Local corticosteroid injection for trigger finger

Peters-Veluthamaningal C, van der Windt DAWM, Winters JC, Meyboom- de Jong B

Published Online:

January 21, 2009

This summary of a Cochrane review presents what we know from research about the effect of corticosteroid injection for trigger finger.

Pain and symptoms of people with trigger finger may improve with a corticosteroid injection.

What is trigger finger and corticosteroid injection?

Trigger finger is a disease of the tendons of the finger, which makes the finger difficult to straighten. It causes snapping or locking of the affected finger when flexing or stretching. Sometimes it can cause the hand to become painful.

Corticosteroid injections are shots with a needle into a joint (such as your finger) or a tendon. Corticosteroids work by reducing the inflammation of the finger. The injection itself might also help to relieve the pressure on the tendon.

Best estimate of what happens after a corticosteroid injection:

37 out of 100 people benefited from corticosteroid injection combined with a painkiller; compared to 17 out of 100 people who benefited following injection with a painkiller only.

Abstract (click to read)

Background:

Trigger finger is a disease of the tendons of the hand leading to triggering (locking) of affected fingers, dysfunction and pain. Available treatments include local injection with corticosteroids, surgery, or splinting.

Objectives:

To summarize the evidence on the efficacy and safety of corticosteroid injections for trigger finger in adults using the following endpoints: treatment success, frequency of triggering or locking, functional status of the affected fingers, and severity of pain of the fingers.

Search strategy:

The databases CENTRAL, DARE, MEDLINE (1966 to November 2007), EMBASE (1956 to November 2007), CINAHL (1982 to November 2007), AMED (1985 to November 2007) and PEDro (a physiotherapy evidence database) were searched.

Selection criteria:

We selected randomized and controlled clinical trials evaluating efficacy and safety of corticosteroid injections for trigger finger in adults.

Data collection and analysis:

The databases were searched for titles of eligible studies. After screening abstracts of these studies, full text articles of studies which fulfilled the selection criteria were obtained. Data were extracted using a predefined electronic form. The methodological quality of included trials was assessed by using items from the checklist developed by Jadad and the Delphi list. We planned to extract data regarding information on the primary outcome measures: treatment success, frequency of triggering or locking, and functional impairment of fingers, severity of the trigger finger; and the secondary outcome measures: proportion of patients with side effects, types of side effects, and patient satisfaction with injection.

Main results:

Two randomized controlled studies were found that involved 63 participants: 34 were allocated to corticosteroids and lidocaine, and 29 were allocated to lidocaine alone. Corticosteroid injection with lidocaine was more effective than lidocaine alone on treatment success at four weeks (relative risk 3.15, 95% CI 1.34 to 7.40). The number needed to treat to benefit was 3. No adverse events or side effects were reported.

Authors' conclusions:

The effectiveness of local corticosteroid injections was studied in only two small randomized controlled trials of poor methodological quality. Both studies showed better short-term effects of corticosteroid injection combined with lidocaine compared to lidocaine alone on the treatment success outcome. In one study the effects of corticosteroid injections lasted up to four months. No adverse effects were observed. The available evidence for the effectiveness of intra-tendon sheath corticosteroid injection for trigger finger can be graded as a silver level evidence for superiority of corticosteroid injections combined with lidocaine over injections with lidocaine alone.

This record should be cited as:

Peters-Veluthamaningal C, van der Windt DAWM, Winters JC, Meyboom- de Jong B. Corticosteroid injection for trigger finger in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005617. DOI: 10.1002/14651858.CD005617.pub2

Assessed as up to date:

April 29, 2008

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Primary Review Group:

Musculoskeletal Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective are corticosteroid injections for trigger finger (stenosing tenosynovitis) in adults?

Bottom line:

Intra-tendon sheath corticosteroid injection with lidocaine was more effective (37%) than lidocaine alone (17%) on treatment success at 4 weeks (NNT* 3). No adverse events or side effects were reported. In 1 study, the effects of corticosteroid injections lasted up to 4 months. *NNT= number needed to treat to benefit 1 individual

Caveat:

The methodological quality of the 2 studies included was poor and there were some flaws in the quality of reporting. The 2 trials were performed in the setting of secondary care and generalisability to other settings (eg, primary care) remains to be established.

Context:

Trigger finger (stenosing tenosynovitis) is a disease of the tendons of the hand leading to triggering, snapping or locking of affected fingers, dysfunction and pain. The lifetime prevalence of trigger finger among a group of non-diabetics above the age of 30 years has been estimated at 2.2%. Available treatments include local injection with corticosteroids, surgery or splinting.

Cochrane Systematic Review:

Review Peters-Veluthamaningal C et al. Corticosteroid injection for trigger finger in adults. Cochrane Reviews 2009, Issue 1. Article No. CD005617. DOI: 10.1002/14651858.CD005617.pub2. This review contains 2 trials involving 63 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Arthritis topics:

Chronic Musculoskeletal Pain > Hand pain

Health topics:

Rheumatology > Soft tissue disorders > Upper limb pain

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Independent high-quality evidence for health care decision making

Local corticosteroid injection for trigger finger

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