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Management Trigger Finger: Maximizing Non-Operative Success Without Increasing Morbidity
Alyssa R. Golas, MD1; Robert S. Reiffel, MD2
1New York University Langone Medical Center, New York, NY; 2White Plains Hospital Medical Center, White Plains, NY

Introduction: Traditional non-operative management of trigger finger is limited to 1 long-acting steroid injection, followed by surgery in the case of failure. Recently, non-operative strategies have been extended to include 2-3 injections despite the absence of large prospective studies supporting this practice.

Materials & Methods: A prospective study was performed of all patients presenting with trigger finger to a single surgeon over a 22-year period. Patients with potentially confounding comorbidities were excluded. All patients received 1-3 injections of triamcinolone acetonide+local anesthetic into the tendon sheath. Data were analyzed by digit.

Results: 401 patients with 571 digits were included in the study. Average follow-up was 14.7 months. 472 digits (83%) demonstrated complete response within 1.00.9 months of an initial injection and had been symptomatic for 4.79.9 months prior to treatment. Of these 472, 347 (74%) achieved permanent remission without surgery after a total of 1-3 injections. In contrast, 99 digits (17%) demonstrated partial/no response to an initial injection and had been symptomatic for mean 8.621 months (p=0.04). Of these 99 non-responders, 49 (49%) achieved permanent remission after 1-2 additional injections (2-3 total). Digits that were symptomatic for ?3 months were more likely to demonstrate a complete response after 1 injection than those that were symptomatic for >3 months (OR 2.6, 95% CI 1.67-4.0, p<0.01). For the digits that failed to resolve after the 1st injection, those that were symptomatic ?5 months prior to the first injection were more likely to respond to a 2nd injection than those that were symptomatic for >5 months (OR 9.4, 95% CI 3.0-29.7, p<0.01). There were no instances of tendon or pulley rupture, infection, or soft-tissue atrophy.

Conclusions: Trigger finger is more likely to respond to non-operative therapy when treated before 3 months. However, even when digits fail to improve after 1 injection, those symptomatic for ?5 months prior to treatment are more likely to demonstrate a complete response following a 2nd injection than those symptomatic for longer. Digits whose symptoms fully resolve after 1 injection, even if only transiently, ~75% will achieve full remission with subsequent injections. It is both safe and reasonable to pursue non-operative management in the setting of initial treatment failure, as 2nd and 3rd doses increase the overall remission rate without increasing morbidity.


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