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Patients with trigger finger more likely to need surgery after two steroid injections
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Researchers found similar outcomes with one or two injections of corticosteroids in patients with trigger finger.
“There was no significant difference between these two groups in terms of overall failure,” William M. Sayde, MD, said. “We did find a higher surgical rate in the two-injection group. Diabetes seems to be a predilection within the failure group that ended up requiring surgery.”
No previous prospective randomized trials examined one vs. two corticosteroid injections for trigger finger, Sayde and colleagues noted.
The researchers randomized 97 patients diagnosed with 101 trigger fingers into two groups. Initially, there were 56 patients in the one-injection group and 45 patients in the two-injection group in the intention to treat analysis. After investigators accounted for crossover, this left 42 patients in the one-injection group and 59 patients in the two-injection group.
The one-injection group received a triamcinolone and local anesthetic mixture and the two-injection group received the same concoction twice. In the two-injection group, the second injection was given 6 weeks after the first one. Follow-up was at 6 weeks, 3 months, 6 months, 1 year and 2 years.
Investigators used the reconfigured patient randomization for their final analysis. They considered the procedure a failure if patients needed an injection beyond that allowed in their group or required later surgery.
The Cox proportional hazards model results showed no significant difference in failure rates for the one-injection vs. two-injection group. The latter had higher surgery rates and an earlier time to surgery.
Among the patients with overall failure, diabetes was a predilection for needing surgery.
“In terms of our overall success rate, only about 40% of the patients in both groups were asymptomatic at final 2-year follow-up,” Sayde said.
Patients did not have a greater likelihood of needing surgery if their thumb was involved rather than a finger or if their dominant hand was involved.
The study’s strengths included a prospective, randomized design and that it was carried out at one institution with up to 2 years follow-up, Sayde said. “We found no significant benefit of giving patients a staged injection at the 4- to 6-week mark,” he said. “But reinjection based on recurrent symptoms may delay surgery.” – by Renee Blisard Buddle
- Reference:
- Sayde W. Paper #148. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.
- For more information:
- William M. Sayde, MD, can be reached at The Rothman Institute, 111 South 11th St., Philadelphia, PA 19107, USA; email: saydew@gmail.com.
Disclosure: Sayde has no relevant financial disclosures.