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Comparison of One-year Outcome among Different Low Dosage Triamcinolone Acetonide Injections for Trigger Finger
Junko Sato, MD, PhD; Yoshinori Ishii, MD, PhD; Hideo Noguchi, MD; Ikuko Takahashi, M.D.
Ishii Orthopaedic & Rehabilitation Clinic, Gyoda, Saitama, Japan
Background: This study was designed to compare the one-year outcome among the groups with different low-dosage triamcinolone acetonide (TA) injections for trigger finger.
Methods:In the study period, trigger digits were initially injected with 2, 4, or 8 mg TA. We checked whether they had a second injection or surgery during the following year by either patients' revisit or telephone interview. The groups with different injections were compared according to recurrency and symptom relief period. A second corticosteroid injection or surgery was regarded as the initial injection failure and patients' symptoms recurred. Statistical comparisons among the three groups were made on one-year success rate and on the interval between initial injection and these additional treatments for the recurrent fingers. We also assessed the six-week outcome to confirm the short-term improvement. Patients' background such as gender, age, body mass index, hand dominance, affected side (right or left), the presence or absence of DM, previous history of trigger finger, and Quinnell grade at the time of the injection were compared among the groups.
Results:Totally, 198 digits in 163 patients were finally enrolled in our one-year outcome study with details illustrated as a flowchart below. Of these, 85.4% (169/198) in 140 patients were assessed at six weeks after initial injection. Table 1 and 2 report the finally enrolled patients' demographics and backgrounds in six-week and one-year outcome study, respectively. About 60% of the injected fingers required additional treatment in each group without significant difference (Table 3). The interval between the initial injection and additional treatment in the recurrent cases averaged 5 months in the 2 and 4 mg TA group, being significantly extended for short term of 1.5 months in the 8 mg TA group (Table 4). All the groups showed a significant improvement of the patients' clinical severity at six weeks after injection without any difference among the groups. There was no adverse event.
Conclusions:Low dosage TA injection for trigger finger within 8mg yielded satisfactory results, not being inferior to those with higher dosage up to 40 mg in the comparison with previous reports (Table 5). Our findings implied that increasing TA dosage might bring short-extended symptom relief, however, not reduce the recurrency. While not offering great benefit, lower dosage TA injection for trigger finger can be chosen aiming for cost-effectiveness, safety, and small injection site pain.
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