Scientific article
A Prospective Randomized Controlled Trial of Injection of Dexamethasone Versus Triamcinolone for Idiopathic Trigger Finger

https://doi.org/10.1016/j.jhsa.2008.01.001Get rights and content

Purpose

This study was designed to test the null hypothesis that there is no difference in resolution of triggering 3 months after injection with either a soluble (dexamethasone) or insoluble (triamcinolone) corticosteroid for idiopathic trigger finger.

Methods

Eighty-four patients were enrolled in a prospective randomized controlled trial comparing dexamethasone and triamcinolone injection for idiopathic trigger finger. Sixty-seven patients completed the 6-week follow-up (35 triamcinolone arm, 32 dexamethasone arm), and 72 patients completed the 3-month follow-up (41 triamcinolone arm, 31 dexamethasone arm). Outcome measures included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, trigger finger grading according to Quinnell, and satisfaction on a visual analog scale. To preserve autonomy, patients were permitted additional injections and operative treatment at any time. Twenty-five patients requested a second injection (10 triamcinolone arm, 15 dexamethasone arm), and 21 elected operative treatment (10 triamcinolone arm, 11 dexamethasone arm) during the study period. The analysis was according to intention to treat principles.

Results

Six weeks after injection, absence of triggering was documented in 22 of 35 patients in the triamcinolone cohort and in 12 of 32 patients in the dexamethasone cohort. The rates 3 months after injection were 27 of 41 in the triamcinolone cohort and 22 of 31 in the dexamethasone cohort. The triamcinolone cohort had significantly better satisfaction and Quinnell grades than did the dexamethasone cohort at the 6-week follow-up but not at the 3-month follow-up. There were no significant differences between Disabilities of the Arm, Shoulder, and Hand scores at the 6-week follow-up and the 3-month follow-up. After the close of the study, there were 8 recurrences among patients with documented absence of triggering in the triamcinolone cohort and 1 in the dexamethasone cohort.

Conclusions

Although there were no differences 3 months after injection, our data suggest that triamcinolone may have a more rapid but ultimately less durable effect on idiopathic trigger finger than does dexamethasone.

Type of study/level of evidence

Therapeutic I.

Section snippets

Materials and Methods

The study protocol was approved by our human research committee. Patients with idiopathic trigger finger that presented to the office of 1 of 3 hand surgeons between March 1, 2005, and November 30, 2005, were invited to participate in the study. Inclusion criteria included any adult patient (age 18 years or greater) with an isolated new diagnosis of 1 or more idiopathic trigger fingers of any Quinnell grade 2 or greater. According to the Quinnell system, trigger fingers are rated as follows: 0,

Baseline Patient Characteristics

There were no statistical differences in demographic and baseline study data between cohorts. (Table 1) Among the 40 patients in the dexamethasone cohort, the thumb was involved in 8, the index finger in 4, the long finger in 16, the ring finger in 7, and the small finger in 5. Among the 44 patients in the triamcinolone cohort, the thumb was involved in 13, the long finger in 14, the ring finger in 16, and the small finger in 1.

The average age of patients in the dexamethasone group was 63 years

Discussion

The injection of corticosteroids into the flexor sheath was initially advocated as a method of treatment for trigger finger in 1950.14, 15 The reported effectiveness has ranged between 25% and 73% (average, 49%) among 12 studies we identified.8, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 In the largest retrospective study we are aware of (338 patients), the overall improvement or absence of triggering rate was 77%: 49% after a single injection, 23% after 2 injections, and 5% after 3 injections.8

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    Support was received from AO Foundation, Wright Medical, Joint Active Systems, Smith and Nephew, Small Bone Innovations, and Biomet.

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