Midaxial Proximal Phalanx Corticosteroid Injection for Stenosing Tenosynovitis
Craig Dent, M.S.1, Riley Schlub, M.D.2, Michael Kucharik, M.D.3, Nino Coutelle, M.D.1, Layanne Nayfeh, B.S.1, Michael C Doarn, MD4, Alfred Vincent Hess, MD5 and Peter Simon, Ph. D.1, (1)Foundation For Orthopaedic Research and Education, Tampa, FL, (2)Florida Orthopaedic Institute, Tampa, FL, (3)University of South Florida, Tampa, FL, (4)Hand and Upper Extremity Surgery, Florida Orthopaedic Insititue, Tampa, FL, (5)Orthopedic Surgery/ Hand and Wrist, Florida Orthopaedic Institute, Tampa, FL
Introduction: Trigger finger is a common complaint of patients seen in the clinic of hand surgeons. Conservative management usually relies on the use of corticosteroid injections to decrease the inflammation associated with its pathology. However, these injections can be painful, and still often progress to surgical release. With this study we hope aim evaluate the efficacy and perceived pain of midaxial and traditional palmar corticosteroid injection techniques.
Methods: A retrospective cohort study was completed evaluating 750 patients who received midaxial injections versus 889 who received palmar injections. Primary outcomes were reduced pain, conversion to surgical release, and injection pain. Patient comorbidities, laterality, digit, and number of injections were recorded.
Results: Among the midaxial cohort, there was a statistically significant improvement in symptoms (56.7% vs 51.0%) compared to conventional injections. No statistical difference was found in rates of conversion to surgery (23.5% vs 21.2%). Patients receiving the midaxial technique had a non-significantly lower average rating of injection pain of 5.4/10, compared to 5.8/10 with the conventional injection technique. Of four comorbidities of interest (Diabetes, Inflammatory arthritis, Osteoarthritis, Thyroid disease), autoimmune thyroid disease was found to be the only comorbidity with significant effect on conversion to surgery or improvement in symptoms.
Conclusion: The midaxial proximal phalanx intrasynovial injection is as effective at relieving symptoms and at preventing conversion to surgery as conventional techniques at our institution. There was a non-significant lower reported pain with the midaxial technique. The use of the midaxial proximal phalanx injection technique for the conservative management of trigger fingers is as effective as the conventional midpalmar technique and could potentially be less painful.
Back to 2024 Abstracts