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Outcomes of Corticosteroid Treatment for Trigger Finger by Stage

Shultz, Kevin J., M.D.; Kittinger, Janae L., M.D.; Czerwinski, Wendy L., M.D.; Weber, Robert A., M.D.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 983–990
doi: 10.1097/PRS.0000000000004761
Hand/Peripheral Nerve: Original Articles

Background: Although steroid injection remains a common first-line treatment of trigger finger, clinical experience suggests that not all cases of trigger finger respond the same. The purpose of this study was to use a classification system for trigger finger that is simple and reproducible, and produces clearly definable, clinically relevant cutoff points to determine whether responsiveness to steroid injection correlates to clinical staging.

Methods: The authors conducted a prospectively collected longitudinal study of trigger finger patients separated into four stages of severity. Each subject received a single injection of 6 mg of dexamethasone acetate. One-month outcomes were analyzed to evaluate the efficacy of steroid injection. These outcomes were further stratified based on baseline characteristics and stage of triggering.

Results: A total of 99 digits and 69 subjects were included. Two variables were found to be significant in predicting response to initial injection: (1) multiple affected digits and (2) stage severity. Patients with multiple involved fingers were 5.8 times more likely to have no resolution of symptoms compared with those with a single affected finger. For every level of stage increase, the odds doubled for having no resolution of symptoms.

Conclusions: Steroid injection remains a viable first-line option for patients presenting with mild triggering (stage 1 and 2). For more severe triggering (stage 3 and 4) or multiple affected digits, the success of steroid injection is significantly lower at 1 month. For the latter patients, surgery may be a more reasonable initial treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Temple, Texas

From Scott & White Medical Center.

Received for publication July 24, 2017; accepted April 25, 2018.

Presented at the 96th Annual Meeting of the American Association of Plastic Surgeons, in Austin, Texas, March 25 through 28, 2017.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

This work was supported by THE PLASTIC SURGERY FOUNDATION.

Robert A. Weber, M.D., 2401 South 31st Street, Temple, Texas 76508, robert.weber@bswhealth.org

©2018American Society of Plastic Surgeons