Establishing an Efficient Care Paradigm for Trigger Finger

Abstract

Background: To identify the time course for efficacy of corticosteroid injections in the treatment of trigger finger. Methods: A prospective single-center observational study was conducted, consisting of 38 patients with 41 trigger digits that were injected. Enrolled patients completed an initial Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire to determine the severity of their symptoms. Following the injection, patients were contacted at scheduled time points for up to 12 weeks to determine if, and when, objective resolution of symptoms occurred. Patients who received additional treatment, such as a second injection or surgery, and those who did not have objective relief of symptoms by 12 weeks were classified as failed. Upon symptom resolution or injection failure, patients were given a DASH exit questionnaire. Results: 30 of 41 injected trigger digits resolved and 11 failed treatment with a single corticosteroid injection. The latest that any study participant experienced resolution of symptoms was 69 days. At 38 days, the rate of resolution of the study population slowed significantly. Conclusions: Although symptomatic resolution of trigger finger from a single corticosteroid injection can occur early on, a follow-up of 4 weeks (28 days) does not allow enough time for symptom resolution. The earliest a surgeon and patient should consider a secondary treatment is at 38 days. After 69 days without resolution, both surgeon and patient can be confident that further treatment is needed.

Corticosteroid injection treatment for dactylitis in psoriatic arthritis

“… 48 For trigger finger, in patients with partial improvement, optimal timing of the next injection appears to be after 69 days. 49 , 50 …”

Trigger Finger? Just Shoot!

“…37 , 41 , 48 , 49 Lower rates of resolution have been demonstrated in fingers (vs thumbs), in diabetics, those with multiple TF, diffuse swelling (vs a palpable nodule) and patients with more severe grades of disease. 8 , 38 , 50 , 51 For patients with partial improvement, optimal timing of the next injection appears to be after 69 days, 52 not sooner. 53 …”

“…37,41,48,49 Lower rates of resolution have been demonstrated in fingers (vs thumbs), in diabetics, those with multiple TF, diffuse swelling (vs a palpable nodule) and patients with more severe grades of disease. 8,38,50,51 For patients with partial improvement, optimal timing of the next injection appears to be after 69 days, 52 not sooner. 53 Ultrasound guidance offers no advantage over landmark guidance, other than greater accuracy of intrasheath placement of steroid, 54 which did not correlate with higher efficacy in a 1998 radiographic dye study 55 or in 2 randomized trials of US-guided intrasheath versus landmark-guided intrasheath injections.…”

National Benchmarks for the Efficacy of Trigger Finger and the Risk Factors Associated With Failure

“…16 Surgical intervention with percutaneous, endoscopic, or open A1 pulley release may be indicated in patients with trigger finger refractory to conservative management and corticosteroid injections. 17 - 19 In more than 90% of cases, surgical intervention results in successful resolution of symptoms. 2 , 20 …”

“…16 Surgical intervention with percutaneous, endoscopic, or open A1 pulley release may be indicated in patients with trigger finger refractory to conservative management and corticosteroid injections. [17][18][19] In more than 90% of cases, surgical intervention results in successful resolution of symptoms. 2,20 Although previous literature has focused on how demographics, comorbidities, and injection technique affect the efficacy of the injection, [21][22][23] the literature is less clear regarding patients who have failed corticosteroid injections and comparing their success with different follow-up treatment options.…”