Corticosteroid Injection Therapy for Trigger Finger or Thumb: A Retrospective Review of 577 Digits

Abstract

Background

Stenosing flexor tenosynovitis of the digital flexor tendon (trigger digit) is a common condition encountered by hand surgeons. Our purpose was to determine the efficacy of corticosteroid injections and review the demographic profile of patients with trigger digits.

Methods

We reviewed the records of 362 patients (577 trigger digits) treated with steroid injections (8 mg of triamcinolone acetonide in 1 % lidocaine) from 1998 through 2011. Follow-up (intervention to last visit) averaged 66.4 months. We assessed patient demographics (e.g., gender, age, diabetes mellitus, hand dominance, trigger digit distribution) and determined recurrence rate and injection duration of efficacy. If one injection failed, additional injections or surgical A1 pulley release were offered. Results were analyzed with Student's t test or Fisher's exact test (significance, p<0.05).

Results

Women (258, 71.3 %) were affected significantly (p<0.001) more frequently than men (104, 28.7 %) and at a significantly (p<0.001) younger age (average, 58.3 versus 62.1 years, respectively). Eighty patients (22.1 %) were diabetic. We observed no correlation between trigger digit and hand dominance. The two most commonly affected digits were the right long finger (17.8 %) and right thumb (17.7 %). For 721 injections, the recurrence rate was 20.3 %; there were no major complications. For recurrences, the injection efficacy averaged 315 days. Surgery was required for 117 patients.

Conclusions

Injection therapy is safe and highly effective (79.7 %). Women were affected by trigger digits more often than men and at a younger age. Surgical release provides a definitive therapeutic option if corticosteroid injection fails.

Keywords

Corticosteroid injection Efficacy Open trigger finger release Recurrence Stenosing tendovaginitis Stenosing tenosynovitis Trigger digits Trigger finger

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References

Akhtar

Bradley

M.J.

Quinton

D.N.

Management and referral for trigger finger/thumb. BMJ. 2005;331:30–3.

Anderson

Kaye

Treatment of flexor tenosynovitis of the hand (‘trigger finger’) with corticosteroids. A prospective study of the response to local injection. Arch Intern Med. 1991;151:153–6.

Baumgarten

K.M.

Gerlach

Boyer

M.I.

Corticosteroid injection in diabetic patients with trigger finger. A prospective, randomized, controlled double-blinded study. J Bone Joint Surg Am. 2007;89:2604–11.

Benson

L.S.

Ptaszek

A.J.

Injection versus surgery in the treatment of trigger finger. J Hand Surg Am. 1997;22:138–44.

Blyth

M.J.

Ross

D.J.

Diabetes and trigger finger. J Hand Surg Br. 1996;21:244–5.

Bristol-Myers Squibb Company. Kenalog-40 injection (triamcinolone acetonide injectable suspension, USP). Package insert. http://packageinserts.bms.com/pi/pi_kenalog-40.pdf. Accessed 3 Dec 2012.

Chammas

Bousquet

Renard

Dupuytren's disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Am. 1995;20:109–14.

Clapham

P.J.

Chung

K.C.

A historical perspective of the Notta's node in trigger fingers. J Hand Surg Am. 2009;34:1518–22.

Dostal

G.H.

Gamelli

R.L.

The differential effect of corticosteroids on wound disruption strength in mice. Arch Surg. 1990;125:636–40.

10.

Fahey

J.J.

Bollinger

J.A.

Trigger-finger in adults and children. J Bone Joint Surg Am. 1954;36:1200–18.

11.

Fleisch

S.B.

Spindler

K.P.

Lee

D.H.

Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review. J Am Acad Orthop Surg. 2007;15:166–71.

12.

Freiberg

Mulholland

R.S.

Levine

Nonoperative treatment of trigger fingers and thumbs. J Hand Surg Am. 1989;14:553–8.

13.

Gorsche

Wiley

J.P.

Renger

Prevalence and incidence of stenosing flexor tenosynovitis (trigger finger) in a meat-packing plant. J Occup Environ Med. 1998;40:556–60.

14.

Howard

L.D.

Jr Pratt

D.R.

Bunnell

The use of compound F (hydrocortone) in operative and non-operative conditions of the hand. J Bone Joint Surg Am. 1953;35:994–1002.

15.

Kalms

S.B.

Hojgaard

A.D.

Trigger finger: report of an unusual case. J Trauma. 1991;31:582–3.

16.

Lambert

M.A.

Morton

R.J.

Sloan

J.P.

Controlled study of the use of local steroid injection in the treatment of trigger finger and thumb. J Hand Surg Br. 1992;17:69–70.

17.

Makkouk

A.H.

Oetgen

M.E.

Swigart

C.R.

Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1:92–6.

18.

Maneerit

Sriworakun

Budhraja

Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone. J Hand Surg Br. 2003;28:586–9.

19.

Marks

M.R.

Gunther

S.F.

Efficacy of cortisone injection in treatment of trigger fingers and thumbs. J Hand Surg Am. 1989;14:722–7.

20.

Moore

J.S.

Flexor tendon entrapment of the digits (trigger finger and trigger thumb). J Occup Environ Med. 2000;42:526–45.

21.

Murphy

Failla

J.M.

Koniuch

M.P.

Steroid versus placebo injection for trigger finger. J Hand Surg Am. 1995;20:628–31.

22.

Newport

M.L.

Lane

L.B.

Stuchin

S.A.

Treatment of trigger finger by steroid injection. J Hand Surg Am. 1990;15:748–50.

23.

Nimigan

A.S.

Ross

D.C.

Gan

B.S.

Steroid injections in the management of trigger fingers. Am J Phys Med Rehabil. 2006;85:36–43.

24.

Notta

Recherches sur une affection particuliere des gaines tendineuses de la main, caracterisee par le developement d'une nodosite sur le trajet des tendons flechisseurs des doigts et par l'empechement de leurs mouvements. Arch Gen Med. 1850;4:142–61.

25.

Patel

M.R.

Bassini

Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am. 1992;17:110–3.

26.

Peters-Veluthamaningal

Van der Windt

D.A.

Winters

J.C.

Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev 2009;CD005617.

27.

Peters-Veluthamaningal

Winters

J.C.

Groenier

K.H.

Corticosteroid injections effective for trigger finger in adults in general practice: a double-blinded randomised placebo controlled trial. Ann Rheum Dis. 2008;67:1262–6.

28.

Pollack

S.V.

Systemic medications and wound healing. Int J Dermatol. 1982;21:489–96.

29.

Ring

Lozano-Calderon

Shin

A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger. J Hand Surg Am. 2008;33:516–22.

30.

Ryzewicz

Wolf

J.M.

Trigger digits: principles, management, and complications. J Hand Surg Am. 2006;31:135–16.

31.

Saldana

M.J.

Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9:246–52.

32.

Sampson

S.P.

Badalamente

M.A.

Hurst

L.C.

Pathobiology of the human A1 pulley in trigger finger. J Hand Surg Am. 1991;16:714–21.

33.

Taras

J.S.

Raphael

J.S.

Pan

W.T.

Corticosteroid injections for trigger digits: is intrasheath injection necessary?

J Hand Surg Am. 1998;23:717–22.

34.

Thorpe

A.P.

Results of surgery for trigger finger. J Hand Surg Br. 1988;13:199–201.

35.

Trezies

A.J.

Lyons

A.R.

Fielding

Is occupation an aetiological factor in the development of trigger finger?

J Hand Surg Br. 1998;23:539–40.

36.

Turowski

G.A.

Zdankiewicz

P.D.

Thomson

J.G.

The results of surgical treatment of trigger finger. J Hand Surg Am. 1997;22:145–9.

37.

Will

Lubahn

Complications of open trigger finger release. J Hand Surg Am. 2010;35:594–6.