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Treatment of Flexor Tenosynovitis of the Hand ('Trigger Finger') With Corticosteroids: A Prospective Study of the Response to Local Injection

Treatment of Flexor Tenosynovitis of the Hand ('Trigger Finger') With Corticosteroids: A... Abstract We developed a protocol to maximize medical therapy for "trigger finger." Fifty-eight patients with 77 episodes of flexor tenosynovitis of the hand that was resistant to rest, therapy with nonsteroidal anti-inflammatory drugs, and/or splinting were treated with single or multiple injections of depo-methylprednisolone acetate or triamcinolone acetonide. Patients were prospectively followed up for an average of 4.6 years. Results showed that symptoms and signs resolved in 61% after a single injection. Recurrent episodes, after prolonged pain-free intervals, occurred in 27% and were effectively re-treated with injection. In 12% of cases, either injection failed or early recurrence required surgical release. Local adverse reactions to injection, including pain at the injection site, stiffness, ecchymosis, or atrophy of subcutaneous fat, were self-limited. No episodes of postinjection infection or tendon rupture occurred. The medical management of flexor tenosynovitis with local corticosteroid injection(s) is effective in nearly 90% of cases and is free from serious adverse reactions. (Arch Intern Med. 1991;151:153-156) References 1. Schnour E, Anger O, Hahn-Petersen A. Treatment of bursitis trigger finger, tenosynovitis crepitans and ganglion, with hydrocortisone . Acta Chir Scand. 1958;115:319-323. 2. Bunnell S, Howard LD, Pratt DR. The use of compound F (hydrocortisone) in operative and nonoperative conditions of the hand . J Bone Joint Surg Am. 1953;35:994-1002. 3. Sorenson VK. Treatment of trigger fingers . Acta Orthop Scand. 1970;41:428-432.Crossref 4. Quinnel RC. Conservative management of trigger finger . Practitioner. 1980;224:187-190. 5. Gray RG, Kiem IM, Gottlieb NL. Intratendon sheath corticosteroid treatment of rheumatoid arthritis-associated and idiopathic flexor tenosynovitis . Arthritis Rheum. 1978;21:92-96.Crossref 6. Gelberman RH, Rhoades CE, Manjarris JF. Stenosing tenosynovitis of the fingers and thumb . Clin Orthop. 1984;190:236-238. 7. Clark DD, Ricker JH, MacCollum MS. The efficacy of local steroid injection in the treatment of stenosing tenosynovitis . Plast Reconstr Surg. 1973;49:179-180.Crossref 8. Ellis RM, Hollingworth GR, Hattersley TS. Comparison of injection techniques for shoulder pain: results of a double blind, randomized study . BMJ. 1983;287:1339-1341.Crossref 9. Hollander JL, Brown EM, Jessar RA, Brown CY. Hydrocortisone and cortisone injected into arthritic joints: comparative effects of and use of hydrocortisone as local antiarthritic agent . JAMA. 1951;147:1629-1631.Crossref 10. Green DP. Operative Hand Surgery . 2nd ed. New York, NY: Churchill Livingstone Inc; 1988:2122-2124. 11. McCarty DJ. Arthritis and Allied Conditions. 10th ed. Philadelphia, Pa: Lea & Febiger; 1985:552. 12. Hollander JL, Jessar RA, Brown EM. Intrasynovial corticosteroid therapy: a decade of use . Bull Rheum Dis. 1961;11:239-240. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Treatment of Flexor Tenosynovitis of the Hand ('Trigger Finger') With Corticosteroids: A Prospective Study of the Response to Local Injection

Anderson, Bruce; Kaye, Sam
Archives of Internal Medicine , Volume 151 (1) – Jan 1, 1991
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References (14)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400010155024
Publisher site
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Abstract

Abstract We developed a protocol to maximize medical therapy for "trigger finger." Fifty-eight patients with 77 episodes of flexor tenosynovitis of the hand that was resistant to rest, therapy with nonsteroidal anti-inflammatory drugs, and/or splinting were treated with single or multiple injections of depo-methylprednisolone acetate or triamcinolone acetonide. Patients were prospectively followed up for an average of 4.6 years. Results showed that symptoms and signs resolved in 61% after a single injection. Recurrent episodes, after prolonged pain-free intervals, occurred in 27% and were effectively re-treated with injection. In 12% of cases, either injection failed or early recurrence required surgical release. Local adverse reactions to injection, including pain at the injection site, stiffness, ecchymosis, or atrophy of subcutaneous fat, were self-limited. No episodes of postinjection infection or tendon rupture occurred. The medical management of flexor tenosynovitis with local corticosteroid injection(s) is effective in nearly 90% of cases and is free from serious adverse reactions. (Arch Intern Med. 1991;151:153-156) References 1. Schnour E, Anger O, Hahn-Petersen A. Treatment of bursitis trigger finger, tenosynovitis crepitans and ganglion, with hydrocortisone . Acta Chir Scand. 1958;115:319-323. 2. Bunnell S, Howard LD, Pratt DR. The use of compound F (hydrocortisone) in operative and nonoperative conditions of the hand . J Bone Joint Surg Am. 1953;35:994-1002. 3. Sorenson VK. Treatment of trigger fingers . Acta Orthop Scand. 1970;41:428-432.Crossref 4. Quinnel RC. Conservative management of trigger finger . Practitioner. 1980;224:187-190. 5. Gray RG, Kiem IM, Gottlieb NL. Intratendon sheath corticosteroid treatment of rheumatoid arthritis-associated and idiopathic flexor tenosynovitis . Arthritis Rheum. 1978;21:92-96.Crossref 6. Gelberman RH, Rhoades CE, Manjarris JF. Stenosing tenosynovitis of the fingers and thumb . Clin Orthop. 1984;190:236-238. 7. Clark DD, Ricker JH, MacCollum MS. The efficacy of local steroid injection in the treatment of stenosing tenosynovitis . Plast Reconstr Surg. 1973;49:179-180.Crossref 8. Ellis RM, Hollingworth GR, Hattersley TS. Comparison of injection techniques for shoulder pain: results of a double blind, randomized study . BMJ. 1983;287:1339-1341.Crossref 9. Hollander JL, Brown EM, Jessar RA, Brown CY. Hydrocortisone and cortisone injected into arthritic joints: comparative effects of and use of hydrocortisone as local antiarthritic agent . JAMA. 1951;147:1629-1631.Crossref 10. Green DP. Operative Hand Surgery . 2nd ed. New York, NY: Churchill Livingstone Inc; 1988:2122-2124. 11. McCarty DJ. Arthritis and Allied Conditions. 10th ed. Philadelphia, Pa: Lea & Febiger; 1985:552. 12. Hollander JL, Jessar RA, Brown EM. Intrasynovial corticosteroid therapy: a decade of use . Bull Rheum Dis. 1961;11:239-240.

Journal

Archives of Internal Medicine – American Medical Association

Published: Jan 1, 1991

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