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

Abstract

Background: The purpose of this study was to compare the efficacy of single and multiple corticosteroid injections used for symptomatic trigger finger. The rates of subsequent injections and the rate of tendon sheath release are reported along with the identification of risk factors correlated with failure of injection. Methods: A retrospective review of a national healthcare database was conducted identifying patients with a diagnosis of trigger finger or thumb. Inclusion required a tendon sheath injection on the same day or within six weeks of diagnosis. Patient cohorts were further stratified based on treatment success and those requiring additional injections within 6 months or surgery within 1 year of initial diagnosis.Results: Thirty-one thousand seven hundred fifty-one patients met inclusion criteria and underwent an initial injection within the study period. The efficacy of initial, second, and third injection was 66.3%, 79.4%, and 79.6%, respectively. Of the patients who failed an injection, 9.4% had tendon sheath release after a primary injection, 23.1% had surgery after a second injection, and 30.4% had surgery after a third injection. Only obesity (OR 1.2; P , 0.0001) and concomitant diagnosis of carpal tunnel syndrome (OR 1.4; P , 0.0001) were found to be significant for injection failure on multivariate logistic regression analysis. Discussion: Overall corticosteroid injections were effective in greater than 65% of patients. This information may help guide treatment practice because there seems to be continued additional benefit to repeat corticosteroid injections after injection failure. Stenosing tenosynovitis, commonly known as trigger finger, is a common condition with a 2% to 3% lifetime risk of occurrence. 1 Trigger finger most often occurs idiopathically with an inconsistency between the diameter of the tendon sheath and the flexor tendon of the affected finger; this leads to a narrowing of the sheath and prevents the tendon from moving smoothly through the sheath. [2][3][4] Pain may occur with flexion or extension, and patients often report a clicking or locking sensation with

Evidence in treatment of trigger finger: a review

“…This therapy has been used in isolation, demonstrating an effectiveness in resolving symptoms of 60-70%, although it has also been used in combination with the use of orthoses or preoperatively, as in the study published by Kerrigan and Stanwix in 2009, in which it was concluded that the most successful and cost-effective management strategy for TF is the algorithm of two steroid injections before surgical intervention. 10,11 A systematic review published by Fleisch, et al in 2007, documented a 56% success rate with single steroid injection, while Lewis et al sought to document serial steroid injection, finding much more encouraging results, with symptom remission rates of 66.3%, 79.4% and 79.6% in the first, second and third injection, respectively. 12 Injection of steroids into the tendon sheath is a procedure that can be performed in an office, as long as the necessary aseptic conditions are available.…”