Predictors of Treatment Efficacy for Stenosing Tenosynovitis of the Thumb by Grade
Rachel A Guest, MD; Kerilyn N Godbe, MD; Nicole Ost, BS; David Megee, MD; Jacob Brubacher, MD
University of Kansas Medical Center, Kansas City, KS
Introduction: Trigger fingers are common pathologies encountered by the hand surgeon with accepted treatment modalities ranging from conservative management to steroid injections and surgical release. While there are numerous studies regarding the impact of medical comorbidities on treatment efficacy, studies evaluating the impact of trigger finger grade have been inconclusive. Additionally, there is a paucity of literature regarding management options for trigger thumbs. The purpose of this study is to understand the impact of medical comorbidities and trigger thumb grade on treatment outcomes.
Materials & Methods: A retrospective review of all patients presenting to the orthopedic surgery department between 2014 and 2021 with isolated stenosing tenosynovitis of the thumb was performed. Patients lost to follow-up and trigger thumbs with unclear grade were excluded. Data analysis was performed with a=0.05.
Results: 269 trigger thumbs were reviewed and divided into four groups by grade. The majority were grade 2 (43.9%) or grade 3 (33.1%) with 16 grade 4 trigger thumbs (5.9%). There were no significant differences age or medical comorbidities between the groups. In patients with prior history of trigger fingers, there were no significant differences in treatment strategies. Splinting demonstrated poor efficacy for trigger thumbs of all grades. There were no significant differences in efficacy of steroid injections between the groups (p=.633). Steroid efficacy decreased for all grades with each subsequent injection. While grade 2-4 trigger thumbs completely resolved with surgical intervention in 100% of cases, only 80% of grade 1 trigger thumbs resolved with this modality (p=.02). Diabetes mellitus (DM) was not a significant predictor of treatment efficacy of steroid injections (OR 0.742, CI .374-1.472, p=.393); however, insulin dependency was predictive of treatment success. Patients with non-insulin dependent diabetes mellitus (NIDDM) had a 3.732 odds of achieving complete resolution of symptoms with steroid injections using insulin dependent DM (IDDM) as a reference (CI 1.062-13.120, p=.04). Similarly, while steroid injections had a 73.08% efficacy in patients with NIDDM, the efficacy was only 26.9% in patients with IDDM (p=.036). Lower grade trigger thumbs were not significant predictors of steroid efficacy using grade 4 trigger thumbs as a reference.
Conclusions: Steroid injections are an effective treatment modality for stenosing tenosynovitis of the thumb of any grade, though efficacy may decrease with subsequent injections. Patients with insulin-dependent diabetes mellitus should be counseled on possibility of persistent symptoms.
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