Steroid Injection Versus NSAID Injection for Trigger Finger: A Comparative Study of Early Outcomes

doi:10.1016/j.jhsa.2012.03.040

The Journal of Hand Surgery

Volume 37, Issue 7, July 2012, Pages 1319-1323

https://doi.org/10.1016/j.jhsa.2012.03.040 Get rights and content

Purpose

Stenosing tenosynovitis of the flexor tendon sheath of the digits of the hand results from a discrepancy between the diameter of the flexor tendon and its sheath at the A1 pulley. The treatment options for trigger digits include oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local NSAID applications, splintage, steroid injection, and percutaneous and open release of the A1 pulley. Injectable NSAID is used intramuscularly and locally in other sites. The hypothesis is that an injectable NSAID is as effective as the traditionally used steroid injection in the treatment of trigger digit, based on Quinnell grading, and that the treatment works as well in patients with diabetes as in those without diabetes.

Methods

In this prospective, randomized, double-blinded controlled study for trigger digits, we injected diclofenac sodium locally in one group (NSAID group) and triamcinolone acetonide in another (corticosteroid group). A total of 100 patients (50 patients in each group) were followed up and assessed 3 weeks and 3 months after the injection.

Results

At the end of the follow-up, 35 patients (70%) in the corticosteroid group and 28 patients (53%) in the NSAID group had complete symptomatic resolution. There was no difference between the response of patients with and without diabetes. There was no significant difference found in Quinnell score between treatments at 3 months, although at 3 weeks, the patients who received steroid had significantly better Quinnell scores.

Conclusions

We concluded that, although steroids gave quicker relief, NSAID injections are equally effective at 3 months in the treatment of trigger digits. We were unable to detect a statistically significant difference in the response of patients with and without diabetes to either treatment.

Type of study/level of evidence

Therapeutic I.

Section snippets

Materials and Methods

This research was conducted as a prospective, randomized, double-blinded controlled study. Patients were told that the established steroid treatment was less effective in patients with diabetes and that an alternative treatment was being investigated. Treatment was determined by drawing from a container with equal numbers of slips marked “STEROID” or “NSAID,” and blinded assessors reviewed the patients. The inclusion criteria for the study were clinically diagnosed patients with trigger digits

Results

The overall change in Quinnell grading is shown in Table 2. The mean grade improvement for both groups is shown in Table 3. Scores from both groups were ranked and analyzed using the Mann-Whitney U test. The change in grading at 3 weeks was significantly different between the corticosteroid group and the NSAID group (P = .002). The corticosteroid group obtained better ranks at first, but between 3 weeks and 3 months, the grades were ranked again and the NSAID group did significantly better (P =

Discussion

This study was conducted to compare the outcome of injectable NSAIDs against corticosteroid injection in the treatment of trigger digit. The mechanism of action of corticosteroid is via the arachidonic acid pathway, whereas that of NSAIDs is via the cyclooxygenase pathway. Nevertheless, the ultimate result is the decrease in inflammation. Hence, it could be hypothesized that NSAIDs should bring the same effect as that of corticosteroid when injected for trigger digits.

The outcome in the

References (22)

D. Murphy et al.
Steroid versus placebo injection for trigger finger
J Hand Surg
(1995)
M. Marks et al.
Efficacy of cortisone injection in treatment of trigger fingers and thumbs
J Hand Surg
(1989)
D. Eastwood et al.
Percutaneous release of the trigger finger: an office procedure
J Hand Surg
(1992)
M. Patel et al.
Trigger fingers and thumb: when to splint, inject, or operate
J Hand Surg
(1992)
M. Marks et al.
Efficacy of cortisone injection in treatment of trigger fingers and thumbs
J Hand Surg
(1989)
M. Newport et al.
Treatment of trigger finger by steroid injection
J Hand Surg
(1990)
M. Paavola et al.
Treatment of tendon disordersIs there a role for corticosteroid injection?
Foot Ankle Clin
(2002 Sep)
A. Wang et al.
The effect of corticosteroid injection for trigger finger on blood glucose level in diabetic patients
J Hand Surg
(2006)
M. Blyth et al.
Diabetes and trigger finger
J Hand Surg
(1996)
S. Stahl et al.
Outcome of trigger finger treatment in diabetes
J Diabetes Complications
(1997)

S. Griggs et al.

Treatment of trigger finger in patients with diabetes mellitus

J Hand Surg

(1995)

Cited by (47)

Responsiveness of PROMIS Instruments for Trigger Digit After Corticosteroid Injection or A1 Pulley Release
2023, Journal of Hand Surgery
The purpose of the study was to determine if the patient-reported outcomes measurement information system (PROMIS) is sufficiently sensitive to detect improvement after 2 common treatments of trigger finger: corticosteroid injection or A1 pulley release.
This retrospective cohort study included 72 patients in the injection group and 51 in the A1 pulley release group. PROMIS physical function (PF), pain interference (PI), and upper extremity (UE) scores were collected at baseline and 6 weeks after injection for the injection group and at baseline, and 1 week, 6 weeks, and 3 months after surgery for A1 pulley release patients. Descriptive statistics and paired t tests were used to compare PROMIS scores within each cohort. Standardized response means (SRMs) were calculated for each PROMIS domain to gauge instrument responsiveness.
Average age was 62 years, 65% were female patients, and 86% were White for the steroid injection cohort, compared to 60 years, 71%, and 88%, respectively, for the A1 pulley release cohort. For the steroid injection group, mean PROMIS PI scores (−4.0 points; SRM = −0.6) and PROMIS UE scores (+3.3 points; SRM = 0.5) improved significantly at 6 weeks after injection compared to baseline. Meanwhile, A1 pulley release patients improved significantly in mean PI scores (−3.7 points; SRM = −0.5) and in UE scores (+4.9 points; SRM = 0.7) at 3 months after surgery compared to baseline.
Clinical improvements after trigger digit treatments are reflected in improved PROMIS PI and UE scores that reach previously accepted minimum clinically important difference values for hand patients. PROMIS PI and UE also are more responsive than PROMIS PF in capturing improvement for trigger digit treatments.
As health care payers continue to emphasize patient-reported outcomes to determine treatment value and set reimbursement rates, this study helps establish that clinical improvement after trigger digit treatments are reflected in PROMIS PI and UE domains by reaching previously established minimum clinically important difference values for hand patients.
A single-pulsed electromagnetic field enhances collagen synthesis in tendon cells
2020, Medical Engineering and Physics
Citation Excerpt :
It is a failed healing response to repetitive overloading with an imbalance between the synthesis and degeneration of the matrix [6,7]. Non-steroidal anti-inflammatory medications (NSAIDS) and local corticosteroid injections are used as conventional treatments to alleviate pain and swelling accompanied with inflammation in early tendinopathy [8–13]. However, recent studies indicate little or no inflammation is actually present in chronic tendinopathy [14–16] which has led to a debate about the long-term benefits of anti-inflammatory pharmacotherapy [17].
Tendinopathy is a progressive pathology of tendon that is characteristic of imbalance between matrix synthesis and degeneration and is often caused by failure to adapt to mechanical loading. Non-steroidal anti-inflammatory medications (NSAIDS) are used as a conventional treatment to alleviate pain and swelling in the short term, but the ideal treatment for tendinopathy remains unclear. Here, we show a single pulsed electromagnetic field (SPEMF, 0.2 Hz) that up-regulated tenogenic gene expression (Col1a1, Col3a1, Scx, Dcn) and down-regulated inflammatory gene expression (Mmp1) in vitro. After five days of SPEMF stimulation (3 min/day), the collagen type I and total collagen synthesis protein levels were significantly increased. Under pro-inflammatory cytokine (IL-1β) irritation, the decreased expression of Col1a1/Col3a1 was up-regulated by SPEMF treatment, and the increased expression of Mmp1 was also reversed. From the above, it can be inferred that SPEMF that enhances matrix synthesis and reduces matrix degeneration may counteract the imbalance in tendinopathy. SPEMF application may be developed as a potential future strategy for therapeutic intervention in tendon disorders.
Efficacy of corticosteroid injection in rock climber's tenosynovitis
2019, Hand Surgery and Rehabilitation
While many finger conditions in climbers have been studied extensively, no data exist on the treatment of rock climber's finger flexor tenosynovitis. The purpose of this study was to evaluate the outcomes after corticosteroid injection. The study included rock climbing athletes suffering from chronic (longer than 6 weeks) finger flexor tenosynovitis who were seen at our clinic in 2017. All 42 patients received two corticosteroid injections within a 7–10 day period. Thirty-one climbers (73.8%) were pain free after the second injection and a mean of 20.9 ± 23.1 days. The climbers reported an 84.2% decrease in pain level and no complications. The positive outcome after corticosteroid injection therapy and the absence of complications justifies this invasive approach in rock climbing athletes.
Il existe déjà des études très poussées sur l’état des doigts chez des grimpeurs de haut niveau, mais il n’en existe aucune sur le traitement d‘une ténosynovite des fléchisseurs du doigt. Notre étude avait pour but d’évaluer les résultats d’injections de corticostéroïdes chez le patient. L’étude a inclus les athlètes grimpeurs souffrant de ténosynovite chronique des fléchisseurs du doigt (plus de 6 semaines) dans notre clinique en 2017. Tous les patients (42) ont reçu 2 injections de corticostéroïdes en l’espace de 7 à 10 jours. Trente et un d’entre eux (73,8 %) n’avaient plus de douleurs après la seconde injection, à un délai compris entre 20,9 et 23,1 jours. Les symptômes ont été réduits de 84,2 %, sans complications. Le résultat positif obtenu après injection de corticostéroïdes et l‘absence de complications justifient cette nouvelle approche chez des athlètes grimpeurs.
Are non-steroidal anti-inflammatory drug injections an alternative to steroid injections for musculoskeletal pain?: A systematic review
2018, Journal of Orthopaedics
Citation Excerpt :
Therefore, the above finding could suggest that NSAIDs might be able to offer prolonged symptom relief compared to corticosteroids. Overall, the authors demonstrated that local NSAID injections appear to be safe for the treatment of trigger finger, with comparable effectiveness to that of steroid injections.28 In the study by Min et al., the greater improvements in pain and function (p = 0.03) and reduced side effects found in the NSAID injection group demonstrate that NSAID injections may not only be equivalent to, but could potentially be superior to corticosteroid injections.27
Given the potential side effect profile of steroids, the need for an alternative injectable anti-inflammatory is needed. The purpose of this systematic review was to compare corticosteroid injections with non-steroidal anti-inflammatory drug (NSAID) injections for musculoskeletal pain.
Reviewers with methodological and content expertise searched three databases: PUBMED, Medline and EMBASE. Two blinded reviewers searched, screened, and evaluated the data quality. Data was abstracted in duplicate. Agreement and descriptive statistics are presented.
Four studies were included. All four studies found no statistically significant differences in improvements on the visual analog scale. The follow-up period within the four studies ranged between 2 weeks and 3 months. No statistically significant differences were demonstrated between the two groups with regards to functional outcomes.
The studies reviewed, while limited in quantity, show that compared with corticosteroids, NSAIDs provide equivalent, if not better, pain relief from the musculoskeletal ailments assessed. Further, there is weak evidence supporting a lower recurrence rate of symptoms with NSAIDs when compared to corticosteroids. There is a need for more long-term high-quality studies on this topic.
Level II (Systematic review of Level II and III studies).
Trigger Finger
2018, Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation
Trigger finger is the snapping, triggering, or locking of the finger that occurs due to thickening of the retinacular sheath most commonly at the level of the A1 pulley. Clinical presentation often includes local pain and functional limitation. When conservative care such as splinting, anti-inflammatory medications, and activity modification is not adequately effective, local corticosteroid injection is a mainstay of treatment. Surgical release of the A1 pulley is effective percutaneously or by open technique.
Nonsteroidal Anti-Inflammatory Drug Injections versus Steroid Injections in the Management of Upper and Lower Extremity Orthopedic Conditions: A Systematic Review with Meta-Analysis
2024, Journal of Clinical Medicine

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Scientific articleSteroid Injection Versus NSAID Injection for Trigger Finger: A Comparative Study of Early Outcomes

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Foot Ankle Clin

J Hand Surg

J Hand Surg

J Diabetes Complications

J Hand Surg

Scientific article
Steroid Injection Versus NSAID Injection for Trigger Finger: A Comparative Study of Early Outcomes