Treatment of Flexor Tenosynovitis of the Hand ('Trigger Finger') With Corticosteroids

Anderson, B.

doi:10.1001/archinte.1991.00400010155024

Cited by 118 publications

(6 citation statements)

References 8 publications

(2 reference statements)

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“…Trigger finger, which was first described by Notta [13] in 1850, is a stenosing tenosynovitis of the flexor tendon that causes pain and dysfunction of the hand [1]. Ever since Howard et al [4] first used hydrocortisone injection as a treatment for trigger finger, therapeutic results of 60%-93% have been reported, and local steroid injection is known as the primary treatment method for trigger finger [5][6][7]. In the present study, the efficacy of our steroid injection technique was investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Local steroid injection in the trigger finger, which was first reported in 1953 by Howard et al [4], is a convenient technique and produces excellent results (therapeutic efficiency of 60%-93%) [5][6][7]. It is important to accurately inject the steroid into the flexor tendon sheath to increase the therapeutic effect of steroids and reduce side effects such as tendon rupture, skin atrophy, and discoloration, which can occur because of local injection [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Steroid injection using tendon excursion for trigger finger: introduction to injection methods and analysis of treatment results

Ko¹,

Kim²,

Lee³

2022

Arch Hand Microsurg

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Purpose: Local corticosteroid injections are routinely used as first-line treatment for trigger finger. However, accurate delivery of steroids into the tendon sheath is important for the effectiveness of the treatment and the prevention of complications. This study aimed to introduce our steroid injection technique for trigger finger, which uses tendon excursion of the flexor tendon, and evaluate the clinical outcomes in patients who were treated with this technique.Methods: A total of 171 patients with trigger finger who were treated with steroid injections were retrospectively reviewed. The efficacy of injection and complications were investigated. The evaluation of the efficacy was classified into “good,” “fair,” and “poor.” The results were analyzed according to the type of finger and the Quinnell grading system.Results: The total efficacy was 83.6% (good/fair, 143 digits; poor, 28 digits). The treatment success rate for Quinnell grade IV was 43.8% (7 of 16), which was significantly lower than those of Quinnell grades II and III, which were 88.9% (88 of 99) and 87.5% (49 of 56), respectively (II vs. IV, p=0.004; III vs. IV, p=0.010). In four fingers (excluding the thumb), the success rate was significantly higher than that of the thumb (88.2% vs. 75.4%, p=0.048).Conclusion: The steroid injection technique using tendon excursion showed excellent results and low complication rates. In particular, the second to fourth fingers and low-grade fingers showed more effective results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Steroid injection using tendon excursion for trigger finger: introduction to injection methods and analysis of treatment results

Ko¹,

Kim²,

Lee³

2022

Arch Hand Microsurg

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“…A second study prospectively followed 77 digits in 58 patients for an average of 4.6 years following injection of methylprednisolone acetate. [10] A total of 61% of digits showed complete resolution of symptoms after a single injection, 27% reported recurrent episodes, and 12% failed or required surgery because of early recurrence. Finally, a double-blind, randomized study showed a success rate of 60% in patients treated with injection of methylprednisolone acetate plus anesthetic compared with 16% in those treated with anesthetic alone (p = 0.02).…”

Section: Discussionmentioning

confidence: 99%

“…[1] The aim of treatment is abolition of pain and restoration of a full range of smooth motion in the involved digit(s). [2] Current treatment options include either conservative management by splinting,[1] treatment with anti-inflammatory drugs or corticosteroid injection (usually with local anesthetic) in the flexor tendon sheath,[2–10] or surgical release of the A1 pulley (via an open or percutaneous approach). [11–14]…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Injection of a Corticosteroid and Hyaluronic Acid

et al. 2011

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Background and Objectives: Stenosing tenosynovitis (trigger finger) is one of the most common causes of pain and disability in the hand, which may often require treatment with anti-inflammatory drugs, corticosteroid injection, or open surgery. However, there is still large room for improvement in the treatment of this condition by corticosteroid injection. The mechanical, viscoelastic, and antinociceptive properties of hyaluronic acid may potentially support the use of this molecule in association with corticosteroids for the treatment of trigger finger. This study examines the feasibility and safety of ultrasound-guided injection of a corticosteroid and hyaluronic acid compared, for the first time, with open surgery for the treatment of trigger finger.Methods: This was a monocentric, open-label, randomized study. Consecutive patients aged between 35 and 70 years with ultrasound-confirmed diagnosis of trigger finger were included. Patients were randomly assigned to either ultrasound-guided injection of methylprednisolone acetate 40 mg/mL with 0.8mL lidocaine into the flexor sheath plus injection of 1mL hyaluronic acid 0.8% 10 days later (n = 15; group A), or to open surgical release of the first annular pulley (n = 15; group B). Clinical assessment of the digital articular chain was conducted prior to treatment and after 6 weeks, and 3, 6, and 12 months. The duration of abstention from work and/or sports activity, and any treatment complications or additional treatment requirements (e.g. physiotherapy, compression, medication) were also recorded.Results: Fourteen patients (93.3%) in group A had complete symptom resolution at 6 months, which persisted for 12 months in 11 patients (73.3%), while three patients experienced recurrences and one experienced no symptom improvements. No patients in group A reported major or minor complications during or after corticosteroid injection, or required a compression bandage. All 15 patients in group B achieved complete resolution of articular impairment by 3 weeks after surgery, but ten patients were assigned to physiotherapy and local and/or oral analgesics for complete resolution of symptoms, which was approximately 30–40 days postsurgery. The mean duration of abstention from work and/or sport was 2–3 days in group A and 26 days in group B.Conclusions: Although the limited sample size did not allow any statistical comparison between treatment groups, and therefore all the findings should be regarded as preliminary, the results of this explorative study suggest that ultrasound-guided injection of a corticosteroid and hyaluronic acid could be a safe and feasible approach for the treatment of trigger finger. It is also associated with a shorter recovery time than open surgery, which leads to a reduced abstention from sports and, in particular, work activities, and therefore may have some pharmacoeconomic implications, which may be further explored. In light of the promising results obtained in this investigation, further studies comparing ultrasound-guided injection of corticos...

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“…52 There have been anecdotal case reports of tendon rupture, pulley rupture, and digital ischaemia. [49][50][51][52][53][54][55][56][57][58][59][60][61] Morbidity with injection is far less than with open surgery, and time off work or sports is quoted at three days compared with 26 days, respectively. 62 Early recurrence within three months was 33% in one large series of 1210 trigger injections, 47 and 55% at 1 year 63 -though this might be reduced with concurrent physiotherapy.…”

Section: Steroid Injectionmentioning

confidence: 99%