Corticosteroid Injections for Trigger Finger Helpful for ManyTrigger finger, medically termed stenosing tenosynovitis, is fairly common among adults. It results in a person's hand taking on the position of getting ready to pull a gun trigger. Unfortunately, treatment for trigger finger doesn't guarantee that it won't come back and many people find themselves with the problem again later on.
Researchers performed a study to see if they could predict which patients may end up having the problem recur, or come back. To do this, the researchers enrolled 130 patients (119 patients completed the study) who had trigger finger for the first time and who had been treated with corticosteroid injections. This treatment is usually the first invasive treatment tried if splinting and/or using anti-inflammatory medications doesn't work.
In order to gather information, the patients completed a questionnaire about how long they had their problem, the severity of the problem, and their medical history. All patients received the same medication (corticosteroid) and amount injected into the affected finger. The patients were then followed for six weeks to watch for improvement.
The researchers used a Visual Analog scale to rate the severity of the patients' symptoms. If it was determined that the patients' symptoms were relieved by more than 50 percent using the scale, they were offered a second corticosteroid injection. If the patients had less than a 50 percent improvement and those with more than 50 percent but refused a second injection were referred for surgery to help relieve the trigger finger.
A year after treatment, researchers contacted the patients to see if they had any recurrence of the symptoms. If they did have symptoms, they were asked how long they had been symptom free and if they had any other treatments. The researchers also asked if any other fingers became affected since the treatment.
Following treatment, all patients reported that they had some relief from the trigger finger. At an average of 5.6 months, an average of 56 percent of fingers had a recurrence after one injection. The researchers noticed that the longer the patients had the symptoms, the slightly higher a risk they had of having a recurrence.
When looking at how long the patients were symptom free, the researchers found that freedom from symptoms was about 70 percent at six months and 45 percent at 12 months.
For the patients who chose to have a second injection, 21 percent ended up having to have surgery, compared with 23 percent who did not have a second injection. Other issues were also examined. People who were younger and/or who had more than one finger affected tended to need a repeat injection. Those who had type 1 diabetes, underactive thyroid hypothyroidism, or overactive thyroid hyperthyroidism, tended to require surgery most often.
In conclusion, the researchers wrote that their study did have some limitations. They included the arbitrarily chosen corticosteroid dosage and the telephone consultation after one year, rather than a face-to-face examination. Otherwise, the researchers say that their findings show that although corticosteroids should continue to be used as one of the first-line treatments, patients who are younger, who have more than one finger affected, and/or who have type 1 diabetes, will have a higher chance of needing additional treatment.
Tamara D. Rozental, David Zurakowski, and Philip E. Blazer. Trigger Finger Prognostic Indicator of Recurrence Following Corticosteroid Injection. In Journal of Bone and Joint Surgery. August 2008. Vol. 90. Pp. 1665-1722.
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