Steroid injection found effective for trigger finger

Long-term results showed 90% cure rate after at least one year.

A steroid injection was found to be an effective treatment for trigger finger, and multiple injections did not decrease positive outcomes, according to findings presented at the American Society for Surgery of the Hand 59th Annual Meeting.

Earl Z. Browne, MD, of the Cleveland Clinic, conducted a study of 388 patients who met the criteria of persistent triggering for two months or locking, according to the paper’s abstract. There were 239 women and 149 men; follow-up was 10 years, with a median of four years. Twenty-seven patients with 31 affected fingers were lost to follow-up. There were no complications other than a small number of patients reporting short-term pain.

“Since 95% of all patients responded well to injection, with no complications, steroid injection should be considered the primary treatment method for true trigger finger,” Browne told Orthopedics Today. “It should be emphasized that all these patients fell into that category, [but it was] not due to a generalized disease.”

More than 500 digits injected

Patients ranged in age from 38 to 90 years, with a median of 58. There were a total of 528 fingers injected in the same way with 0.5 cc triamcinolone acetonide mixed with 0.5 cc of preservative-free 1% lidocaine. Of the fingers injected, 157 were thumbs, 38 were index fingers, 146 were long fingers, 131 were ring fingers and 25 were small fingers. Fingers were grouped into four categories: episodic, constant, episodic with locking, and constant with locking.

“Since 95% of all patients responded well to injection, with no complications, steroid injection should be considered the primary treatment method for true trigger finger.” — Earl Z. Browne

One injection was sufficient to cure 308 fingers (62%). An overall cure rate of 90% was achieved with 189 additional injections. Twelve cured fingers required more than three injections. Another 25 fingers (5%) were controlled by the steroid injection but suffered a recurrence within one year of the previous injection; these were considered not cured. Surgical release was required on 23 fingers (5%) on which the injection failed.

The overall cure rate from injection decreased from radial to ulnar, with 94% of thumbs and 84% of small fingers responding successfully. In the 62% that were cured with one injection, these rates were different, with 69% of thumbs responding but only 50% of index fingers.

Symptom severity not a factor

According to the abstract, severity of symptoms did not seem to affect outcomes. Locking was also not significant, but constancy of symptoms did affect the results. Only one of 74 fingers with episodic symptoms required surgical release, compared with 5% of fingers with constant symptoms. Eight percent of ring fingers were released vs. 3% and 4% for the others.

Browne said that this was a very effective method of treatment, but other steroids might work as well. “Triamcinolone was used in an identical fashion in all patients in order to standardize the method,” he said. “Other agents may be just as effective, though [they] should be aqueous based, and accompanying local anesthetics should be preservative-free in order to prevent possible precipitation of the steroid.”

For more information:

• Browne EZ, Hennigs E. Long-term results of trigger finger injection. #33B. Presented at the American Society for Surgery of the Hand 59th Annual Meeting. Sept. 9-11, 2004. New York.