Outcomes of Corticosteroid Treatment of TriggerFinger by Stage
Kevin Shultz, MD, Robert Weber, MD, Janae Maher, MD, Wendy Czerwinski, MD.
Baylor Scott and White, Temple, TX, USA.
PURPOSE: While the literature reports that trigger fingers have a 90% response rate to a steroid injection, clinical experience suggests that not all trigger fingers respond the same. The purpose of this study was to refine a classification system for trigger finger that is simple and reproducible, with clearly definable and clinically relevant cutoff points, and then use the classification system to determine if responsiveness to steroid injection correlates to clinical staging.
METHODS: This was a prospectively collected longitudinal study of trigger finger patients separated into four stages of severity. Each subject received a single dose of 6 mg betamethasone acetate. One month outcomes were analyzed to evaluate efficacy of steroid injection. These outcomes were further stratified based on baseline characteristics and stage of triggering.
RESULTS: A total of 99 digits and 69 subjects were included. Two variables were found to be significant in predicting response to initial injection: 1. Multiple affected digits 2. Stage severity. Patients with multiple involved fingers were 5.8 times more likely to have no resolution of symptoms compared to those with a single affected finger. For every level of stage increase, the odds double for having no resolution of symptoms.
CONCLUSION: Steroid injection remains a viable first-line option for patients presenting with mild triggering (Stage 1 and 2). For more severe triggering (Stage 3 and 4), or multiple affected digits, success of steroid injection is significantly lower at one month. For these patients, surgery may be a reasonable initial treatment.
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