Stenosing tenosynovitis is a condition due to a size mismatch between the flexor tendons and the first annular pulley. Corticosteroid injection is the mainstay treatment. The purpose of this study is to compare different dosages and volumes of triamcinolone in the treatment of primary stenosing tenosynovitis.
Methods:
Patients with primary Quinnell grades 1 or 2 stenosing tenosynovitis were recruited in this prospective, blinded, randomized trial. Patients were randomized into 1 of 2 groups. Group A received 0.25 mL of triamcinolone 40 mg/mL, mixed with 0.25 mL of 1% lidocaine with epinephrine (10 mg of triamcinolone, 0.5 mL in total volume). Group B received 0.5 mL of triamcinolone 40 mg/mL, mixed with 0.5 mL of 1% lidocaine with epinephrine (20 mg of triamcinolone, 1 mL in total volume). Patients were assessed by a blinded hand therapist at 2 and 4 weeks, and by a blinded hand surgeon at 6 weeks. The primary outcome was complete symptom resolution at 6 weeks. Both per-protocol and intention-to-treat analyses were performed.
Results:
One hundred ninety-one patients were recruited from 2009 to 2018. Eighty-two and 77 patients had complete data in group A and B, respectively. There was no difference in success rates in complete symptom resolution at 6 weeks between group A (59.8%) and group B (62.3%). The mean visual analogue pain scores on injection were 4.31 ± 2.11 for group A and 4.30 ± 2.09 for group B.
Conclusions:
Triamcinolone 10 mg was as effective as 20 mg in the resolution of symptoms of Quinnell grade 1 or 2 stenosing tenosynovitis at 6 weeks.
MooreJS. Flexor tendon entrapment of the digits (trigger finger and trigger thumb). J Occup Environ Med. 2000;42(5):526–545.
2.
RyzewiczMWolfJM. Trigger digits: principles, management, and complications. J Hand Surg Am. 2006;31(1):135–146.
3.
QuinnellRC. Conservative management of trigger finger. Practitioner. 1980;224(1340):187–190.
4.
SampsonSPBadalamenteMAHurstLCSeidmanJ, et al.Pathobiology of the human A1 pulley in trigger finger. J Hand Surg Am. 1991;16(4):714–721.
5.
ManeeritJSriworakunCBudhrajaNNagavajaraP. Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone. J Hand Surg Br. 2003;28(6):586–589.
6.
MarksMRGuntherSF. Efficacy of cortisone injection in treatment of trigger fingers and thumbs. J Hand Surg Am. 1989;14(4):722–727.
7.
PatelMRBassiniL. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am. 1992;17(1):110–113.
8.
SchubertCHui-ChouHGSeeAPDeuneEG. Corticosteroid injection therapy for trigger finger or thumb: a retrospective review of 577 digits. Hand (N Y)2013;8(4):439–444.
9.
GrandizioLCSpeeckaertABrothersJGrahamJKlenaJC. Predictors of recurrence after corticosteroid injection for trigger digits. Hand. 2017;12(4):352–356.
10.
MurphyDFaillaJMKoniuchMP. Steroid versus placebo injection for trigger finger. J Hand Surg Am. 1995;20(4):628–631.
11.
FleischSBSpindlerKPLeeDH. Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review. J Am Acad Orthop Surg. 2007;15(3):166–171.
12.
RingDLozano-CalderónSShinRBastianPMudgalCJupiterJ. A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger. J Hand Surg Am. 2008;33(4):516–524.
13.
Peters-VeluthamaningalCWintersJCGroenierKHMeyboom-de JongB. Corticosteroid injections effective for trigger finger in adults in general practice: a double-blinded randomised placebo controlled trial. Ann Rheum Dis. 2008;67(9):1262–1266.
14.
Peters-VeluthamaningalCvan der WindtDAWintersJCMeyboom-de JongB. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev. 2009;21(1):CD005617.
15.
Dala-AliBMNakhdjevaniALloydMASchreuderFB. The efficacy of steroid injection in the treatment of trigger finger. Clin Orthop Surg. 2012;4(4):263–268.
16.
CastellanosJMuñoz-MahamudEDomínguezEDel AmoPIzquierdoOFillatP. Long-term effectiveness of corticosteroid injections for trigger finger and thumb. J Hand Surg Am. 2015;40(1):121–126.
17.
MaSWangCLiJZhangZYuYLvF. Efficacy of corticosteroid injection for treatment of trigger finger: a meta-analysis of randomized controlled trials. J Invest Surg. 2019;32(5):433–441. Epub 2018.
18.
NimiganASRossDCGanBS. Steroid injections in the management of trigger fingers. Am J Phys Med Rehabil. 2006;85(1):36–43.
19.
BaumgartenKMGerlachDBoyerMI. Corticosteroid injection in diabetic patients with trigger finger. a prospective, randomized, controlled double-blinded study. J Bone Joint Surg Am. 2007;89(12):2604–2611.
20.
ChangCJChangSPKaoLTTaiTWJouIM. A meta-analysis of corticosteroid injection for trigger digits among patients with diabetes. Orthopedics. 2018;41(1):e8–e14.
21.
KegelGMarshallABarronOACatalanoLWGlickelSZKuhnM. Steroid injection in the upper extremity: experienced clinical opinion versus evidence-based practices. Orthopedics. 2013;36(9):1141–1148.
22.
PruzanskyJSGoljanPLundmarkDPShinEKJacobySMOstermanAL. Treatment preferences for trigger digit by members of the American association for hand surgery. Hand (N Y). 2014;9(4):529–533.
23.
DahlJHammertW. Overview of injectable corticosteroids. J Hand Surg Am. 2012;37(8):1715–1717.
24.
RifatSFMoellerJL. Injection and aspiration techniques for the primary care physician. Compr Ther. 2002;28(4):222–229.
25.
LambertMAMortonRJSloanJP. Controlled study of the use of local steroid injection in the treatment of trigger finger and thumb. J Hand Surg. 1992;17(1):69 -70.
26.
SheikhEPetersJDSaydeWMaltenfortMLeinberryC. A prospective randomized trial comparing the effectiveness of one versus two (staged) corticosteroid injections for the treatment of stenosing tenosynovitis. Hand, 2014;9(3):340–345.
27.
HahnS. Understanding noninferiority trials. Korean J Pediatr. 2012;55(11):403–407.
28.
RozentalTDZurakowskiDBlazarPE. Trigger finger: prognostic indicators of recurrence following corticosteroid injection. J Bone Joint Surg Am. 2008;90(8):1665–1672.
29.
KosiyatrakulALoketkraweeWLuenamS. Different dosages of triamcinolone acetonide injection for the treatment of trigger finger and thumb: a randomized controlled trial. J Hand Surg Asian Pac Vol. 2018;23(2):163–169.
30.
ShultzKJKittingerJLCzerwinskiWLWeberRA. Outcomes of corticosteroid treatment for trigger finger by stage. Plast Reconstr Surg. 2018;142(4):983–990.
31.
GoldfarbCAGelbermanRHMcKeonKChiaBBoyerM. Extra-articular steroid injection: early patient response and the incidence of flare reaction. J Hand Surg Am. 2007;32(10):1513–1520.
32.
TarasJSRaphaelJSPanWTMovagharniaF. Corticosteroid injections for trigger digits: is intrasheath injection necessary?J Hand Surg Am. 1998;23(4):717–722.
33.
ShinomiyaRSunagawaTNakashimaYYoshizukaMAdachiN. Impact of corticosteroid injection site on the treatment success rate of trigger finger: a prospective study comparing ultrasound-guided true intra-sheath and true extra-sheath injections. Ultrasound Med Biol. 2016;42(9):2203–2208.
34.
Mardani-KiviMKarimi-MobarakehMBabaei JandaghiAKeyhaniSSaheb-EkhtiariKHashemi-MotlaghK. Intra-sheath versus extra-sheath ultrasound guided corticosteroid injection for trigger finger: a triple blinded randomized clinical trial. Phys Sportsmed. 2018;46(1):93–97.
35.
PaceCSBlanchetNPIsaacsJE. Soft tissue atrophy related to corticosteroid injection: review of the literature and implications for hand surgeons. J Hand Surg Am. 2018;43(6):558–563.
36.
YamadaKMasukoTIwasakiN. Rupture of the flexor digitorum profundus tendon after injections of insoluble steroid for a trigger finger. J Hand Surg Eur. 2011;36(1):77–78.
37.
TanakaTOgawaTYanaiT, et al.Disruption of flexor tendon after intrasheath triamcinolone acetonide injection for trigger digits: two case reports. J Hand Surg Asian Pac. 2017;22(3):380–383.
38.
FitzgeraldBTHofmeisterEPFanRAThompsonMA. Delayed flexor digitorum superficialis and profundus ruptures in a trigger finger after a steroid injection: a case report. J Hand Surg Am. 2005;30(3):479–482.
39.
JulkaAVranceanuAMShahASPetersFRingD.Predictors of pain during and the day after corticosteroid injection for idiopathic trigger finger. J Hand Surg Am. 2012; 37(2):237-242.
