trigger finger injections


A study from Missouri assessed the longterm outcome of a single corticosteroid injection for a trigger finger (see trigger finger injection j bone surg 2014​ in dropbox, or J Bone Joint Surg Am 2014 Nov 19; 96:1849​). they assessed 366 patients who had a first injection and followed a minimum of 5 years. 

background: 
    --trigger fingers are pretty common. lifetime risk estimated in general population of 2.6%, 4-10% in diabetics
    --and, from my patients, pretty uncomfortable and affects daily functioning

results:
--66% female, average age 59 yo, 44% with multiple trigger fingers, 24% with diabetes. majority had symptom of "catching" but able to actively extend the digit​.
--their protocol was injecting the A1 pulley area with methylprednisolone 40mg/cc, 1cc, and lidocaine without epinephrine 1%, 0.5 to 1 cc. 
--primary outcome (which was to not get subsequent injection or surgical release) of the affected digit was in 45% of patients, with a 56% success rate in females (vs 35% in males), and approx 38% in males and females with multiple trigger fingers. 
--of the treatment failures, 64% got another injection, 33% had surgical release
--84% of treatment failures were in the first 2 years after injection (ie, those who lasted 2 years did well longterm)
--other studies have found even higher longish term success rates (one with 92% for trigger thumbs, another with 72%)

so, a few comments:
--these are really easy injections. i use just 1/2 cc of triamcinolone 40mg/cc plus 1/2 cc of lidocaine 1% and inject with a 30 gauge short needle (though it still hurts: thick skin and too many nerves), injecting where i palpate the nodule, which is right at the A1 pulley entrance, close to the MCP joint on the volar surface). and, though i have not looked at the success rate rigorously, i am confident that in the dozens i have injected, at least  90% have had really good responses and it is pretty rare that patients come back for more. and, even if the injection lasted only 1 year, that's a lot of relief for the patient, and re-injections (done rarely by me) have also been successful.  after 2 injections, i would suggest surgical intervention.
--the injections take about 3 minutes and are the easiest of my patient visits (a thousand times easier than the more frequent patient with uncontrolled diabetes, hypertension, depression, domestic violence.......). and, as an aside, an orthopedic surgeon doing this injection probably gets as much $$ as my health center collects for 5 visits of my more difficult patients...

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