewer to 4% more), and the relative percent change translates to worsening of 2% (43% better to 84% worse). The NNTH n/a⁴.
Neurovascular injury Follow‐up: range 6 to 12 months	31 per 1000	67 per 1000 (22 to 208)	RR 2.17 (0.7 to 6.77)	270 (2 RCTs)	⊕⊕⊝⊝ LOW ^1,3	Absolute risk difference: 2% more people had neurovascular injury with open surgery (6% fewer to 11% more); relative change: 117% more (30% fewer to 577% more). The NNTB n/a⁴.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹The trials had methodological flaws: risk of detection bias. ²Inconsistency: heterogeneity was high. ³Imprecision: the total number of events was small, or the 95% confidence interval includes both open surgery and steroid injection groups, or the 95% confidence interval includes both no clinical effect, and "appreciable benefit" in favour of the open surgery group. ⁴Number needed to treat to benefit (NNTB), or harm (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office).

Summary of findings for the main comparison. Open surgery versus steroid injection for treating trigger finger

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Summary of findings 2. Percutaneous surgery versus steroid injection for treating trigger finger

Percutaneous surgery versus steroid injection for treating trigger finger
Patient or population: patients with trigger finger Settings: hospital Intervention: percutaneous surgery Comparison: steroid injection
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Steroid injection	Percutaneous surgery
Resolution of symptoms (after 1 or more injections) Follow‐up: range 6 to 12 months	545 per 1000	1000 per 1000 (169 to 1000)	RR 2.11 (0.31 to 14.51)	191 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^1,2,3	Absolute difference: 42% more had resolution of symptoms with percutaneous surgery (15% fewer to 98% more); relative change: 111% more (69% fewer to 1351% more) NNTB n/a⁴
Pain (Visual analogue scale: 0 to 10 points) Follow‐up: 1 month	The mean pain in the control group was 2.7	The mean pain in the intervention group was 1.8 lower (5.72 lower to 2.12 higher)		222 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^1,2,3	Absolute reduction: 18% pain reduction with percutaneous surgery (57% reduction to 21% increase), and the relative percent change translates to improvement of 25% (29% worse to 78% better)⁵. NNTB n/a⁴ Although a decrease of 1.8 in the VAS score (VAS: 0 to 10 points; where 0 mean no pain and 10 severe pain) may correspond to clinical improvement, there was no statistical difference between the groups and some participants' pain worsened).
Function Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Participant global assessment of success Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Recurrence Follow‐up: range 6 to 12 months	197 per 1000	112 per 1000 (41 to 313)	RR 0.57 (0.21 to 1.59)	392 (5 RCTs)	⊕⊝⊝⊝ VERY LOW ^2,3,6	Absolute risk difference: 9% fewer people had recurrence with percutaneous surgery (19% fewer to 2% more), and the relative percent change translates to improvement of 43% (59% worse to 79% better). The NNTB n/a⁴.
Adverse events (infection, partial loss of movement, tendon or −0 injury, dysaesthesia, and skin atrophy or hypopigmentation) Follow‐up: range 6 to 12 months	89 per 1000	140 per 1000 (81 to 244)	RR 1.58 (0.91 to 2.75)	392 (5 RCTs)	⊕⊝⊝⊝ VERY LOW ^3,6	Absolute risk difference: 3% more people had adverse events with percutaneous surgery (5% fewer to 11% more), and the relative percent change translates to worsening of 58% (9% better to 175% worse). The NNTH n/a⁴.
Neurovascular injury Follow‐up: range 6 to 12 months	30 per 1000	11 per 1000 (1 to 100)	RR 0.35 (0.04 to 3.29)	191 (2 RCTs)	⊕⊕⊝⊝ LOW ^1,3	Absolute difference: fewer than 1% had neurovascular injury with percutaneous surgery (5% fewer to 3% more); relative change: 65% fewer (229% fewer to 96% more). The NNTB n/a⁴.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹The two trials had methodological flaws; they did not blind the outcome assessor, and they had selective reporting or unclear risk for incomplete outcome data. ²Inconsistency: heterogeneity was high. ³Imprecision: the total number of events was small, or the 95% confidence interval includes both percutaneous surgery and steroid injection groups, or the 95% confidence interval includes both no clinical effect, and "appreciable benefit" in favour of the steroid injection group. ⁴Number needed to treat for an additional beneficial outcome (NNTB), or for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office). ⁵Basis for assumed risk was the mean baseline risk from the studies in the meta‐analysis. ⁶The five trials had methodological flaws; two were quasi‐randomised; four did not blind the outcome assessor and three had unclear risk for incomplete outcome data (one trial had follow‐up loss 17%, but 'intention to treat analysis' was not done; two trials did not report the follow‐up loss); four trials had selective reporting. We opted by double downgrade.

Summary of findings 2. Percutaneous surgery versus steroid injection for treating trigger finger

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Summary of findings 3. Open surgery versus steroid injection plus hyaluronic acid injection guided by ultrasound for treating trigger finger

Open surgery versus steroid injection plus hyaluronic acid injection guided by ultrasound for treating trigger finger
Patient or population: patients with trigger finger Settings: hospital Intervention: open surgery Comparison: steroid injection plus hyaluronic acid injection guided by ultrasound
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Steroid injection plus hyaluronic acid injection guided by ultrasound	Open surgery
Resolution of symptoms Follow up: 12 months	733 per 1000	990 per 1000 (719 to 1000)	RR 1.35 (0.98 to 1.85)	30 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute difference: 27% more had resolution of symptoms with open surgery (3% to 50% more); relative change: 35% more (2% fewer to 85% more). The NNTB n/a³.
Pain (short‐term) Not measured	See comment	See comment		‐	See comment	Pain in 6‐month follow‐up was assessed by visual analogue scale (VAS: 0 to 10 points; where 0 means no pain and 10 severe pain), but the authors failed to report any measurement of variance: standard deviation, standard errors, P values, or confidence intervals. The VAS score was 1 point (range 0 to 2) in open surgery group, and 1 point (range 0 to 3) in steroid plus hyaluronic acid injection group. This is not clinically significant.
Function Not measured	See comment	See comment		‐	See comment	Functional status of the hand in follow‐up of 6 months was assessed by DASH score, but the authors failed to report any measurement of variance. The DASH score was 11% (range 7 to 16) in open surgery group and 13% (range 7 to 20) in steroid plus hyaluronic acid injection group; it translates to absolute improvement of 2% (DASH score: 0 to 100%; where 0 means no disability and 100 the most severe disability) in the open surgery group. This is not a clinically significant difference.
Participant global assessment of success Not measured	See comment	See comment		‐	See comment	Patient satisfaction in follow‐up was at 6 months assessed by satisfaction visual analogue scale (SVAS: 0 to 10 points; where 0 means totally unsatisfied and 10 completely satisfied), but the authors failed to report any measurement of variance: standard deviation, standard errors, P values, or confidence intervals. The SVAS score was 7.8 points (3 to 10 range) in the open surgery group, and 7.4 points (2 to 10 range) in steroid plus hyaluronic acid injection group; it translates to absolute improvement of 0.4 point in the open surgery group. This is not a clinically significant difference.
Recurrence Follow‐up: 12 months	200 per 1000	28 per 1000 (2 to 510)	RR 0.14 (0.01 to 2.55)	30 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute risk difference: 20% fewer people had recurrence with open surgery (42% fewer to 2% more), and the relative percent change translates to improvement of 86% (99% worse to 155% better). The NNTB n/a³.
Adverse events (partial loss of movement, algodystrophic syndrome) Follow‐up: 12 months	67 per 1000	200 per 1000 (23 to 1000)	RR 3.00 (0.35 to 25.68)	30 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute risk difference: 13% more people had adverse events with open surgery (11% fewer to 37% more), and the relative percent change translates to worsening of 200% (2468% worse to 65% better). The NNTH n/a³.
Neurovascular injury Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹The trial had methodological flaws; it did not describe how random sequence generation was created and whether allocation concealment was done; the outcome assessor was not blinded, and it had selective reporting. We opted by double downgrade. ²Imprecision: the total number of events was small, or the 95% confidence interval includes both no clinical effect, and "appreciable benefit" in favour of the open surgery group, or the 95% confidence interval includes both open surgery and steroid injection plus hyaluronic acid injection groups. ³Number needed to treat for an additional beneficial outcome (NNTB), or for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office).

Summary of findings 3. Open surgery versus steroid injection plus hyaluronic acid injection guided by ultrasound for treating trigger finger

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Summary of findings 4. Percutaneous surgery plus steroid injection compared to steroid injection for trigger finger

Percutaneous surgery plus steroid injection versus steroid injection for treating trigger finger
Patient or population: patients with trigger finger Settings: hospital Intervention: percutaneous surgery plus steroid injection Comparison: steroid injection
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Steroid injection	Percutaneous surgery plus steroid injection
Resolution of symptoms (after 1 or more injections) Follow up: range 6 to 42 months	590 per 1000	891 per 1000 (714 to 1000)	RR 1.51 (1.21 to 1.90)	127 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute difference: 30% more had resolution of symptoms with percutaneous surgery plus steroid injection (16% to 45% more); relative change: 51% more (21% to 90% more). NNTB 4 (95% CI 3 to 6).
Pain (short‐term) Not measured	See comment	See comment	See comment	‐	See comment	Pain in follow‐up of 2 weeks was assessed by visual analogue scale (VAS: 0 to 10 points; where 0 means no pain and 10 severe pain), but the authors failed to report any measurement of variance: standard deviation, standard errors, P values, or confidence intervals. The VAS score was 0.4 point in percutaneous surgery plus steroid injection group, and 0.3 point in steroid injection group; it translates to absolute worsening of 0.1 point in the percutaneous surgery plus steroid injection group. This is not a clinically significant difference.
Function Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Participant global assessment of success Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Recurrence Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Adverse events (infection, partial loss of movement) Follow‐up: range 6 to 42 months	33 per 1000	30 per 1000 (4 to 209)	RR 0.92 (0.13 to 6.36)	127 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute risk difference: 0% (6% fewer to 6% more); relative percentage change: 8% fewer (536% fewer to 87% more). The NNTB n/a³.
Neurovascular injury Follow‐up: range 6 to 42 months	16 per 1000	15 per 1000 (1 to 237)	RR 0.92 (0.06 to 14.46)	127 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute risk difference: 0% (4% fewer to 4% more); relative percentage change: 8% fewer (1346% fewer to 94% more). The NNTB n/a³.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹The trial had methodological flaws; it did not describe how random sequence generation was created and whether allocation concealment was done; the outcome assessor was not blinded and it had selective reporting. We opted by double downgrade. ²Imprecision: the total number of events was small, or the 95% confidence interval includes both percutaneous surgery plus steroid injection, and steroid injection groups. ³Number needed to treat to benefit (NNTB), or harm (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office).

Summary of findings 4. Percutaneous surgery plus steroid injection compared to steroid injection for trigger finger

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Summary of findings 5. Percutaneous surgery versus open surgery for treating trigger finger

Percutaneous surgery versus open surgery for treating trigger finger
Patient or population: patients with trigger finger Settings: hospital Intervention: percutaneous surgery Comparison: open surgery
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Open surgery	Percutaneous surgery
Resolution of symptoms Follow‐up: range 2 to 6 months	995 per 1000	995 per 1000 (965 to 1000)	RR 1.00 (0.97 to 1.02)	429 (5 RCTs)	⊕⊕⊝⊝ LOW ¹	Absolute risk difference: 0% (3% fewer to 2% more); relative percentage change: 0% (3% fewer to 2% more). NNTB n/a².
Pain (1 to 6 scale) Follow‐up: 1 week	The mean pain short term (1 to 6 scale) in the control group was 2.5	The mean pain short term (1 to 6 scale) in the intervention group was 0.3 higher (0.34 lower to 0.94 higher)	‐	36 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^3,4	Absolute risk difference: 6% increase in pain with percutaneous surgery (7% reduction to 19% increase), and the relative percent change translates to worsening of 7% (22% worse to 8% better)⁵. NNTH n/a². The difference of 0.3 points in the pain score (pain score: 1 to 6 points; where 1 means no pain and 6 extreme pain) is not clinically significant.
Function Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Participant global assessment of success Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Recurrence Follow‐up: range 2 to 6 months	5 per 1000	1 per 1000 (0 to 34)	RR 0.28 (0.01 to 6.83)	397 (4 RCTs)	⊕⊕⊝⊝ VERY LOW ^4,6	Absolute risk difference: 0% (2% fewer to 2% more); relative percentage change: 72% fewer (583% fewer to 99% more). The NNTB n/a².
Adverse events (infection, partial loss of movement, tendon or pulley injury, oedema or inflammation or hematoma, adherence) Follow‐up: range 2 to 6 months	14 per 1000	11 per 1000 (2 to 52)	RR 0.80 (0.17 to 3.68)	429 (5 RCTs)	⊕⊝⊝⊝ VERY LOW ^1,4	Absolute risk difference: 0% (2% fewer to 2% more); relative percentage change: 20% fewer (268% fewer to 83% more). The NNTB n/a².
Neurovascular injury Follow‐up: range 2 to 6 months	0 per 1000	0 per 1000 (0 to 0)	Could not be estimated	397 (4 RCTs)	⊕⊝⊝⊝ VERY LOW ^4,6	There was no injury in both groups.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹All five trials had methodological flaws; one was quasi‐randomised; three had adequate concealed treatment allocation, and one did not describe how this allocation concealment was done; the subjective outcomes assessor was blinded in one, and no trial blinded the objective outcomes assessor; selective reporting was observed in three trials. We choe to double downgrade. ²Number needed to treat to benefit (NNTB), or harm (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office). ³This quasi‐randomised trial had bias in the random sequence generation and allocation concealment; the outcome assessor was not blinded, and it had selective reporting. We opted by double downgrade. ⁴Imprecision: the total number of events was small, or the 95% confidence interval includes both no clinical effect and "appreciable benefit" in favour of the open surgery group, or the 95% confidence interval includes both percutaneous and open surgery. ⁵Basis for assumed risk was the mean baseline risk from the study in the meta‐analysis. ⁶ The four trials had methodological flaws; one was quasi‐randomised; only two had adequate concealed treatment allocation, and one did not describe how this allocation concealment was done; the outcome assessor was not blinded and three had selective reporting in the trial. We opted by double downgrade.

Summary of findings 5. Percutaneous surgery versus open surgery for treating trigger finger

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Summary of findings 6. Endoscopic surgery versus open surgery for treating trigger finger

Endoscopic surgery versus open surgery for treating trigger finger
Patient or population: patients with trigger finger Settings: hospital Intervention: endoscopic surgery Comparison: open surgery
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Open surgery	Endoscopic surgery
Resolution of symptoms Follow‐up: 3 months	1000 per 1000	1000 per 1000 (980 to 1000)	RR 1.00 (0.98 to 1.02)	231 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute risk difference: 0% (2% fewer to 2% more); relative percentage change: 0% (2% fewer to 2% more).The NNTB n/a³.
Pain (short‐term) Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Function Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Participant global assessment of success Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Recurrence Not measured	See comment	See comment	See comment	‐	See comment	Not measured in any trial.
Adverse events (infection, dysaesthesia) Follow‐up: 3 months	26 per 1000	70 per 1000 (19 to 258)	RR 2.74 (0.74 to 10.06)	231 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute risk difference: 4% more people had adverse events with endoscopic surgery (1% fewer to 10% more), and the relative percent change translates to worsening of 174% (906% worse to 26% better). The NNTH n/a³.
Neurovascular injury Follow‐up: 3 months	0 per 1000	0 per 1000 (0 to 0)	RR 3.08 (0.13 to 74.79)	231 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute difference: 1% more had neurovascular injury with endoscopic surgery (2% fewer to 3% more); relative change: 208% more (87% fewer to 7379% more). The NNTH n/a³.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹The trial had methodological flaws; the authors did not describe how randomisation sequence was created and whether allocation concealment was done; the outcome assessor was not blinded and the trial had selective reporting. We chose to double downgrade. ²Imprecision: the total number of events was small, or the 95% confidence interval includes both open surgery and endoscopic surgery groups. ³Number needed to treat for an additional beneficial outcome (NNTB), or for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office).

Summary of findings 6. Endoscopic surgery versus open surgery for treating trigger finger

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Summary of findings 7. Open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease compared to open surgery by longitudinal incision of the skin for trigger finger

Open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease compared to open surgery by longitudinal incision of the skin for trigger finger
Patient or population: patients with trigger finger Setting: hospital Intervention: open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease Comparison: open surgery by longitudinal incision of the skin
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Open surgery by longitudinal incision of the skin	Open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease
Resolution of symptoms Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Pain (short‐term) Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Function (DASH score: 0 to 100 points) Follow‐up: 12 months	The mean DASH score in the control group was 15.3	The mean DASH score in the intervention group was 8.9 lower (23.35 lower to 5.55 higher)	‐	21 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute risk difference: 8.9% increase in hand function with open surgery by transverse incision of the skin about 2–3 mm distally from the distal palmar crease (23.35% increase to 5.55% reduction), and the relative percentage change translates to improvement of 21.7% (13.54% worse to 56.95% better)³. NNTH n/a⁴. The difference of 8.9 points in the DASH score (DASH: 0 to 100 points; where 0 means no disability and 100 means the most severe disability) is not clinically significant.
Participant global assessment of success Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Recurrence Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Adverse events Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Neurovascular injury Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ The trial had methodological flaws; the authors did not describe how randomisation sequence was created and whether allocation concealment was done; the outcome assessor was not blinded and the trial had selective reporting. We opted by double downgrade. ² Imprecision: the total number of events was small, or the 95% confidence interval includes both groups (transverse incision of the skin about 2–3 mm distally from distal palmar crease and longitudinal incision of the skin). ³Basis for assumed risk was the mean baseline risk from the study in the meta‐analysis. ⁴Number needed to treat to benefit (NNTB), or harm (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office).

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Summary of findings 8. Open surgery by transverse incision of the skin in the distal palmar crease compared to open surgery by longitudinal incision of the skin for trigger finger

Open surgery by transverse incision of the skin in the distal palmar crease compared to open surgery by longitudinal incision of the skin for trigger finger
Patient or population: patients with trigger finger Setting: hospital Intervention: open surgery by transverse incision of the skin in the distal palmar crease Comparison: open surgery by longitudinal incision of the skin
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Open surgery by longitudinal incision of the skin	Open surgery by transverse incision of the skin in the distal palmar crease
Resolution of symptoms Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Pain (short‐term) Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Function (DASH score: 0 to 100 points) Follow‐up: 12 months	The mean DASH score in the control group was 15.3	The mean DASH score in the intervention group was 3.1 higher (21.28 lower to 27.48 higher)	‐	22 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute reduction: 3.1% function reduction with open surgery by transverse incision of the skin in the distal palmar crease (27.48% reduction to 21.28% increase), and the relative percent change translates to worsening of 7.56% (67.02% worse to 51.9% better)³. NNTB n/a⁴. The difference of 3.1 points in the DASH score (DASH: 0 to 100 points; where 0 means no disability and 100 means the most severe disability) is not clinically significant.
Participant global assessment of success Not measured	See comment	See comment	Not estimable	‐	See comment	Not measured in any trial.
Recurrence Not measured	See comment	See comment	Not estimable	‐	See comment	Not measured in any trial.
Adverse events Not measured	See comment	See comment	Not estimable	‐	See comment	Not measured in any trial.
Neurovascular injury Not measured	See comment	See comment	Not estimable	‐	See comment	Not measured in any trial.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ The trial had methodological flaws; the authors did not describe how randomisation sequence was created and whether allocation concealment was done; the outcome assessor was not blinded and the trial had selective reporting. We chose to double downgrade. ² Imprecision: the total number of events was small, or the 95% confidence interval includes both groups (transverse incision of the skin in the distal palmar crease and longitudinal incision of the skin). ³Basis for assumed risk was the mean baseline risk from the study in the meta‐analysis. ⁴Number needed to treat to benefit (NNTB), or harm (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office).

Summary of findings 8. Open surgery by transverse incision of the skin in the distal palmar crease compared to open surgery by longitudinal incision of the skin for trigger finger

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Summary of findings 9. Open surgery by transverse incision of the skin in the distal palmar crease compared to open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease for trigger finger

Open surgery by transverse incision of the skin in the distal palmar crease compared to open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease for trigger finger
Patient or population: patients with trigger finger Setting: hospital Intervention: open surgery by transverse incision of the skin in the distal palmar crease Comparison: open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease	Open surgery by transverse incision of the skin in the distal palmar crease
Resolution of symptoms Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Pain (short‐term) Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Function (DASH score: 0 to 100 points) Follow‐up: 12 months	The mean DASH score in the control group was 6.4	The mean DASH score in the intervention group was 12 higher (8.84 lower to 32.84 higher)	‐	21 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^1,2	Absolute risk difference: 12% decrease in function with open surgery by transverse incision of the skin in the distal palmar crease (32.84% reduction to 8.84% increase), and the relative percentage change translates to worsening of 61.22% (167.55% worse to 45.1% better)³. NNTH n/a⁴. Although an increase of 12 in the DASH score (DASH: 0 to 100 points; where 0 means no disability and 100 means the most severe disability) may correspond to clinical worsening, there was no statistical difference between the groups and some participants' hand function improved).
Participant global assessment of success Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Recurrence Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Adverse events Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
Neurovascular injury Not measured	See comment	See comment		‐	See comment	Not measured in any trial.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ The trial had methodological flaws; the authors did not describe how randomisation sequence was created and whether allocation concealment was done; the outcome assessor was not blinded and the trial had selective reporting. We chose to double downgrade. ² Imprecision: the total number of events was small, or the 95% confidence interval includes both groups (transverse incision of the skin in the distal palmar crease and transverse incision of the skin about 2–3 mm distally from distal palmar crease). ³Basis for assumed risk was the mean baseline risk from the study in the meta‐analysis. ⁴Number needed to treat to benefit (NNTB), or harm (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office).

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Comparison 1. Open surgery versus steroid injection

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of trigger finger Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Resolution of symptoms after one or more injections (six to 12 months)	2	270	Risk Ratio (M‐H, Random, 95% CI)	1.48 [0.79, 2.76]
2 Pain on the palm of the hand Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Pain short‐term (one week)	1	105	Risk Ratio (M‐H, Random, 95% CI)	3.69 [1.99, 6.85]
2.2 Pain intermediate‐term (six months)	1	105	Risk Ratio (M‐H, Random, 95% CI)	0.10 [0.01, 1.77]
3 Pain (1 to 10 scale) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Pain short‐term (three months)	1	156	Mean Difference (IV, Random, 95% CI)	0.0 [‐0.23, 0.23]
3.2 Pain long‐term (12 months)	1	153	Mean Difference (IV, Random, 95% CI)	‐2.0 [‐2.68, ‐1.32]
4 Frequency of recurrence Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 Recurrence (range six to 12 months)	2	270	Risk Ratio (M‐H, Random, 95% CI)	0.17 [0.09, 0.33]
5 Adverse events Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Infection	2	270	Risk Ratio (M‐H, Random, 95% CI)	2.65 [0.88, 7.99]
5.2 Tendon or pulley injury	1	105	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.3 Flare around procedure site	1	165	Risk Ratio (M‐H, Random, 95% CI)	0.51 [0.23, 1.15]
5.4 Cutaneous discomfort around procedure site (after 12 months)	1	165	Risk Ratio (M‐H, Random, 95% CI)	3.62 [1.25, 10.44]
5.5 Fat necrosis at the procedure site	1	165	Risk Ratio (M‐H, Random, 95% CI)	1.29 [0.47, 3.54]
5.6 Total adverse events	2	270	Risk Ratio (M‐H, Random, 95% CI)	1.02 [0.57, 1.84]
6 Neurovascular injury Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Neurovascular injury	2	270	Risk Ratio (M‐H, Random, 95% CI)	2.17 [0.70, 6.77]
7 Subgroup analyses for resolution Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

7.1 Resolution short‐term	1	165	Risk Ratio (M‐H, Random, 95% CI)	1.08 [0.96, 1.21]
7.2 Resolution intermediate‐term	1	105	Risk Ratio (M‐H, Random, 95% CI)	1.17 [1.04, 1.31]
7.3 Resolution long‐term	1	165	Risk Ratio (M‐H, Random, 95% CI)	1.90 [1.49, 2.43]
8 Subgroup analyses for recurrence Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

8.1 Recurrence intermediate‐term (six months)	1	105	Risk Ratio (M‐H, Random, 95% CI)	0.06 [0.00, 1.00]
8.2 Recurrence long‐term (12 months)	1	165	Risk Ratio (M‐H, Random, 95% CI)	0.18 [0.09, 0.36]

Comparison 1. Open surgery versus steroid injection

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Comparison 2. Percutaneous surgery versus steroid injection

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of trigger finger Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Resolution of symptoms after one or more injections (six to 12 months)	2	191	Risk Ratio (M‐H, Random, 95% CI)	2.11 [0.31, 14.51]
2 Pain (VAS: 0 to 10 scale) Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Pain short‐term (one month)	2	198	Mean Difference (IV, Random, 95% CI)	‐1.80 [‐5.72, 2.12]
2.2 Pain long‐term (12 months)	1	93	Mean Difference (IV, Random, 95% CI)	‐6.5 [‐7.25, ‐5.75]
3 Pain on the palm of the hand Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 Pain short‐term (one week)	1	94	Risk Ratio (M‐H, Random, 95% CI)	3.63 [1.94, 6.78]
3.2 Pain intermediate‐term (six months)	1	94	Risk Ratio (M‐H, Random, 95% CI)	0.12 [0.01, 2.18]
4 Frequency of recurrence Show forest plot	5		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 Recurrence (range six to 12 months)	5	392	Risk Ratio (M‐H, Random, 95% CI)	0.57 [0.21, 1.59]
5 Adverse events Show forest plot	5		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Infection	2	191	Risk Ratio (M‐H, Random, 95% CI)	0.35 [0.04, 3.29]
5.2 Partial loss of movement	3	201	Risk Ratio (M‐H, Random, 95% CI)	3.09 [0.87, 10.97]
5.3 Tendon or pulley injury	4	267	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.21, 4.81]
5.4 Dysaesthesia	2	76	Risk Ratio (M‐H, Random, 95% CI)	0.20 [0.02, 1.67]
5.5 Skin atrophy or hypopigmentation	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.14 [0.01, 2.63]
5.6 Total adverse events	5	392	Risk Ratio (M‐H, Random, 95% CI)	1.58 [0.91, 2.75]
6 Neurovascular injury Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Neurovascular injury	2	191	Risk Ratio (M‐H, Random, 95% CI)	0.35 [0.04, 3.29]
7 Subgroup analyses for resolution Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

7.1 Resolution short‐term	1	97	Risk Ratio (M‐H, Random, 95% CI)	2.18 [1.55, 3.05]
7.2 Resolution intermediate‐term	1	94	Risk Ratio (M‐H, Random, 95% CI)	1.16 [1.03, 1.31]
7.3 Resolution long‐term	1	97	Risk Ratio (M‐H, Random, 95% CI)	3.90 [2.37, 6.42]
8 Subgroup analyses for recurrence Show forest plot	5		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

8.1 Recurrence short‐term (one month)	1	125	Risk Ratio (M‐H, Random, 95% CI)	1.73 [0.76, 3.94]
8.2 Recurrence intermediate‐term (six months)	2	219	Risk Ratio (M‐H, Random, 95% CI)	0.37 [0.02, 5.50]
8.3 Recurrence long‐term (range nine to 12 months)	3	173	Risk Ratio (M‐H, Random, 95% CI)	0.55 [0.10, 2.99]

Comparison 2. Percutaneous surgery versus steroid injection

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Comparison 3. Open surgery versus steroid injection plus hyaluronic acid injection guided by ultrasound

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of trigger finger Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Resolution of symptoms long‐term (12 months)	1	30	Risk Ratio (M‐H, Random, 95% CI)	1.35 [0.98, 1.85]
1.2 Resolution of symptoms intermediate‐term (six month)	1	30	Risk Ratio (M‐H, Random, 95% CI)	1.07 [0.89, 1.28]
2 Frequency of recurrence Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Recurrence long‐term (12 months)	1	30	Risk Ratio (M‐H, Random, 95% CI)	0.14 [0.01, 2.55]
2.2 Recurrence intermediate‐term (six months)	1	30	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
3 Adverse events Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 Partial loss of movement	1	30	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.20, 19.78]
3.2 Algodystrophic syndrome	1	30	Risk Ratio (M‐H, Random, 95% CI)	3.0 [0.13, 68.26]
3.3 Total adverse events	1	30	Risk Ratio (M‐H, Random, 95% CI)	3.0 [0.35, 25.68]

Comparison 3. Open surgery versus steroid injection plus hyaluronic acid injection guided by ultrasound

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Comparison 4. Percutaneous surgery plus steroid injection versus steroid injection

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of trigger finger Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Resolution of symptoms after one or more injections (range 6 to 42 months)	1	127	Risk Ratio (M‐H, Random, 95% CI)	1.51 [1.21, 1.90]
2 Adverse events Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Infection	1	127	Risk Ratio (M‐H, Random, 95% CI)	0.46 [0.04, 4.97]
2.2 Partial loss of movement	1	127	Risk Ratio (M‐H, Random, 95% CI)	1.85 [0.17, 19.87]
2.3 Total adverse events	1	127	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.13, 6.36]
3 Neurovascular injury Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 Neurovascular injury	1	127	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.06, 14.46]

Comparison 4. Percutaneous surgery plus steroid injection versus steroid injection

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Comparison 5. Percutaneous surgery versus open surgery

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of trigger finger Show forest plot	5		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Resolution of symptoms (range 2 to 6 months)	5	429	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.97, 1.02]
2 Pain (1 to 6 scale) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Pain short‐term (1 week)	1	36	Mean Difference (IV, Random, 95% CI)	0.30 [‐0.34, 0.94]
2.2 Pain short‐term (12 weeks)	1	36	Mean Difference (IV, Random, 95% CI)	0.0 [‐0.52, 0.52]
3 Pain on the palm of the hand Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 Pain short‐term (one week)	1	101	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.75, 1.29]
3.2 Pain intermediate‐term (six months)	1	101	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4 Frequency of recurrence Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 Recurrence (range 2 to 6 months)	4	397	Risk Ratio (M‐H, Random, 95% CI)	0.28 [0.01, 6.83]
5 Adverse events Show forest plot	5		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Infection	2	133	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.2 Partial loss of movement	1	32	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.3 Tendon or pulley injury	2	261	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.4 Edema or inflammation or hematoma	2	136	Risk Ratio (M‐H, Random, 95% CI)	0.80 [0.12, 5.30]
5.5 Adherence	1	100	Risk Ratio (M‐H, Random, 95% CI)	0.28 [0.01, 6.83]
5.6 Others (it did not specified)	1	100	Risk Ratio (M‐H, Random, 95% CI)	2.56 [0.11, 61.45]
5.7 Total adverse events	5	429	Risk Ratio (M‐H, Random, 95% CI)	0.80 [0.17, 3.68]
6 Subgroup analyses for resolution Show forest plot	5		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Resolution of symptoms (short‐term)	4	328	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.97, 1.02]
6.2 Resolution of symptoms (intermediate‐term)	1	101	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.96, 1.04]
7 Subgroup analyses for recurrence Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

7.1 Recurrence short‐term (eight to 12 weeks)	3	296	Risk Ratio (M‐H, Random, 95% CI)	0.28 [0.01, 6.83]
7.2 Recurrence intermediate‐term (six months)	1	101	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Percutaneous surgery versus open surgery

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Comparison 6. Endoscopic surgery versus open surgery

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of trigger finger Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Resolution of symptoms (three months)	1	231	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.98, 1.02]
2 Adverse events Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Infection	1	231	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Dysesthesia	1	231	Risk Ratio (M‐H, Random, 95% CI)	2.74 [0.74, 10.06]
2.3 Total adverse events	1	231	Risk Ratio (M‐H, Random, 95% CI)	2.74 [0.74, 10.06]
3 Neurovascular injury Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 Neurovascular injury	1	231	Risk Ratio (M‐H, Random, 95% CI)	3.08 [0.13, 74.79]

Comparison 6. Endoscopic surgery versus open surgery

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Comparison 7. Open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease versus open surgery by longitudinal incision of the skin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 DASH score Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 DASH score short‐term (one month)	1	21	Mean Difference (IV, Random, 95% CI)	‐1.5 [‐19.19, 16.19]
1.2 DASH score short‐term (three months)	1	21	Mean Difference (IV, Random, 95% CI)	‐2.0 [‐16.45, 12.45]
1.3 DASH score long‐term (12 months)	1	21	Mean Difference (IV, Random, 95% CI)	‐8.9 [‐23.35, 5.55]

Comparison 7. Open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease versus open surgery by longitudinal incision of the skin

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Comparison 8. Open surgery by transverse incision of the skin in the distal palmar crease versus open surgery by longitudinal incision of the skin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 DASH score Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 DASH score short‐term (one month)	1	22	Mean Difference (IV, Random, 95% CI)	5.20 [‐16.67, 27.07]
1.2 DASH score short‐term (three months)	1	22	Mean Difference (IV, Random, 95% CI)	1.60 [‐15.27, 18.47]
1.3 DASH score long‐term (12 months)	1	22	Mean Difference (IV, Random, 95% CI)	3.10 [‐21.28, 27.48]

Comparison 8. Open surgery by transverse incision of the skin in the distal palmar crease versus open surgery by longitudinal incision of the skin

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Comparison 9. Open surgery by transverse incision of the skin in the distal palmar crease versus open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 DASH score Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 DASH score short‐term (one month)	1	21	Mean Difference (IV, Random, 95% CI)	6.70 [‐13.67, 27.07]
1.2 DASH score short‐term (three months)	1	21	Mean Difference (IV, Random, 95% CI)	3.60 [‐12.84, 20.04]
1.3 DASH score long‐term (12 months)	1	21	Mean Difference (IV, Random, 95% CI)	12.00 [‐8.84, 32.84]

Comparison 9. Open surgery by transverse incision of the skin in the distal palmar crease versus open surgery by transverse incision of the skin about 2–3 mm distally from distal palmar crease

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