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Comparison of Corticosteroid Drugs for Trigger Fingers
Kalpit N. Shah, MD
1, Jordan K Penn, BS
2, Julie C McCauley, MPHc
2, Michael A Thompson, MD
3, Jake Hamer, MD
3; Lorenzo L Pacelli, MD
3(1)Scripps Clinic, Oceanside, CA, (2)Shiley Center for Orthpaedic Research at Scripps Clinic, La Jolla, CA, (3)Scripps Clinic, La Jolla, CA
Introduction: Stenosing tenosynovitis or trigger finger (TF) is often treated with a corticosteroid injection (CSI). However, there is no consensus on the ideal CSI medication for TFs. The purpose of this study is to evaluate the efficacy of different medications when treating TFs. We hypothesize that there will be no difference between different medications.
Methods: Patients with a single TF per hand were prospectively enrolled by four fellowship-trained hand surgeons between 2022-2024. Each surgeon used a different drug by preference including betamethasone, dexamethasone, triamcinolone and methylprednisolone. Patients with other concomitant diagnoses, more than one TF per hand and diabetes mellitus were excluded. All included patients were administered a CSI at the first visit and followed at 6-week intervals. Another CSI was administered if the symptoms persisted on follow-up. Surgical intervention was offered for persistent symptoms after 2 CSIs. Clinical evaluation at each visit included the Quinell grade (Figure 1), QuickDASH, and visual analog score for pain (VAS). Complications associated with CSIs were noted.
Results: A total of 169 patients (54.7% female, mean age 67 yrs) were included, of which 42 (24.9%) received betamethasone, 62 (36.7%) received dexamethasone, 27 (16.0%) received methylprednisolone, and 38 (22.5%) received triamcinolone. Patient demographics, VAS and outcomes scores along with the severity of Quinell grade upon presentation were similar.
Following 1 CSI, resolution of the TF was found in 19 pts (45.2%) for betamethasone, 8 pts (12.9%) for dexamethasone, 12 pts (44.4%) for methylprednisolone, and 25 pts (65.8%) for triamcinolone. This increased to 25 pts (59.5%) for betamethasone, 35 pts (56.5%) for dexamethasone, 23 pts (85.2%) for methylprednisolone, and 34 pts (89.5%) for triamcinolone after 2 or more CSIs (Figure 2), which differed significantly (P=0.0007).
Water-soluble CSI (dexamethasone and betamethasone) has a combined resolution rate of 26.0% after 1 CSI, and 57.7% after 2 or more CSIs. Fat-soluble CSI (triamcinolone and methylprednisolone) had a resolution rate of 56.9% after 1 CSI, and 87.7% after 2 or more CSIs. Fat-soluble CSI has a significantly higher resolution rate (P<0.0001).
Conclusions: A high-resolution rate is noted after all CSIs for TFs. Fat-soluble CSIs (triamcinolone and methylprednisolone) have a significantly higher resolution rates than water-soluble CSIs (dexamethasone and betamethasone).
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