title: Long-Term Effectiveness of Repeat Corticosteroid Injections for Trigger Finger.
abstract: OBJECTIVE
  To quantify the long-term success of repeat injections for trigger fingers and to identify predictors of treatment outcomes.
  
  
  METHODS
  This retrospective case series analyzed 292 repeat corticosteroid injections for trigger fingers administered by hand surgeons at a single tertiary center between January 2010 and January 2013. One hundred eighty-seven patients (64%) were female, 139 patients (48%) had multiple trigger fingers, and 63 patients (22%) were diabetic. The primary outcome, treatment failure, was defined as receiving a subsequent injection or surgical treatment. Patients without either documented failure or a return office visit in 2015 or 2016 were surveyed by telephone to determine if they had required subsequent treatment. Kaplan-Meier analyses with log-rank testing assessed the median time to treatment failure and the effect of demographic and disease-specific characteristics on injection success rate and predictors of injection outcome (success vs failure) were assessed with multivariable logistic regression.
  
  
  RESULTS
  Second injections provided long-term treatment success in 39% (111 of 285) of trigger fingers with 86 receiving an additional injection and 108 ultimately undergoing surgical release. Thirty-nine percent (24 of 62) of third injections resulted in long-term success, with 22 receiving an additional injection, and 23 ultimately undergoing surgery. Median times-to-failure for second and third injections were 371 and 407 days, respectively. Success curves did not differ significantly according to any patient or disease factor. Logistic regression identified that advancing patient age and injection for trigger thumb were associated with success of second injections.
  
  
  CONCLUSIONS
  Thirty-nine percent of second and third corticosteroid injections for trigger finger yield long-term relief. Although most patients ultimately require surgical release, 50% of patients receiving repeat trigger injections realize 1 year or more of symptomatic relief. Repeat injections of trigger fingers should be considered in patients who prefer nonsurgical treatment.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Agnes Z
authors.initials: AZ
authors.lastname: Dardas
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: James
authors.initials: J
authors.lastname: VandenBerg
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Tony
authors.initials: T
authors.lastname: Shen
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Gelberman
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: calfeer@wudosis.wustl.edu.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Calfee
mesh_terms: D000368:Aged; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D052582:Trigger Finger Disorder / Q000188:drug therapy*
chemical_list: D005938:Glucocorticoids
keywords: Corticosteroid; injection; repeat; stenosing tenosynovitis; trigger finger