A Prospective Randomized Trial Comparing the Effectiveness of One versus Two (Staged) Corticosteroid Injections for the Treatment of Stenosing Tenosynovitis. (September 2014)

• Record Type: Journal Article
• Authors: Sheikh, Emran; Peters, John D.; Sayde, Will; Maltenfort, Mitchell; Leinberry, Charles
• Is Part Of: Hand. Volume 9:Number 3(2014)
• Page Start: 340
• Page End: 345
• Publication Date: 2014-09
• Subjects: Trigger finger -- Stenosing tenosynovitis -- Cortisone injection -- DASH; Hand -- Surgery -- Periodicals; Hand -- Surgery; Periodicals; 617.57005
• DOI: 10.1007/s11552-014-9603-4
• Languages: English
• ISSNs: 1558-9447

Abstract

Background: Stenosing tenosynovitis or trigger finger is a common clinical condition regularly treated with steroid injections. Varied success is reported at early time points following injection. We present a prospective, randomized IRB-approved study to confirm these findings at a long-term follow-up. Methods: Adult patients presenting with symptoms of stenosing tenosynovitis who agreed to participate were randomized into two groups. Group 1 received an initial injection of triamcinolone and local anesthetic mixture. Group 2 received the same initial injection and an additional staged injection at 6 weeks. The patients were then followed beyond 2 years. If Group 1 patients were still symptomatic at 6 weeks, another injection was given. An additional injection or surgery was defined as treatment failure. DASH scores were obtained at baseline, 3, 6, and 12 months. Results: Ninety-seven patients (101 trigger digits) were enrolled in the prospective trial. Fifty-six digits were randomized to the one-injection group versus 45 digits randomized to the two-injection group ("intention to treat analysis"—ITT). After accounting for crossover between the groups, 42 patients received one-injection versus fifty-nine patients receiving two injections ("actual" analysis). Overall failure was the same between the two groups. However, a higher surgery rate was noted for patients having undergone two injections versus one injection [47 % versus 27 % ( p <0.013), ITT]. Diabetes was associated with a higher surgery rate at 1 year within the group of overall failures [56 % versus 37 % ( p =0.0505), ITT]. High baseline DASH score (>40) was associated with a median time of 10 months for failure and 6 months for surgery as per a Kaplan-Meier survival analysis ( p <0.005 and p <0.001, respectively, ITT). Conclusions: As overall failure of steroid injection for trigger finger is not improved with staged, two-injection treatment, we recommend a single injection initial treatment for trigger finger with a second injection given in cases of recurrence or failure. Diabetes was a risk factor for needing surgery if failure occurred within 1 year. The baseline DASH score is helpful in predicting which patients have a higher chance of failing as well as needing surgery.