Efficacy Comparison of Hyaluronic Acid and Corticosteroid Injection in Treatment of Trigger Digits: A Randomized Controlled Trial

Abstract

Background: Although the current nonsurgical treatment for trigger digits is corticosteroid (CS) injection, it often comes with adverse effects that may cause some limitations. Currently, Hyaluronic acid (HA) has been successfully used in tendinopathy and may be used in stenosing tenosynovitis. The aim of this study is to compare the efficacy of ultrasound-guided injection between the HA and CS in trigger digits treatment. Methods: Double-blind randomized controlled trial was conducted. Fifty patients with 66 trigger digits were randomly assigned into an intervention group (1 ml of low-molecular weight HA) and a control group (1 ml of 10mg/ml triamcinolone acetate). The ultrasound-guided injection and local anesthesia (0.5 ml of 1% lidocaine without adrenaline) were used. The Quinnell grading, Visual Analog Scale (VAS) score of pain, Disabilities of the Arm, Shoulder and Hand (DASH) score and complications were collected at 1-, 3-and 6-month follow-up. Results: The mean age of HA group (33 digits) and CS group (33 digits) were 58.3 years and 54.7 years respectively. Nine patients were loss of follow-up (7 in HA group and 2 in CS group). The Quinnell grades have shown an improvement in both group. The CS group had a significant better improvement at 1-month (p-value < 0.001) and there was no significant difference at 3-and 6-month follow-up between the two groups. The median of VAS and DASH score were significantly improved by time in both groups (p-value < 0.01). The CS group showed a better significant improvement in early period of follow-up (p-value < 0.05). However, there was no significant difference between the two groups in the last follow-up. Conclusions: HA and CS injection has a comparable therapeutic effect in treatment of trigger digits. However, CS injection has higher efficacy of pain and inflammation reduction in the early phase of the disease.

The Role of Hyaluronic Acid Injection for the Treatment of Tendinopathy

“…Injection therapy was associated with a shorter recovery time, with a consequent reduced absence from sports and work activities and fewer complications (52). In accordance, other Authors found that HA achieved similar effect as steroid injection in trigger finger with a long-lasting functional improvement (MHQ scores continued to increase in the HA group at 3 months follow-up) without adverse events, until 6 months of follow-up (53,54). Orlandi et al compared the 6 months outcome of three different ultrasound guided percutaneous injection treatment for de Quervain's disease (steroid alone, steroid with saline, steroid with HA).…”

Comparative effectiveness of various treatment strategies for trigger finger by pairwise meta-analysis

“…After systematic review, 24 articles met the inclusion criteria. 5,6,9,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Among them, 8 of them were excluded from our meta-analysis (Supplemental Appendix B) and 16 of them (including 1185 patients) which reported success were included in our meta-analysis ( Figure 1). 5,6,9,10,[14][15][16][17][18][19][20][21][22][23][24][25] The main characteristics of the included articles are shown in Table 1.…”

Low Molecular Weight Hyaluronic Acid (500–730 Kda) Injections in Tendinopathies—A Narrative Review

“…The authors noted that both LMW-HA and corticosteroids provide a comparable therapeutic effect in the medium term. However, it is necessary to consider that corticosteroids have a cytotoxic effect on tendons [ 51 ].…”