This Article Full Text Full Text (PDF) CME: Take the activity for this article: CME 3: July, August, September 2008 (publication date October 3, 2008; expi... Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rozental, T. D. Articles by Blazar, P. E. Search for Related Content PubMed Articles by Rozental, T. D. Articles by Blazar, P. E. Related Collections Hand/Wrist Social Bookmarking             What's this?

Trigger Finger: Prognostic Indicators of Recurrence Following Corticosteroid Injection

¹ Harvard Medical School, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215. E-mail address: trozenta{at}bidmc.harvard.edu
² Harvard Medical School, Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
³ Harvard Medical School, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115

Investigation performed at Harvard Medical School, Departments of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Children's Hospital Boston, and Brigham and Women's Hospital, Boston, Massachusetts

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: One hundred and thirty consecutive patients with trigger digits treated with corticosteroid injection were prospectively enrolled. Exclusion criteria were prior treatment and inflammatory arthritis. Demographic data and information on existing comorbidities were identified with a questionnaire. Patients were contacted at one year after treatment to determine symptom recurrence. Kaplan-Meier analysis and the Cox regression model were used to estimate recurrence rates and identify predictors.

Results: One hundred and twenty-four trigger digits in 119 patients (average age, 62.3 years) were included. The most commonly involved digits were the thumb (35% of the digits), ring finger (31%), and long finger (23%). Seventy digits (56%) had a recurrence of symptoms at a median of 5.6 months (range, 0.5 to 13.1 months) after the injection. Twenty-two digits (18%) underwent surgical release at a median of 7.4 months after the injection. According to the Kaplan-Meier analysis, the estimated rate of freedom from symptom recurrence was 70% (95% confidence interval, 63% to 77%) at six months and 45% (95% confidence interval, 36% to 54%) at twelve months and the estimated rate of freedom from surgical release was 95% (95% confidence interval, 92% to 98%) at six months and 83% (95% confidence interval, 77% to 89%) at twelve months. Insulin-dependent diabetes mellitus was identified as a strong predictor of symptom recurrence (p < 0.01). Younger age (p < 0.01), involvement of other digits prior to presentation (p < 0.01), and a history of other tendinopathies of the upper extremity (p = 0.02) were all independent predictors of a surgical release. The duration and severity of symptoms were not predictive of poor outcomes following injections.

Conclusions: At one year following injection, 56% of the digits had a recurrence of symptoms. Younger age, insulin-dependent diabetes mellitus, involvement of multiple digits, and a history of other tendinopathies of the upper extremity were associated with a higher rate of treatment failure. Symptoms often recurred several months after the injection.

Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				Steroid Injections for Trigger Finger Journal Watch (General), August 28, 2008; 2008(828): 3 - 3. [Full Text]

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2008 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.