A randomized controlled trial comparing ketorolac and triamcinolone injections in adults with trigger digits

Abstract

We assessed the efficacy of ketorolac trometamol injections compared with triamcinolone acetonide injections in trigger digits. Patients with trigger digits were randomized to receive either ketorolac or triamcinolone. They were followed up at 3, 6, 12 and 24 weeks, and monitored for resolution of triggering, pain and total active motion. One hundred and twenty-one patients with single trigger digits were recruited (59 ketorolac, 62 triamcinolone). At 6 weeks, 54% of patients in the triamcinolone group had complete resolution of trigger, whereas no patients in the ketorolac group had resolution. At 12 weeks, 58% of patients in the triamcinolone group had complete resolution of trigger compared with 6.7% in the ketorolac group. At 24 weeks, both groups had comparable rates of resolution at 26% and 25%, respectively. Patients in the triamcinolone group had significantly better resolution of pain at 3, 6 and 12 weeks. But at 24 weeks, there was no significant difference in pain between both groups. Significantly less flexion deformity was reported at 3 weeks and 6 weeks in the triamcinolone group. In the short term, ketorolac was less effective in relieving symptoms of trigger digit than triamcinolone. Level of evidence: I.

Comparative effectiveness of various treatment strategies for trigger finger by pairwise meta-analysis

“…After systematic review, 24 articles met the inclusion criteria. 5,6,9,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Among them, 8 of them were excluded from our meta-analysis (Supplemental Appendix B) and 16 of them (including 1185 patients) which reported success were included in our meta-analysis ( Figure 1). 5,6,9,10,[14][15][16][17][18][19][20][21][22][23][24][25] The main characteristics of the included articles are shown in Table 1.…”

“…16 Our meta-analysis showed that the efficacy of nonsteroidal anti-inflammatory drug injection was similar to steroid injection for most of the follow-ups. The two included articles used two different nonsteroidal anti-inflammatory drugs: ketorolac 5 and diclofenac sodium which is a regular nonsteroidal anti-inflammatory drug. 23 Although ketorolac has better anti-inflammatory efficacy than regular nonsteroidal anti-inflammatory drugs, our meta-analysis showed that the efficacy of ketorolac in the treatment of trigger finger was worse than a regular nonsteroidal antiinflammatory drug injection when compared with steroid injection ( Figure 5).…”

“…4 Power grip and repeated digital flexion are considered the causes of trigger finger. 2 A variety of treatments have been suggested to treat trigger finger, including nonsteroidal antiinflammatory drug injection, 5 physiotherapy, 6 steroid injection, 7,8 percutaneous release 9 and open surgery. 10 Two systematic reviews have investigated the efficacy of various treatments for treating trigger finger.…”

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

“…ISSN: 0894-9115 DOI: 10.1097/PHM.0000000000001963(diclofenac or ketorolac) with glucocorticoid injections. The mean age of participants in the Shakeel et al9 was 60 yrs, and the mean age of participants in the study by Leow et al10 was 57.5 years. Participants in both studies did not receive previous injections in the affected finger.…”

Ultrasound-Guided Percutaneous A1 Pulley Release by Acupotomy (Needle-Knife): A Cadaveric Study of Safety and Efficacy

“…2 Symptomatic trigger finger refers to non-surgical treatment, physical therapy, and corticosteroid injection, with an effective rate of 45-80%. 3 Open surgical release is indicated for refractory symptoms, the effective rate of A1 pulley release is between 90% and 100%. 4 However, surgical complications, including infection, weakness, nerve injury, stiffness, flexor tendon bow stringing, and scarring, have been reported in an incidence of up to 12%.…”