To the Editor:

In Dr. Boyer's commentary on the article by Maneerit et al(1) that appears in the "Evidence Based Medicine" section of the Jounal, he provides an outstanding brief review of current medical practice and the anatomical basis of managing the trigger thumb. It is interesting, though, that the conclusions of this well written article were completely ignored. Despite the findings of the source article that the NNT=3-4 with percutaneous release, Dr. Boyer suggests that "Percutaneous release adds an unnecessary layer of risk and complexity to a treatment that is straightforward and has withstood the test of time"(2).

That statement is in direct disagreement with the article's results. In that study, there were no injuries to neurovascular structures and infections were actually less frequent(although insufficient power was present to detect meaningful statistical conclusions about harm). Perhaps a more reasonable interpretation of the reslts would be that percutaneous release deserves further study in a larger group of patients. This might allow for the detection of less common injuries, or dispel previously held beliefs that have not undergone evidence-based evaluation.

1. Maneerit J, Sriworakun C, Budhraja N, Nagavajara P. Trigger Thumb: Results of a Prospective Randomised Study of Percutaneous Release with Steroid Injection Versus Steroid Injection Alone. J Hand Surg Br. 2003 Dec;28:586-9.

2. Boyer, M. Percutaneous Release with Steroid Injection Was More Effective Than Steroid Injection Alone for Trigger Thumb. J Bone Joint Surg Am 2004;86 1103