title: Corticosteroid injection therapy for trigger finger or thumb: a retrospective review of 577 digits.
abstract: BACKGROUND
  Stenosing flexor tenosynovitis of the digital flexor tendon (trigger digit) is a common condition encountered by hand surgeons. Our purpose was to determine the efficacy of corticosteroid injections and review the demographic profile of patients with trigger digits.
  
  
  METHODS
  We reviewed the records of 362 patients (577 trigger digits) treated with steroid injections (8 mg of triamcinolone acetonide in 1 % lidocaine) from 1998 through 2011. Follow-up (intervention to last visit) averaged 66.4 months. We assessed patient demographics (e.g., gender, age, diabetes mellitus, hand dominance, trigger digit distribution) and determined recurrence rate and injection duration of efficacy. If one injection failed, additional injections or surgical A1 pulley release were offered. Results were analyzed with Student's t test or Fisher's exact test (significance, p < 0.05).
  
  
  RESULTS
  Women (258, 71.3 %) were affected significantly (p < 0.001) more frequently than men (104, 28.7 %) and at a significantly (p < 0.001) younger age (average, 58.3 versus 62.1 years, respectively). Eighty patients (22.1 %) were diabetic. We observed no correlation between trigger digit and hand dominance. The two most commonly affected digits were the right long finger (17.8 %) and right thumb (17.7 %). For 721 injections, the recurrence rate was 20.3 %; there were no major complications. For recurrences, the injection efficacy averaged 315 days. Surgery was required for 117 patients.
  
  
  CONCLUSIONS
  Injection therapy is safe and highly effective (79.7 %). Women were affected by trigger digits more often than men and at a younger age. Surgical release provides a definitive therapeutic option if corticosteroid injection fails.
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287 USA.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Schubert
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287 USA.
authors.forename: Helen G
authors.initials: HG
authors.lastname: Hui-Chou
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287 USA.
authors.forename: Alfred P
authors.initials: AP
authors.lastname: See
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287 USA ; c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A665, Baltimore, MD 21224-2780 USA.
authors.forename: E Gene
authors.initials: EG
authors.lastname: Deune
keywords: Corticosteroid injection; Efficacy; Open trigger finger release; Recurrence; Stenosing tendovaginitis; Stenosing tenosynovitis; Trigger digits; Trigger finger