Day-by-day symptom relief after corticosteroid injection for trigger digit: a randomized controlled study of two techniques

Abstract

This prospective randomized controlled study compared two injection techniques for trigger digit: either dorsal to the tendons in the proximal phalanx (PP group) or anterior to the tendons at the A1 pulley level (A1 group) in 106 patients. The primary outcome was the number of days to total relief of pain, stiffness and triggering, as recorded by the patients on visual analogue scales day-by-day for 6 weeks. The median number of days to complete symptom relief was 9 days in the PP group and 11 days in the A1 group for pain, 11 days and 15 days for stiffness and 21 and 20 days for triggering, respectively. Ninety-one per cent of all patients did not require any additional treatment, but 11 patients in both groups reported some remaining symptoms at 6 weeks. This study did not detect any significant difference between the two injection techniques, but provides detailed data of the rate and order of symptomatic relief after corticosteroid injection for this common condition. Level of evidence: I

The management of trigger fingers: commentary and personal opinion

“…Other studies have suggested that placing the steroid near to the sheath is as effective as an injection into the sheath, but perhaps placing the steroid in the sheath produces faster results. The study of Bitar et al. (2023) study does not seem to suggest the effects are any longer lasting.…”

“…Trigger fingers are a common condition, so much so that it would be unusual in a general hand surgery clinic to not have someone present with symptoms of triggering. Three recent articles in the Journal look at the management of trigger fingers (Atthakomol et al., 2023; Bitar et al., 2023; Jeon et al., 2023). The aim of this article is to provide commentaries on these articles and my own opinion on the management of this painful but common condition.…”

“…(2023) use 20 mg triamcinolone, Atthakomol et al. (2023) 10 mg triamcinolone with 1% lidocaine and Bitar et al. (2023) 20 mg of methylprednisolone (mixed with lidocaine).…”

“…For the injection itself, Atthakomol et al. (2023) and Bitar et al. (2023) both use a 25G needle and a 2.5/3 ml syringe; 25 and 27G needles were used by Ring et al.…”

“…The actual injection site of the steroid has been previously studied, looking at whether different sites of injection are effective and whether the steroid actually needs to be placed into the flexor sheath. Bitar et al. (2023) have performed a RCT comparing injections given to the A1 pulley, palmar to the flexor tendons, with those given in the proximal phalanx, dorsal to the flexor tendons.…”