Resolution and recurrence rates of idiopathic trigger finger after corticosteroid injection
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This study addresses factors associated with apparent resolution and recurrence of triggering using data from providers with various treatment strategies.
A retrospective review identified 878 adult patients with 1,210 Quinnell grade 2 or 3 trigger fingers that had one or more corticosteroid injections by one of three surgeons between 2001 and 2011. Two surgeons injected dexamethasone, but one had patients return 1 month after injection and was quick to recommend surgery (strategy A) and the other had patients return 2 months after injection, offered another injection or surgery, and followed the patient’s preference. One surgeon used triamcinolone, had patients return only if the injection did not work, and waited at least 3 months to offer surgery. Factors associated with apparent resolution and recurrence of triggering were sought in bivariable and multivariable statistical analysis.
Triamcinolone injection was associated with more frequent apparent resolution (83 %), than dexamethasone injection (30 %). Apparent resolution of triggering was also associated with a delayed surgery treatment strategy (B and C) and the affected finger (long and ring fingers were less likely to resolve). Return with triggering after documented or presumed resolution occurred in 188 fingers (33 %) and was associated with triamcinolone injection, index, long and ring finger, and orally treated non-insulin-dependent diabetes mellitus. Strategy A had the lowest initial apparent resolution rate, the highest proportion of patients having surgery, and the lowest final triggering rate of 10 %.
Both treatment strategy and type of corticosteroid determine apparent resolution and recurrence rates.
KeywordsTrigger finger Resolution Recurrence Corticosteroid injections
- 3.Benson LS, Ptaszek AJ. Injection versus surgery in the treatment of trigger finger. J Hand Surg. 1997;22A(1):138–44.Google Scholar
- 6.Gyuricza C, Umoh E, Wolfe SW. Multiple pulley rupture following corticosteroid injection for trigger digit: case report. J Hand Surg. 2009;34A(8):1444–8.Google Scholar
- 8.Kerrigan CL, Stanwix MG. Using evidence to minimize the cost of trigger finger care. J Hand Surg. 2009;34A(6):997–1005.Google Scholar
- 10.Lambert MA, Morton RJ, Sloan JP. Controlled study of the use of local steroid injection in the treatment of trigger finger and thumb. J Hand Surg. 1992;17B(1):69–70.Google Scholar
- 11.Maneerit J, Sriworakun C, Budhraja N, et al. Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone. J Hand Surg. 2003;28B(6):586–9.Google Scholar
- 12.Marks MR, Gunther SF. Efficacy of cortisone injection in treatment of trigger fingers and thumbs. J Hand Surg. 1989;14A(4):722–7.Google Scholar
- 13.Murphy D, Failla JM, Koniuch MP. Steroid versus placebo injection for trigger finger. J Hand Surg. 1995;20A(4):628–31.Google Scholar
- 14.Newport ML, Lane LB, Stuchin SA. Treatment of trigger finger by steroid injection. J Hand Surg. 1990;15A(5):748–50.Google Scholar
- 15.Park J, Dumanian GA. Shower emboli and digital necrosis after a single corticosteroid injection for trigger thumb: case report. J Hand Surg. 2009;34A(2):313–6.Google Scholar
- 17.Ring D, Lozano-Calderon S, Shin R, et al. A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger. J Hand Surg. 2008;33A(4):516–22. discussion 523–514.Google Scholar
- 21.Yam A, Teoh LC, Yong FC. Necrotising fasciitis after corticosteroid injection for trigger finger: a severe complication from a 'safe' procedure. J Hand Surg. 2009;34B(5):689–90.Google Scholar
- 22.Yamada K, Masuko T, Iwasaki N. Rupture of the flexor digitorum profundus tendon after injections of insoluble steroid for a trigger finger. J Hand Surg. 2011;36B(1):77–8.Google Scholar
- 23.Zyluk A, Jagielski G. Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial. J Hand Surg. 2011;36B(1):53–6.Google Scholar