A randomized controlled trial of dorsal web space versus palmar midline injection of steroid in the treatment of trigger digits

Jiménez, Isidro; Garcés, Gerardo L.; Marcos-García, Alberto; Medina, José

doi:10.1177/1753193420927999

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…This is in keeping with previous literature on the use of ethyl chloride spray 48 . Jiménez et al 49 compared a technique of corticosteroid injection that utilized an approach from the dorsal web space into the area of the A1 pulley and the typical palmar midline technique. This study showed a significantly lower mean visual analog scale score for pain of 3.6 for patients who underwent the dorsal webspace technique compared with 5.4 for patients who underwent the palmar midline technique.…”

Section: Trigger Fingermentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

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The intent is to serve as an update of the hand surgery literature for the practicing general orthopaedic surgeon. Carpal Tunnel SyndromeCarpal tunnel syndrome is one of the most common disorders in hand surgery. Nevertheless, the optimum method for diagnosis remains controversial. A growing body of evidence suggests that electrodiagnostic studies [1][2][3][4] are not more sensitive and specific than diagnosis by ultrasound or clinical history and examination. D'Auria et al. 5 examined the role of electrodiagnostic studies compared with clinical judgment and found that the utility of electrodiagnostic studies may be greatest in patients for whom a diagnosis of carpal tunnel syndrome is questionable. Even so, electrodiagnostic studies are performed in many patients with carpal tunnel syndrome 6 . Less expensive, office-based diagnostic tools such as the Carpal Tunnel Syndrome 6 (CTS-6), a 26-point scale that incorporates aspects of the history and clinical examination to predict the probability of carpal tunnel syndrome, and ultrasound will likely supplant the routine use of electrodiagnostic studies for carpal tunnel syndrome.Strong evidence exists for the use of night splints and corticosteroid injections for early treatment of carpal tunnel syndrome. In a comparison of the 2 treatments, 100 patients with a diagnosis of carpal tunnel syndrome were randomized to a night splint or a corticosteroid injection 7 . In the 95 patients who completed follow-up, corticosteroid injections were superior in terms of nocturnal paresthesias, pain, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.A novel study on hand function with decreased sensation showed that a digital nerve block to the thumb had the greatest negative impact on dexterity and a loss of sensation in the index and long fingers caused decreased grip and chuck pinch strength, thus explaining the common symptoms of decreased dexterity and strength in patients with carpal tunnel syndrome 8 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G899).

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Section: Trigger Fingermentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

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“…(2023) did not find a difference in pain experienced during the injection between the two sites. Jiménez et al. (2020) carried out a prospective RCT comparing steroid injection over the A1 pulley palmately and a dorsal web space injection site, both aiming to deliver steroid near to, but not into, the flexor sheath.…”

Section: Introductionmentioning

confidence: 99%

The management of trigger fingers: commentary and personal opinion

Arrowsmith

2023

J Hand Surg Eur Vol

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Trigger fingers are common. Although the options for management are well-described, including conservative measures such as steroid injection, or surgical options such as open or percutaneous release, there remains variations in the way these are administered. In addition, there is a recent emphasis on patient-reported outcome measures in this condition. The purpose of this further knowledge article is to look at three recently published articles to gather some evidence about best practice in the management of this painful but common condition.

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“…The first annular (A1) pulley is where the main triggering occurs, followed by compression and long-term friction obstructing the flexor tendon to glide in the fibrous sheath involving the thumb [ 3 ]. There have been various proven effective treatments (percutaneous needle [PN] release under local anesthesia with a 93% success rate, corticosteroid injections, and nonsteroidal anti-inflammatory drugs with an 85% success rate) to overcome this painful condition [ 4 , 5 ]. However, all cases could only be resolved partially [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…There have been various proven effective treatments (percutaneous needle [PN] release under local anesthesia with a 93% success rate, corticosteroid injections, and nonsteroidal anti-inflammatory drugs with an 85% success rate) to overcome this painful condition [ 4 , 5 ]. However, all cases could only be resolved partially [ 4 , 5 ]. The overall success rate ranges from 35% to 85% in the decrease in pain and triggering after corticosteroid injection [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

An innovation percutaneous needle knife use for trigger finger: A retrospective cohort study

Velmurugan

Huang

et al. 2023

Tzu Chi Medical Journal

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A BSTRACT Objectives: This study retrospectively evaluated the effectiveness of percutaneous pulley release by our newly designed needle knife in terms of cure, relapse, and complication rates. Materials and Methods: Two hundred and fifty-seven patients were allocated into male and female groups between October 2014 and September 2021. We included patients >15 years of age with a trigger finger (TF) (types II–VI). The primary outcome was the absence of a TF and pain-free movement. In contrast, the secondary outcome included second-time surgery and the number of complications such as infection and admission for antibiotics. Results: One hundred patients were male, and 157 patients were female. Males and females had mean ages of 62.45 ± 11.76 and 61.50 ± 8.57 years, respectively. The operative time was significantly longer in males than in females (7.88 ± 6.02 vs. 6.52 ± 3.74 min in males and females, respectively, P = 0.027). However, the percentages of diabetes mellitus and gout were the same in both groups. For the percutaneous methods with our needle knife, remission of the trigger was achieved in all cases. In addition, seven patients received revision and three patients with complications. After needle surgery, topical and joint pain scores were improved in both groups (from 5.09 ± 1.31 to 0.80 ± 1.56). Conclusion: The percutaneous methods with our needle knife displayed effectiveness. The cure rate was high, and the relapse rate was low. Further large-scale clinical trials comparing percutaneous needle to open surgery for releasing the TF will be needed to confirm our results.

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A randomized controlled trial of dorsal web space versus palmar midline injection of steroid in the treatment of trigger digits

Cited by 7 publications

References 25 publications

What’s New in Hand and Wrist Surgery

What’s New in Hand and Wrist Surgery

The management of trigger fingers: commentary and personal opinion

An innovation percutaneous needle knife use for trigger finger: A retrospective cohort study

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