scholarly journals Steroid Injection Using Tendon Excursion for Trigger Finger: Introduction to Injection Methods and Analysis of Treatment Results

2021 ◽  
Author(s):  
Sang Hyun Ko ◽  
Dong Eun Kim ◽  
Tong Joo Lee
Keyword(s):  
Success Rate ◽  
Steroid Injection ◽  
Treatment Success ◽  
Tendon Sheath ◽  
Trigger Finger ◽  
Injection Technique ◽  
Low Grade ◽  
Complication Rates ◽  
Injection Methods ◽  
Tendon Excursion

Purpose: Local corticosteroid injections are routinely used as first-line treatment for trigger finger. However, accurate delivery of steroids into the tendon sheath is important for the effectiveness of the treatment and the prevention of complications. This study aimed to introduce our steroid injection technique for trigger finger, which uses tendon excursion of the flexor tendon, and evaluate the clinical outcomes in patients who were treated with this technique.Methods: A total of 171 patients with trigger finger who were treated with steroid injections were retrospectively reviewed. The efficacy of injection and complications were investigated. The evaluation of the efficacy was classified into “good,” “fair,” and “poor.” The results were analyzed according to the type of finger and the Quinnell grading system.Results: The total efficacy was 83.6% (good/fair, 143 digits; poor, 28 digits). The treatment success rate for Quinnell grade IV was 43.8% (7 of 16), which was significantly lower than those of Quinnell grades II and III, which were 88.9% (88 of 99) and 87.5% (49 of 56), respectively (II vs. IV, p=0.004; III vs. IV, p=0.010). In four fingers (excluding the thumb), the success rate was significantly higher than that of the thumb (88.2% vs. 75.4%, p=0.048).Conclusion: The steroid injection technique using tendon excursion showed excellent results and low complication rates. In particular, the second to fourth fingers and low-grade fingers showed more effective results.

Diabetes and Trigger Finger

1996 ◽  
Vol 21 (2) ◽  
pp. 244-245 ◽  
Author(s):  
M. J. G. BLYTH ◽  
D. J. ROSS
Keyword(s):  
Steroid Injection ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Surgical Decompression ◽  
Adult Patients ◽  
Trigger Finger ◽  
Day Case ◽  
Day Case Surgery ◽  
Case Surgery ◽  
Insulin Dependent

Trigger finger is a stenosing tenovaginitis in which there is a constriction of the annular sheath associated with a nodule in the digital flexor tendon. Clinically this can present as triggering or snapping of the nodule as it passes through the tight constricting tendon sheath. Although many triggering fingers settle spontaneously, and others respond to local anaesthestic and steroid injection, others require surgical decompression. The association between diabetes and trigger finger, although not widely known, has been described and forms part of the “diabetic hand syndrome”. We studied 100 adult patients in the group that required surgery. Eighteen of the 100 patients were diabetic with six insulin dependent diabetics (IDDM) and 12 non-insulin dependent diabetics (NIDDM). In the current climate of day case surgery this has significant implications both for the management of known diabetics as well as the preoperative detection of those with the condition.

scholarly journals Percutaneous trigger finger release

2013 ◽  
Vol 1 (1) ◽  
Author(s):  
BK Pandey ◽  
S Sharma ◽  
RR Manandhar ◽  
RL Pradhan ◽  
S Lakhey ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Clinical Evidence ◽  
Steroid Injection ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Trigger Finger ◽  
Digital Nerve ◽  
Open Release ◽  
Percutaneous Release ◽  
A1 Pulley

BACKGROUND: Trigger finger is caused by formation of nodule or thickening of A1 pulley by its fibrocartilage metaplasia resulting in entrapment of the flexor tendon. Conservative treatment of this condition consists of NSAIDs, splint immobilization and steroid injection into the tendon sheath. Failure of the conservative treatment is the indication of an open release. Percutaneous release of trigger finger is advised by several authors. The purpose of this prospective study is to evaluate the results of percutaneous release of trigger finger with 18 gauge needle. METHODS: Fifty one patients with 58 trigger digits were treated by percutaneous release using 18 gauge needle under local anaesthesia. Patients were followed up for an average of 12 months. RESULTS: Overall, 97% achieved an excellent or good result. Two digits experienced recurrent symptoms and required an open release. There was no clinical evidence of digital nerve injury or tendon bowstringing. CONCLUSIONS: We recommend this technique as a safe and effective outpatient procedure for releasing trigger finger. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8126 Nepal Orthopaedic Association Journal Vol.1(1) 2010

PROXIMAL PHALANX INJECTION FOR TRIGGER FINGER: RANDOMIZED CONTROLLED TRIAL

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 313-317 ◽  
Author(s):  
K. Pataradool ◽  
T. Buranapuntaruk
Keyword(s):  
Pain Score ◽  
Recurrence Rate ◽  
Steroid Injection ◽  
Proximal Phalanx ◽  
Trigger Finger ◽  
Injection Pain ◽  
Injection Technique ◽  
Palmar Surface ◽  
Satisfactory Outcome ◽  
Significant Difference

Trigger finger is one of the most common upper extremity problems in the outpatient department. Conservative treatment is the mainstay for management of trigger digits especially steroid injection with highly satisfactory outcome and minimal complication. Conventional injection technique (CI) that approaches flexor tendon sheath over metacarpal head directly causes pain for most patients. The proximal phalanx injection technique (P1I) at palmar surface of midproximal phalanx is simple and less painful for the patients. We compared pain result and effectiveness between these two methods. Forty patients with primary trigger fingers were placed in a prospective randomized study to receive steroid injection with either the CI or P1I techniques. Demographic data were recorded. Immediately after the injection, pain score was recorded for each patient using the pain visual analog scale. The patients were followed every month for three months to determine recurrent symptoms. Student's t-test, chi-square and Fisher's exact test were used for data analysis. The mean pain VAS scores immediately post-injection were 7.3 ± 1.3 and 3.2 ± 2.2 in the CI and P1I techniques, respectively. The P1I technique group had a significantly lower pain score than CI technique group (p < 0.001). The recurrence rate was 15% in the CI technique when compared to 25% in the P1I technique which was not significant (p = 0.685). We concluded that the P1I technique is less painful than the CI technique without any significant difference in recurrence rate between the two groups at three months follow-up.

CLINICAL OUTCOME OF EXTRASYNOVIAL STEROID INJECTION FOR TRIGGER FINGER

Hand Surgery ◽  
2006 ◽  
Vol 11 (01n02) ◽  
pp. 1-4 ◽  
Author(s):  
K. Kazuki ◽  
T. Egi ◽  
M. Okada ◽  
K. Takaoka
Keyword(s):  
Clinical Study ◽  
Steroid Injection ◽  
Clinical Results ◽  
Tendon Sheath ◽  
Clinical Severity ◽  
Trigger Finger ◽  
Prospective Clinical Study ◽  
Steroid Injections ◽  
A1 Pulley ◽  
Surgical Release

A prospective clinical study was performed to investigate the clinical results of extrasynovial (subcutaneous) steroid injection for trigger finger. One hundred and twenty-nine trigger fingers were investigated in 100 adult patients; 76 were women and 24 were men. Their mean age was 60 years (range: 17 to 88 years). We classified trigger fingers into three different grades according to clinical severity at a medical examination. All patients were injected with betamethasone mixed with lidocaine. Surgical release of the A1 pulley was performed at the patients' request if steroid injection therapy was not effective. Pain and snapping were relieved in 98% and 74% of cases, respectively. Recurrence occurred in about half our patients, but the same clinical benefit was obtained after re-injection. Surgery was performed for seven fingers. No complications of steroid injections were observed. This study suggests that extrasynovial steroid injection is a valuable conservative treatment for trigger finger and it is not necessary to try and inject into the tendon sheath to get a good result and markedly reduce the risk of causing damage to tendons and other structures.

Comparative effectiveness of various treatment strategies for trigger finger by pairwise meta-analysis

2020 ◽  
Vol 34 (9) ◽  
pp. 1217-1229
Author(s):  
Po-Chih Shen ◽  
Shih-Hsiang Chou ◽  
Cheng-Chang Lu ◽  
Yin-Chih Fu ◽  
Chun-Kuan Lu ◽  
...  
Keyword(s):  
Success Rate ◽  
Steroid Injection ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Trigger Finger ◽  
Cochrane Library ◽  
Drug Injection ◽  
Inflammatory Drug ◽  
Significant Difference ◽  
Anti Inflammatory

Objective: To compare the efficacy of various strategies in the treatment of trigger finger. Data sources: A systematic literature search for randomized controlled trials to compare treatments for trigger finger was conducted through three online databases, Pubmed, Embase and Cochrane Library, from their inception dates to 22 May 2020. Methods: Relative risk (RR) with 95% confidence interval (CI) was used to evaluate the effect sizes in success rate for included articles. Results: Sixteen articles ( n = 1185) were included in our meta-analysis. The results showed that the efficacy of steroid injection was significantly better than the placebo group at short-term follow-ups (RR = 19.00, 95% CI = 1.17–309.77 for one-week; RR = 3.70, 95% CI = 3.70, 95% CI = 1.61–8.53 for one-month), and then became non-significant at four months (RR = 3.21, 95% CI = 0.88–11.79). There was no significant difference in success rate between steroid injection and nonsteroidal anti-inflammatory drug injection, and between open surgery and percutaneous release at all the follow-ups. Only surgical treatment had significantly better efficacy in success rate than steroid injection at all follow-ups (RR = 0.48, 95% CI = 0.34–0.66 for one-month; RR = 0.87, 95% CI = 0.80–0.96 for three-month; RR = 0.58, 95% CI = 0.48–0.68 for six-month; RR = 0.38, 95% CI = 0.20–0.72 for 12-month). Conclusion: There were no differences in efficacy between steroid injection and shockwave or nonsteroidal anti-inflammatory drug injection. The surgical treatments had the best efficacy among these treatments.

scholarly journals Effect of using electronic medication monitors on tuberculosis treatment outcomes in China: a longitudinal ecological study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Ni Wang ◽  
Lei Guo ◽  
Hemant Deepak Shewade ◽  
Pruthu Thekkur ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Success Rate ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
Coverage Rate ◽  
Treatment Success Rate ◽  
County Level ◽  
Time Data ◽  
Tb Treatment ◽  
Random Intercept ◽  
Relative Change

Abstract Background In China, an indigenously developed electronic medication monitor (EMM) was designed and used in 138 counties from three provinces. Previous studies showed positive results on accuracy, effectiveness, acceptability, and feasibility, but also found some ineffective implementations. In this paper, we assessed the effect of implementation of EMMs on treatment outcomes. Methods The longitudinal ecological method was used at the county level with aggregate secondary programmatic data. All the notified TB cases in 138 counties were involved in this study from April 2017 to June 2019, and rifampicin-resistant cases were excluded. We fitted a multilevel model to assess the relative change in the quarterly treatment success rate with increasing quarterly EMM coverage rate, in which a mixed effects maximum likelihood regression using random intercept model was applied, by adjusting for seasonal trends, population size, sociodemographic and clinical characteristics, and clustering within counties. Results Among all 69 678 notified TB cases, the treatment success rate was slightly increased from 93.5% [95% confidence interval (CI): 93.0–94.0] in second quarter of 2018 to 94.9% (95% CI: 94.4–95.4) in second quarter of 2019 after implementing EMMs. There was a statistically significant effect between quarterly EMM coverage and treatment success rate after adjusting for potential confounders (P = 0.0036), increasing 10% of EMM coverage rate will lead to 0.2% treatment success rate augment. Besides, an increase of 10% of elderly or bacteriologically confirmed TB will lead to a decrease of 0.4% and 0.9% of the treatment success rate. Conclusions Under programmatic settings, we found a statistically significant effect between increasing coverage of EMM and treatment success rate at the county level. More prospective studies are needed to confirm the effect of using EMM on TB treatment outcomes. We suggest performing operational research on EMMs that provides real-time data under programmatic conditions in the future.

scholarly journals Effect of wrist dorsiflexion on ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients: a randomised controlled clinical trial

2021 ◽  
pp. emermed-2020-209504
Author(s):  
Qingyu Xiao ◽  
Dejiang Xu ◽  
Shaohui Zhuang
Keyword(s):  
Success Rate ◽  
Radial Artery ◽  
Adult Patients ◽  
Controlled Clinical Trial ◽  
Complication Rates ◽  
Success Rates ◽  
Time Duration ◽  
Positioning Technique ◽  
Randomised Controlled ◽  
Group D

BackgroundIt is generally recommended to keep the wrist joint mildly dorsiflexed during radial artery catheterisation. However, wrist dorsiflexion might decrease the success rate of radial artery catheterisation with dynamic needle tip positioning technique. Therefore, we assessed the success rates of two groups with or without wrist dorsiflexion by 5 cm wrist elevation in adult patients.MethodsThis randomised controlled clinical trial was performed between March and December 2018 in the First Affiliated Hospital of Shantou University Medical College, China. We recruited 120 adult patients undergoing major surgical procedures and randomly allocated them into two groups: dorsiflexion group (group D) and neutral group (group N). The primary outcome was first-attempt success rates of two groups. Secondary outcomes were overall success rates within 5 min; numbers of insertion and cannulation attempts; overall catheterisation time; duration of localisation, insertion and cannulation; and complication rates of catheterisation.ResultsFirst-attempt success rate was 88.3% in group D and 81.7% in group N (p=0.444). The overall success rate within 5 min was 93.3% in group D compared with 90.0% in group N (p=0.743). Numbers of insertion and cannulation attempts, overall catheterisation time, duration of localisation and insertion, and complication rates did not show a significant difference between the two groups. Cannulation time was longer in group N (35.68 s) than that in group D (26.19 s; p<0.05).ConclusionWrist dorsiflexion may not be a necessity for ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients.Trial registration numberChiCTR1800015262.

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