Steroid injection versus NSAID injection for trigger finger: a comparative study of early outcomes.
OBJECTIVE
Stenosing tenosynovitis of the flexor tendon sheath of the digits of the hand results from a discrepancy between the diameter of the flexor tendon and its sheath at the A1 pulley. The treatment options for trigger digits include oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local NSAID applications, splintage, steroid injection, and percutaneous and open release of the A1 pulley. Injectable NSAID is used intramuscularly and locally in other sites. The hypothesis is that an injectable NSAID is as effective as the traditionally used steroid injection in the treatment of trigger digit, based on Quinnell grading, and that the treatment works as well in patients with diabetes as in those without diabetes.


METHODS
In this prospective, randomized, double-blinded controlled study for trigger digits, we injected diclofenac sodium locally in one group (NSAID group) and triamcinolone acetonide in another (corticosteroid group). A total of 100 patients (50 patients in each group) were followed up and assessed 3 weeks and 3 months after the injection.


RESULTS
At the end of the follow-up, 35 patients (70%) in the corticosteroid group and 28 patients (53%) in the NSAID group had complete symptomatic resolution. There was no difference between the response of patients with and without diabetes. There was no significant difference found in Quinnell score between treatments at 3 months, although at 3 weeks, the patients who received steroid had significantly better Quinnell scores.


CONCLUSIONS
We concluded that, although steroids gave quicker relief, NSAID injections are equally effective at 3 months in the treatment of trigger digits. We were unable to detect a statistically significant difference in the response of patients with and without diabetes to either treatment.
Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia. drshakeel@hotmail.com
Hussain
H
Shakeel
T Sara
TS
Ahmad
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D052582:Trigger Finger Disorder / Q000150:complications / Q000188:drug therapy*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide