Evidence-based management strategies for adult trigger digits: a systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND

The trigger digit is a mechanical condition in which the finger snaps, triggers, or locks due to a thickened retinacular sheath at the A1 pulley.

OBJECTIVE

To evaluate the effectiveness of different treatment options for the trigger finger and thumb.

METHODS

We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) with treatments for trigger digits from their inception to July 29, 2025. This protocol was registered with PROSPERO. We conducted a network meta-analysis to compare outcomes across treatments. Treatment success was pooled as an odds ratio (OR) with a 95% confidence interval (CI), and pain level was pooled as the mean difference (MD) with 95% CI.

RESULTS

We included 27 RCTs (2099 participants) examining 12 different treatments for trigger digits. In the network meta-analysis, percutaneous release had the highest probability of treatment success and significantly higher odds ratio than steroid injection (OR = 22.82; 95% CI, 7.69-67.72). These similar results were obtained from the pain level after excluding an RCT with an extreme pain score in which percutaneous release had significant pain relief compared with steroid injection (MD = -0.94; 95% CI, -1.49 to -0.38). Among non-surgical treatments, steroid injections (OR = 7.49; 95% CI, 2.18-25.71), non-steroidal anti-inflammatory drugs (NSAIDs) injections (OR = 5.38; 95% CI, 1.19-24.34), and extracorporeal shock wave therapy (ESWT) (OR = 7.49; 95% CI, 1.02-55.26) each demonstrated significantly higher odds of success compared with placebo injection. No significant differences in success were observed among these 3 treatments. Severe complications were not observed with any of these treatments.

CONCLUSION

Surgical interventions demonstrated superior efficacy compared to non-surgical therapies or placebo. Among non-surgical options, in addition to steroid injections, NSAID injections and ESWT are viable choices for treating the trigger digit.

PROSPERO REGISTRATION NUMBER: CRD420251000661.