Intra-Tendon Sheath Injection for Trigger Finger: The Randomized Controlled Trial

Abstract

The most common technique used for non-surgical treatment of trigger fingers is the direct injection of steroids into the flexor tendon sheath over the metacarpal head. However, this method causes more pian to the patient and can result in tendon rupture due to insertion of needle into the tendon. Carlson and Curtis described the mid-axial injection technique which is simple and relatively painless. We aim to compare the pain result from the injection between these two methods. The prospective randomised control trial study was designed. There were 103 trigger fingers included in the study which were divided into two groups: the conventional technique of injection (CI technique) and the mid-axial injection technique (MAI technique). The visual analogue scale for pain score had been recorded at the time of injection: one, three and six weeks. The complication after injection and the recurrent symptoms within one year were also recorded. The Student's t-test, Chi-squared and Fisher-exact analysis were used for statistical testing. The results showed that the mean VAS pain scores immediately after needle insertion were 40.19 +/- 23.3 and 48.39 +/- 26.5 in the MAI and CI technique groups, respectively. The MAI technique was less painful than the CI technique (p < 0.05). There were no complications from the injections in both methods. However, the recurrent rate seems to be higher in the conventional technique (p = 0.23). We concluded that the MAI injection technique provided less pain result than the CI technique and there were no complications from this injection technique.

Small longitudinal S incision and page turning style of annular ligament partial resection to treat stenosing tenosynovitis of thumb flexor tendon

“…Some researchers have used closed treatment with steroids and narcotic drugs to treat it [6,7], but the effect is not ideal and often causes tendon rupture [8,9]. Some surgeons reported that they treated stenosing tenosynovitis of the thumb with a mini-scalpel needle and achieved good effect, but with mini-scalpel needle surgery it is very easy to damage nerves, blood vessels, and tendons, in which case repeated surgery may be necessary.…”

Trigger Finger? Just Shoot!

“…54 A modification of that technique is to inject extra-synovial superficial to the tendon sheath. The least painful approach may be to inject the proximal phalangeal portion of the tendon sheath through a lateral approach while carefully avoiding the neurovascular bundle 66,67 ; but this technique is technically more difficult for those infrequently performing such injections. A fourth method and the one we use and teach to our learners in our procedure clinic is a simple, safe entry over the volar proximal phalanx through the tendon to inject into the posterior (deep) space between tendon and sheath without US guidance as shown in Figure 1.…”

Acquired triggering of the fingers and thumb in adults

“…52 There have been anecdotal case reports of tendon rupture, pulley rupture, and digital ischaemia. [49][50][51][52][53][54][55][56][57][58][59][60][61] Morbidity with injection is far less than with open surgery, and time off work or sports is quoted at three days compared with 26 days, respectively. 62 Early recurrence within three months was 33% in one large series of 1210 trigger injections, 47 and 55% at 1 year 63 -though this might be reduced with concurrent physiotherapy.…”