Assessing Injection Techniques in the Treatment of Trigger Finger

Abstract

Background: Trigger finger is characterized by the inability to smoothly flex and extend the digit. Corticosteroids are an accepted non-surgical treatment option and can be delivered via two techniques. While the palmar approach is more commonly used, some have suggested that the mid-axial approach may be less painful for patients and yield higher intrasheath injection rates. The purpose of this study is to compare the accuracy of the palmar and midaxial approaches for delivery of corticosteroids into the flexor tendon sheath using radio-opaque dye in a cadaver model. Methods: A total of 50 injections were performed, 25 via midaxial technique and 25 via palmar technique. A one inch, 25-gauge needle was used to inject 1 mL of Isovue contrast dye into the flexor tendon sheath under live fluoroscopy. The fluoroscopic images were examined after injection to determine intrasheath versus extrasheath delivery of the dye, with visualization of contrast filling the sheath defining a successful injection. Results: The midaxial approach had a success rate of 52% compared to the conventional palmar approach success rate of 36%, p = 0.5. The ring finger is the most common location of trigger finger and the rates of success were equal between groups for this digit (80%). Conclusions: Based on our findings, there is no statistical difference in the accuracy of intrasheath injection between the midaxial technique and palmar technique. The midaxial technique can be considered as an alternative to the palmar technique for trigger finger injection.

Trigger finger management, comparison of conservative and surgical treatment approach in hospital decision making: a case report

“…1,3,4 Pain in the finger may be felt on finger flexion and may radiate to the proximal interphalangeal (PIP) and metacarpophalangeal (MTP). 5,6 Most common cause trigger finger is overuse trauma of the hands from gripping with increased pull on the flexor tendon. The diagnostic is made by palpation and identification of localized tenderness and swelling of the volar tendon sheats, but ultrasound can be used when there are a clinical doubt and diagnostic can be made with hyperechoic lesion with cut-off thickness of 0.62 mm proposed to distinguish a disease from a healthy one, MRI for exclusion of secondary causes in younger patient and plain radiograph (in particular case) which is history of trauma.…”

Trigger Finger

“…The 2 techniques have been found equivalent in delivering medication into the sheath but have not been compared clinically. 20 Kamhim and colleagues 21 demonstrated that injections reach the intrasheath compartment in only 50% of attempts, giving rise to the notion that medication does not need to be in the sheath to be effective. Taras and colleagues 22 compared groups of intrasheath and extrasheath injections and, in contrast to popular belief, found that the extrasheath cohort had better outcomes.…”

Steroid injection using tendon excursion for trigger finger: introduction to injection methods and analysis of treatment results

“…It is important to accurately inject the steroid into the flexor tendon sheath to increase the therapeutic effect of steroids and reduce side effects such as tendon rupture, skin atrophy, and discoloration, which can occur because of local injection [8,9]. However, there is only a 36% to 49% probability that the drug will be accurately injected into the flexor tendon sheath during actual steroid injection [10,11], and only a few studies have reported the steroid injection technique and its clinical results in trigger finger.…”