Assessing Injection Techniques in the Treatment of Trigger Finger
Affiliation(s)
Temple University Hospital, Department of Orthopaedics, Philadelphia, USA. Temple University School of Medicine, Philadelphia, USA. University of Pennyslvania School of Medicine, Philadelphia, USA.
Temple University Hospital, Department of Orthopaedics, Philadelphia, USA. Temple University School of Medicine, Philadelphia, USA. University of Pennyslvania School of Medicine, Philadelphia, USA.
ABSTRACT
Background: Trigger finger is characterized by the inability to smoothly flex and extend the digit. Corticosteroids are an accepted non-surgical treatment option and can be delivered via two techniques. While the palmar approach is more commonly used, some have suggested that the mid-axial approach may be less painful for patients and yield higher intrasheath injection rates. The purpose of this study is to compare the accuracy of the palmar and midaxial approaches for delivery of corticosteroids into the flexor tendon sheath using radio-opaque dye in a cadaver model. Methods: A total of 50 injections were performed, 25 via midaxial technique and 25 via palmar technique. A one inch, 25-gauge needle was used to inject 1 mL of Isovue contrast dye into the flexor tendon sheath under live fluoroscopy. The fluoroscopic images were examined after injection to determine intrasheath versus extrasheath delivery of the dye, with visualization of contrast filling the sheath defining a successful injection. Results: The midaxial approach had a success rate of 52% compared to the conventional palmar approach success rate of 36%, p=0.5. The ring finger is the most common location of trigger finger and the rates of success were equal between groups for this digit (80%). Conclusions: Based on our findings, there is no statistical difference in the accuracy of intrasheath injection between the midaxial technique and palmar technique. The midaxial technique can be considered as an alternative to the palmar technique for trigger finger injection.
Background: Trigger finger is characterized by the inability to smoothly flex and extend the digit. Corticosteroids are an accepted non-surgical treatment option and can be delivered via two techniques. While the palmar approach is more commonly used, some have suggested that the mid-axial approach may be less painful for patients and yield higher intrasheath injection rates. The purpose of this study is to compare the accuracy of the palmar and midaxial approaches for delivery of corticosteroids into the flexor tendon sheath using radio-opaque dye in a cadaver model. Methods: A total of 50 injections were performed, 25 via midaxial technique and 25 via palmar technique. A one inch, 25-gauge needle was used to inject 1 mL of Isovue contrast dye into the flexor tendon sheath under live fluoroscopy. The fluoroscopic images were examined after injection to determine intrasheath versus extrasheath delivery of the dye, with visualization of contrast filling the sheath defining a successful injection. Results: The midaxial approach had a success rate of 52% compared to the conventional palmar approach success rate of 36%, p=0.5. The ring finger is the most common location of trigger finger and the rates of success were equal between groups for this digit (80%). Conclusions: Based on our findings, there is no statistical difference in the accuracy of intrasheath injection between the midaxial technique and palmar technique. The midaxial technique can be considered as an alternative to the palmar technique for trigger finger injection.
Cite this paper
J. R Fowler, L. Ogrich, P. Evangelista and A. A Schaffer, "Assessing Injection Techniques in the Treatment of Trigger Finger," Modern Plastic Surgery, Vol. 2 No. 4, 2012, pp. 83-86. doi: 10.4236/mps.2012.24020.
J. R Fowler, L. Ogrich, P. Evangelista and A. A Schaffer, "Assessing Injection Techniques in the Treatment of Trigger Finger," Modern Plastic Surgery, Vol. 2 No. 4, 2012, pp. 83-86. doi: 10.4236/mps.2012.24020.
References
[1] M. J. Saldana, “Trigger Digits: Diagnosis and Treatment,” Journal of the American Academy of Orthopaedic Surgeons, Vol. 9, No. 4, 2001, pp. 246-252. [2] N. Buch-Jaeger, G. Foucher, S. Ehrler and D. Sammut, “The Results of Conservative Management of Trigger Finger: A Series of 169 Patients,” Annals of Hand & Upper Limb Surgery, Vol. 11, No. 3, 1992, pp. 189-193. [3] K. Kazuki, T. Egi, M. Okada and K. Takaoka, “Clinical outcome of extrasynovial steroid injection for trigger finger,” Hand Surgery, Vol. 11, No. 1-2, 2006, pp. 1-4. doi:10.1142/S0218810406003115 [4] M. Lambert, R. Morton and J. Sloan, “Controlled Study of the Use of Local Steroid Injection in the Treatment of Trigger Finger and Thumb,” The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, Vol. 17, No. 1, 1992, pp. 69-70. doi:10.1016/0266-7681(92)90014-S [5] M. R. Marks and S. F. Gunther, “Efficacy of Cortisone Injection in Treatment of Trigger Fingers and Thumbs,” Journal of Hand Surgery, Vol. 14, No. 4, 1989, pp. 722-727. [6] D. Murphy, J. M. Failla and M. P. Koniuch, “Steroid versus Placebo Injection for Trigger Finger,” Journal of Hand Surgery, Vol. 20, No. 4, 1995, pp. 628-631. [7] C. Carlson Jr. and R. Curtis, “Steroid Injection for Flexor Tenosynovitis,” Journal of Hand Surgery, Vol. 12, No. 2, 1984, pp. 286-287. [8] J. S. Taras, J. S. Raphael, W. T. Pan, F. Movagharnia and D. G. Sotereanos, “Corticosteroid Injections for Trigger Digits: Is Intrasheath Injection Necessary?” Journal of Hand Surgery, Vol. 23, No. 4, 1998, pp. 717-722. [9] A. Freiberg, R. Mulholland and R. Levine, “Nonoperative treatment of trigger fingers and thumbs,” Journal of Hand Surgery, Vol. 14, No. 3, 1989, pp. 553-558. [10] M. Kamhin, J. Engel and M. Heim, “The fate of injected trigger fingers,” Hand, Vol. 15, No. 2, 1983, pp. 218-220. doi:10.1016/S0072-968X(83)80018-7 [11] S. B. Fleisch, K. P. Spindler and D. H. Lee, “Corticosteroid Injections in the Treatment of Trigger Finger: A Level I and II Systematic Review,” Journal of the American Academy of Orthopaedic Surgeons, Vol. 15, No. 3, 2007, pp. 166-171. [12] D. Ring, S. Lozano-Calderón, R. Shin, P. Bastian, C. Mudgal and J. Jupiter, “A Prospective Randomized Controlled Trial of Injection of Dexamethasone versus Triamcinolone for Idiopathic Trigger Finger,” Journal of Hand Surgery, Vol. 33, No. 4, 2008, pp. 516-522.
[1] M. J. Saldana, “Trigger Digits: Diagnosis and Treatment,” Journal of the American Academy of Orthopaedic Surgeons, Vol. 9, No. 4, 2001, pp. 246-252. [2] N. Buch-Jaeger, G. Foucher, S. Ehrler and D. Sammut, “The Results of Conservative Management of Trigger Finger: A Series of 169 Patients,” Annals of Hand & Upper Limb Surgery, Vol. 11, No. 3, 1992, pp. 189-193. [3] K. Kazuki, T. Egi, M. Okada and K. Takaoka, “Clinical outcome of extrasynovial steroid injection for trigger finger,” Hand Surgery, Vol. 11, No. 1-2, 2006, pp. 1-4. doi:10.1142/S0218810406003115 [4] M. Lambert, R. Morton and J. Sloan, “Controlled Study of the Use of Local Steroid Injection in the Treatment of Trigger Finger and Thumb,” The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, Vol. 17, No. 1, 1992, pp. 69-70. doi:10.1016/0266-7681(92)90014-S [5] M. R. Marks and S. F. Gunther, “Efficacy of Cortisone Injection in Treatment of Trigger Fingers and Thumbs,” Journal of Hand Surgery, Vol. 14, No. 4, 1989, pp. 722-727. [6] D. Murphy, J. M. Failla and M. P. Koniuch, “Steroid versus Placebo Injection for Trigger Finger,” Journal of Hand Surgery, Vol. 20, No. 4, 1995, pp. 628-631. [7] C. Carlson Jr. and R. Curtis, “Steroid Injection for Flexor Tenosynovitis,” Journal of Hand Surgery, Vol. 12, No. 2, 1984, pp. 286-287. [8] J. S. Taras, J. S. Raphael, W. T. Pan, F. Movagharnia and D. G. Sotereanos, “Corticosteroid Injections for Trigger Digits: Is Intrasheath Injection Necessary?” Journal of Hand Surgery, Vol. 23, No. 4, 1998, pp. 717-722. [9] A. Freiberg, R. Mulholland and R. Levine, “Nonoperative treatment of trigger fingers and thumbs,” Journal of Hand Surgery, Vol. 14, No. 3, 1989, pp. 553-558. [10] M. Kamhin, J. Engel and M. Heim, “The fate of injected trigger fingers,” Hand, Vol. 15, No. 2, 1983, pp. 218-220. doi:10.1016/S0072-968X(83)80018-7 [11] S. B. Fleisch, K. P. Spindler and D. H. Lee, “Corticosteroid Injections in the Treatment of Trigger Finger: A Level I and II Systematic Review,” Journal of the American Academy of Orthopaedic Surgeons, Vol. 15, No. 3, 2007, pp. 166-171. [12] D. Ring, S. Lozano-Calderón, R. Shin, P. Bastian, C. Mudgal and J. Jupiter, “A Prospective Randomized Controlled Trial of Injection of Dexamethasone versus Triamcinolone for Idiopathic Trigger Finger,” Journal of Hand Surgery, Vol. 33, No. 4, 2008, pp. 516-522.