Corticosteroid injection for trigger finger in adults

Peters-Veluthamaningal, Cyriac; Winters, J.C.; Windt, Dawm Van der; Jong, Betty Meyboom-de

doi:10.1002/14651858.cd005617

Cited by 11 publications

(20 citation statements)

References 11 publications

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“…Corticosteroïdinjectie bij trigger fi nger en trigger thumb De effectiviteit en veiligheid van corticosteroïdinjecties bij een trigger fi nger zijn onderzocht in een Cochrane review [Peters 2009a], in één vergelijkend prospectief niet-gecontroleerd onderzoek [Patel 1992] en in twee observationele onderzoeken [Newport 1990;Anderson 1991]. Lambert 1992;Murphy 1995].…”

Section: Noot 41unclassified

Implementatie van NHG-Standaarden: succes of probleem?

Grol

Braspenning

Hulscher

et al. 2010

HUISARTS WETENSCHAP

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Section: Noot 41unclassified

Implementatie van NHG-Standaarden: succes of probleem?

Grol

Braspenning

Hulscher

et al. 2010

HUISARTS WETENSCHAP

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“…Histologic analyses of the A1 pulley of trigger patients have shown fibrocartilaginous metaplasia and degenerative changes [10,15,20,26,32], which are believed to be adaptations to shear loads. Although TD is called tenosynovitis, histologic evaluations show minimal inflammatory changes within the synovial sheath [10,15,20].…”

Section: Introductionmentioning

confidence: 99%

“…Although TD is called tenosynovitis, histologic evaluations show minimal inflammatory changes within the synovial sheath [10,15,20]. The hypertrophy of the A1 pulley, which may triple in thickness secondary to fibrocartilaginous metaplasia, creates a size discrepancy between the tendon and its sheath [26,30,32]. Constriction of the flexor tendon and increased shear load may lead to a "pinching" of the tendon, causing a nodule to form, further aggravating the trigger symptoms [19,21,26] and restricting flexor tendon excursion, resulting in the inability to extend or flex the digit smoothly.…”

Section: Introductionmentioning

confidence: 99%

“…The hypertrophy of the A1 pulley, which may triple in thickness secondary to fibrocartilaginous metaplasia, creates a size discrepancy between the tendon and its sheath [26,30,32]. Constriction of the flexor tendon and increased shear load may lead to a "pinching" of the tendon, causing a nodule to form, further aggravating the trigger symptoms [19,21,26] and restricting flexor tendon excursion, resulting in the inability to extend or flex the digit smoothly. Symptoms range from painless clicking to locking and triggering, with pain felt at the palm over the A1 pulley and distally at the PIP joint or the IP joint (thumb).…”

Section: Introductionmentioning

confidence: 99%

“…The injection of long-acting corticosteroid into the flexor tendon sheath is a major treatment option for TD. Advantages include ease of administration, low complication rate, low morbidity, office setting applicability, and low cost [4,19,23,26]. The exact mode of action of corticosteroids is not yet exactly understood.…”

Section: Introductionmentioning

confidence: 99%

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Corticosteroid Injection Therapy for Trigger Finger or Thumb: A Retrospective Review of 577 Digits

Schubert

Hui-Chou

See

et al. 2013

Hand (New York, N,Y.)

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A Prospective Randomized Trial Comparing the Effectiveness of One versus Two (Staged) Corticosteroid Injections for the Treatment of Stenosing Tenosynovitis

Sheikh¹,

Peters²,

Sayde³

et al. 2014

Hand (New York, N,Y.)

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Background Stenosing tenosynovitis or trigger finger is a common clinical condition regularly treated with steroid injections. Varied success is reported at early time points following injection. We present a prospective, randomized IRB-approved study to confirm these findings at a long-term follow-up. Methods Adult patients presenting with symptoms of stenosing tenosynovitis who agreed to participate were randomized into two groups. Group 1 received an initial injection of triamcinolone and local anesthetic mixture. Group 2 received the same initial injection and an additional staged injection at 6 weeks. The patients were then followed beyond 2 years. If Group 1 patients were still symptomatic at 6 weeks, another injection was given. An additional injection or surgery was defined as treatment failure. DASH scores were obtained at baseline, 3, 6, and 12 months.Results Ninety-seven patients (101 trigger digits) were enrolled in the prospective trial. Fifty-six digits were randomized to the one-injection group versus 45 digits randomized to the two-injection group ("intention to treat analysis"-ITT). After accounting for crossover between the groups, 42 patients received one-injection versus fifty-nine patients receiving two injections ("actual" analysis).Overall failure was the same between the two groups. However, a higher surgery rate was noted for patients having undergone two injections versus one injection [47 % versus 27 % (p<0.013), ITT]. Diabetes was associated with a higher surgery rate at 1 year within the group of overall failures [56 % versus 37 % (p=0.0505), ITT]. High baseline DASH score (>40) was associated with a median time of 10 months for failure and 6 months for surgery as per a Kaplan-Meier survival analysis (p<0.005 and p<0.001, respectively, ITT). Conclusions As overall failure of steroid injection for trigger finger is not improved with staged, two-injection treatment, we recommend a single injection initial treatment for trigger finger with a second injection given in cases of recurrence or failure. Diabetes was a risk factor for needing surgery if failure occurred within 1 year. The baseline DASH score is helpful in predicting which patients have a higher chance of failing as well as needing surgery.Level of evidence Prospective, randomized trial, level I.

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Corticosteroid injection for trigger finger in adults

Abstract: References to studies excluded from this review Anderson 1991 {published data only} Anderson B, Kaye S. Treatment of flexor tenosynovitis of the hand ("trigger finger") with corticosteroids. A prospective study of the response to local injection.

Cited by 11 publications

References 11 publications

Implementatie van NHG-Standaarden: succes of probleem?

Implementatie van NHG-Standaarden: succes of probleem?

Corticosteroid Injection Therapy for Trigger Finger or Thumb: A Retrospective Review of 577 Digits

A Prospective Randomized Trial Comparing the Effectiveness of One versus Two (Staged) Corticosteroid Injections for the Treatment of Stenosing Tenosynovitis

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