Comparison of Outcome Of Intra Synovial vs Extra Synovial Ultrasound Guided Injection In Trigger Finger
Mohini Rawat, DPT, ECS, OCS, RMSK1; Eitan Melamed, MD1; Mukund Patel, MD1; Vilok Desai, MD2
1NYU Langone Hand surgery Brooklyn, Brooklyn, NY; 2Albany Medical College, Albany, NY
Introduction: The purpose of this study is to compare the outcome of intra-synovial and extra-synovial ultrasound guided flexor tendons sheath cortisone injections.
Materials & Methods: 100 cases of trigger fingers were examined with ultrasound for the presence or absence of tenosynovitis and then randomly selected into treatment group of intra-synovial (50 fingers) and extra-synovial (50 fingers) injection groups under ultrasound guidance. Exclusion criteria was presence of – rheumatoid arthritis, gout, or infection. Flexor tendons of the involved digit were examined using the ultrasound to look for presence or absence of tenosynovitis and to guide the injection into the sheath in intra synovial injection group or outside the sheath in extra synovial injection group. Patients were followed at 1 month, 3 months, 6 months and 12-months intervals.
Results: 95% of extra-synovial injections resulted with intra-synovial infusion into the tendon sheath within one minute or less. In intra synovial injection group, 90 % of cases reported complete resolution of the pain, triggering and satisfaction with care at 12 months follow up. In extra synovial injection group 82.7 % of cases reported complete resolution of the pain, triggering and satisfaction with care at 12 months follow up. 3.4% of intra synovial injection cases received surgery after 1 year follow up as they reported minimal to no improvement in pain and triggering with at least 2 repeated injections. On the other hand, 2.4 % of extra synovial injection cases received surgery after 1 year follow up as they reported minimal to no improvement in pain and triggering with at least 2 repeated injections.
Conclusions: With this study we found that overall ultrasound guided intra synovial injection group and extra-synovial injection group at 12 months follow up had no statistically significant difference in outcome. We believe that the results in both groups are similar because the extra-synovial injection immediately infuses into intra-synovial space within one minute.
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