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Evidence-Based Orthopaedics   |    
Percutaneous Release with Steroid Injection Was More Effective Than Steroid Injection Alone for Trigger Thumb

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Source of funding: Not stated.
For correspondence: J. Maneerit, Department of Orthopaedic Surgery, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Satnsean Road, Dusit, Bangkok 10300, Thailand. E-mail address: maneerit@hotmail.com
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.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 May 01;86(5):1103-1103
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Question: For patients with trigger thumb, is percutaneous release with steroid injection (PRSI) better than steroid injection (SI) alone for relieving symptoms?Design: Randomized (unclear allocation concealment), unblinded, controlled trial with 2-week and 6-month follow-up.Setting: Bangkok, Thailand.Patients: 115 adult patients who had idiopathic trigger thumb (Quinnell grade 2, 3, or 4) and did not have a history of carpal tunnel syndrome or trauma. Follow-up was 98% (mean age, 52 yr; 93% women).
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    todd m sheperd
    Posted on April 30, 2004
    Percutaneous Release of the Thumb Deserves Further Study
    petoskey family medicine

    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

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