Corticosteroid Injections in the Treatment of Trigger Finger: A Level I and II Systematic Review

Fleisch, Sheryl B.; Spindler, Kurt P.; Lee, Donald H.

doi:10.5435/00124635-200703000-00006

Cited by 103 publications

(67 citation statements)

References 22 publications

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“…This is most common at the A1 pulley. Clinically, this presents as symptomatic locking or clicking of the digit as the flexor tendon passes through the A1 pulley [2,3]. Thickening of the A1 pulley can be identified on sonography as a general/focal thickening, with impingement of flexor tendon movement identified dynamically during active and passive movement (Fig.…”

Section: Introductionmentioning

confidence: 98%

Ultrasound-guided percutaneous release of the annular pulley in trigger digit

et al. 2009

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The purpose of this study was to describe and evaluate a new technique for ultrasound-guided percutaneous release of the annular pulley in trigger digit using a modified hypodermic needle. A total of 35 ultrasound-guided percutaneous releases were performed on 25 patients diagnosed and referred by hand surgeons in our institution over 16 months from October 2006. Inclusion criteria were as follows: adulthood, triggering present for at least 4 months, failure to respond to conservative management or steroid injections, no previous history of pulley release in the affected digit. Under ultrasound guidance, the affected pulley was released using a standard 19-gauge hypodermic needle bent at two points as the cutting device. Follow-up took place at 12 weeks and 6 months with improvement in triggering and clinically graded pain. At follow-up, no complications had occurred and all patients demonstrated improvement in their triggering, with complete resolution in 32 digits (91%), good improvement in 2 digits (6%) and some improvement in 1 digit (3%). This new technique uses a widely available and safe cutting device and is safe and can be used to provide definitive management for trigger finger, allowing the procedure to be performed in a variety of clinical settings.

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Section: Introductionmentioning

confidence: 98%

Ultrasound-guided percutaneous release of the annular pulley in trigger digit

et al. 2009

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“…Subsequently, it is common practice to use corticosteroid injections to treat trigger finger symptomology. Steroid injection has been shown to be effective in various studies [6,12,19], including a randomized, controlled prospective study where steroid injections with anesthetic were noted to be significantly more effective than anesthetic injection alone [14]. Success after steroid injections for trigger finger has been cited at greater than 50 %, even in diabetics Fig.…”

Section: Discussionmentioning

confidence: 99%

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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“…Sıkışmanın olduğu bölgeye kortikosteroidin krem olarak sürülmesi, ultrason ile fonoforezis tarzında verilmesi veya parafin gibi sıcak uygulamalar yapılmasının yanı sıra en sık tercih edilen yöntem enjeksiyondur. İki yüz doksan yedi parmağı içeren dört çalışmanın sonuçlarına göre, tetik parmak tedavisinde kortikosteroid enjeksiyonundan sonra başarı oranı %57'dir (11,20).…”

Section: Kortikosteroid Enjeksiyonuunclassified

Exercise Prescription in Forearm, Wrist, and Hand Pain

Kuran¹

2014

Turk J Phys Med Rehab

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The forearm, wrist, and hand are the most frequently used body parts during activities of daily life. Hence, injuries are frequently encountered due to widespread use of computers in modern life, inappropriate ergonomics, mechanical loading during manual weight lifts, and inflammatory and neurological causes. Although pharmacological treatments, physical therapy modalities, and surgical interventions in severe cases are considered as treatments, therapeutic exercise, being cheap and preventive, is the mainstay of evidence-based hand therapy. Different categories of exercises are prescribed to provide nutrition of joint surfaces; to lengthen the shortened, painful periarticular tissue; to increase blood circulation; to stimulate joint proprioceptors to increase joint stability; and to improve muscle power and endurance. During the applications, the physical characteristics of the patient and his daily living needs, pain tolerance, and disease stage, etc., should be considered to hit the right target. In this review, frequently encountered forearm, wrist, and hand pathologies and the exercises prescribed in the treatment of these conditions will be discussed. Key Words: Hand exercises, tennis elbow, De Quervain ÖzetÖn kol, el ve el bileği günlük yaşam aktivitelerinin yerine getirilmesi sırasında en sık kullanılan vücut kısımlarındandır. Günümüzde bilgisayarın yaygın olarak kullanılması, bozuk ergonomi, elle kaldırılan ağırlıklara bağlı mekanik yüklenme, çeşitli inflamatuvar ve nörolojik nedenler sonucu yaralanmalarına sık rastlanır. Semptomların ve fonksiyon bozukluğunun giderilmesinde farmakolojik yaklaşımlar, fizik tedavi uygulamaları ve ileri olgularda cerrahi girişimler yer alsa da egzersiz tedavisi basit, ucuz ve koruyucu olması nedeniyle kanıta dayalı el tedavisinin ayrılmaz bir parçasıdır. Eklem yüzeyinin beslenmesi, eklemin çevresinde boyun ağrı nedeniyle kısalmış dokuların uzaması, kan dolaşımının artması, eklem reseptörlerinin uyarılarak stabilitenin artması, kas kuvvetinin ve dayanıklılığının artması amacıyla değişik egzersiz tipleri uygulanır. Egzersiz uygulamaları sırasında kişinin beden özellikleri, günlük yaşam gereksinimleri, ağrı toleransı, hastalığın evresi vb. özelliklerine göre hedefler belirlenmelidir. Bu yazıda sık rastlanan ön kol, el bilek ve el patolojilerinde uygulanan egzersizler ele alınacaktır. S43El ve el bileği hastalıklarında reçete edilen egzersizlerin amacı hastalığı gidermek veya önlemek, fonksiyonu arttırmak, yaralanma riskini azaltmak ve kişinin genel sağlığına katkıda bulunmaktır. Bu amaçla verilen hareketler veya pozisyonlandırmalar bazı parametrelere ve sonuç ölçeklerine göre değerlendirilirler. Diğer patolojilerde olduğu gibi, el-el bileği hastalıklarında da terapötik egzersiz reçete ederken hastanın tanısı, yaşı, birlikte olan diğer hastalıkları, kullandığı ilaçlar, ağrı toleransı, dominant eli, ev veya işyerinde yapamadıkları, yeti yitimi olup olmadığı sorgulanmalı-dır. Hastalığın hangi evrede (akut/subakut/kronik) olduğu, dalgalanmalar gösterip göstermediği, yar...

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Corticosteroid Injections in the Treatment of Trigger Finger: A Level I and II Systematic Review

Cited by 103 publications

References 22 publications

Ultrasound-guided percutaneous release of the annular pulley in trigger digit

Ultrasound-guided percutaneous release of the annular pulley in trigger digit

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

Exercise Prescription in Forearm, Wrist, and Hand Pain

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