Non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger

Leow, Mabel Qi He; Zheng, Qishi; Shi, Luming; Tay, Shian Chao; Chan, Edwin Sy

doi:10.1002/14651858.cd012789.pub2

Cited by 7 publications

(8 citation statements)

References 92 publications

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“…These reasons support the more potent and faster action of corticosteroids compared with NSAIDs. Other studies have also compared ketorolac and a corticosteroid injection in trigger finger [10][11][12] and radial styloid tenosynovitis [8], and also reported the steroid injection gave better results, similar to our study, thus it may be concluded that NSAID injections may not be the best choice for use in tendon stenosis conditions. This could be because the cause of trigger finger and radial styloid tenosynovitis both result from stenosing tenosynovitis which may not respond well to anti-inflammatories and require more intensive interventions to deal with the symptoms.…”

Section: Discussionsupporting

confidence: 88%

Comparison of the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain’s tenosynovitis: a double-blind randomized controlled trial

Suwannaphisit

Suwanno

Fongsri

et al. 2022

BMC Musculoskelet Disord

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Background De Quervain’s disease is tenosynovitis of the first dorsal compartment causing severely painful radial-side wrist pain and impaired function. Steroids are effective in treating this condition due to their anti-inflammatory properties. However, this drug causes problems such as hypopigmentation, and is contradicted in diabetes mellitus patients. Non-steroidal anti-inflammatory drug (NSAID) which are efficacious in shoulder pathology and not contraindicated in diabetics and can be used to avoid the local effects of steroids could be beneficial for some patients. The present study was a randomized controlled trial to examine the differences in pain scores and functional response to local injections of a corticosteroid and the NSAID ketorolac. Methods Sixty-four patients with radial styloid tenosynovitis were randomized using a computer-generated random number table into two groups receiving either a ketorolac injection or a triamcinolone injection. We evaluated post-injection pain intensity using a verbal numerical rating scale (VNRS), functional outcomes using the Thai Disabilities of the Arm, Shoulder and Hand (DASH) scale, and evaluated grip and pinch strengths, recorded at baseline and 6 weeks after the injection. Results Thirty-one participants in the ketorolac group and 29 participants in the triamcinolone group completed the study and were included in the analysis. There were no significant differences in the assessments at baseline. At the 6-week conclusion of the study, patients in the triamcinolone group had a statistically lower average pain score than in the ketorolac group (0.7 ± 2.0 vs 5.3 ± 3.2, P < 0.001), higher DASH functional score (4.4 ± 6.5 vs 34.1 ± 20.2, P < 0.001), higher right grip strength (60.8 ± 16.8 vs 49.2 ± 18.6, P < 0.015), and higher left grip strength (59.8 ± 18.1 vs 50.3 ± 18.0, P < 0.04). However, there was no difference in pinch strength. Conclusions Our study found that ketorolac injections resulted in inferior pain reduction, functional score and grip improvement than triamcinolone injection in patients with radial styloid tenosynovitis. Future studies are required to examine the effects of ketorolac in larger group and with longer follow-up periods to further elucidate the findings of this study. Trial registration The study was registered at Clinicaltrials.in.th (TCTR20200909006).

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Section: Discussionsupporting

confidence: 88%

Comparison of the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain’s tenosynovitis: a double-blind randomized controlled trial

Suwannaphisit

Suwanno

Fongsri

et al. 2022

BMC Musculoskelet Disord

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“…The 2014 European HANDGUIDE group guidelines recommend corticosteroids injections for trigger finger 11 . However, some patients might prefer NSAIDs injection over glucocorticoid injections because of concerns about blood sugar control or anxiety related to adverse events after steroid injections including infections 1 . However, NSAIDs are less potent anti-inflammatory agents than glucocorticoids.…”

Section: What Are the Implications Of The Cochrane Evidence For Pract...mentioning

confidence: 99%

“…Therefore, considering that trigger finger is a common disorder in the general population, it is important that future clinical trials should address these aspects. The authors have suggested that future RCTs may adopt a noninferiority rather than a superiority hypothesis perspective to answer this question 1 . Clinicians should carefully select the option for injections on a case-to-case basis considering the current guidelines and discussing the possible outcomes and adverse events with the patients.…”

Section: What Are the Implications Of The Cochrane Evidence For Pract...mentioning

confidence: 99%

“…The aim of this commentary is to discuss from a rehabilitation perspective of the Cochrane Review “Non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger” by Leow et al 1 (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012789.pub2/full), published by Cochrane Musculoskeletal. This Cochrane Corner is produced in agreement with the American Journal of Physical Medicine and Rehabilitation by Cochrane Rehabilitation with views of the review summary author(s) in the “implications for practice” section.…”

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confidence: 99%

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What Are the Benefits and Harms of Nonsteroidal Anti-Inflammatory Drugs for Trigger Finger?

Afridi

Rathore

2022

Am J Phys Med Rehabil

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“…In adult patients with trigger fingers, conservative treatments include activity modification, non-steroidal anti-inflammatory drugs, splinting and corticosteroid injection as initial treatment options (Akhtar et al., 2005; Drijkoningen et al., 2018; Kazuki et al., 2006; Makkouk et al., 2008; Murphy et al., 1995; Patel and Bassini, 1992; Ring et al., 2008; Tarbhai et al., 2012). Measurements of the efficacy of various treatments in previous studies have included symptoms of pain, triggering or locking, Quinell grading, recurrence requiring further treatment and patient-reported outcome measures (PROMs) (Langer et al., 2015; Leow et al., 2021; Lunsford et al., 2019; Sheikh et al., 2014; Shen et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

Minimal clinically important difference of the Michigan Hand Outcomes Questionnaire score and the pain visual analogue scale in conservative treatment of trigger finger

Atthakomol,

Tongsu,

Ngamsuprom

et al. 2023

J Hand Surg Eur Vol

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We investigated the minimal clinically important difference (MCID) of the Michigan Hand Outcomes Questionnaire (MHQ) and the pain visual analogue scale (VAS-pain) after conservative treatment of trigger finger. This secondary analysis of a randomized controlled trial compared pain reduction, symptoms and functional improvement at 12 weeks. Patients included were at least 18 years old and able to complete MHQ and VAS-pain at enrolment and 12 weeks after treatment. The MCIDs of MHQ and VAS-pain were evaluated using a distribution-based, anchor-based and receiver operating characteristic (ROC) curve-based approach. Of the 117 patients, the MCIDs of MHQ and VAS-pain using a distribution-based approach were 5.3 and 0.6, respectively; applying ROC method were 23.5 and 2.5, respectively; and using anchor questions were 15 and 2, respectively. These MCID values by anchor-based method with a minimal difference of 15 for MHQ and 2 for VAS-pain are recommended as primary evidence to determine clinically significant improvement after conservative treatment of trigger finger. Level of evidence: I

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Non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger

Cited by 7 publications

References 92 publications

Comparison of the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain’s tenosynovitis: a double-blind randomized controlled trial

Comparison of the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain’s tenosynovitis: a double-blind randomized controlled trial

What Are the Benefits and Harms of Nonsteroidal Anti-Inflammatory Drugs for Trigger Finger?

Minimal clinically important difference of the Michigan Hand Outcomes Questionnaire score and the pain visual analogue scale in conservative treatment of trigger finger

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