{"id":513,"date":"2014-12-18T09:00:49","date_gmt":"2014-12-18T09:00:49","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=513"},"modified":"2017-08-21T12:03:37","modified_gmt":"2017-08-21T12:03:37","slug":"primary-care-corner-with-geoffrey-modest-md-trigger-finger-injections","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/12\/18\/primary-care-corner-with-geoffrey-modest-md-trigger-finger-injections\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Trigger Finger Injections"},"content":{"rendered":"

A study from Missouri assessed the longterm outcome of a single corticosteroid injection for a trigger finger (see\u00a0J Bone Joint Surg Am\u00a02014\u00a0Nov\u00a019;\u00a096:1849<\/strong>\u200b). They assessed 366 patients who had a first injection and followed a minimum of 5 years.<\/p>\n

Background:<\/p>\n

–Trigger fingers are\u00a0pretty common. lifetime risk estimated in general population of 2.6%, 4-10% in diabetics<\/p>\n

–And, from my patients, pretty uncomfortable and affects daily functioning<\/p>\n

Results:<\/p>\n

–66% female, average age 59 yo,\u00a044% with multiple trigger fingers, 24% with diabetes.\u00a0majority had symptom of “catching” but able to actively extend the\u00a0digit\u200b.<\/p>\n

–Their protocol was injecting the A1 pulley area with methylprednisolone 40mg\/cc, 1cc, and lidocaine without epinephrine 1%, 0.5 to 1 cc.<\/p>\n

–Primary outcome (which was to\u00a0not<\/strong> get\u00a0subsequent injection or surgical release) of the affected digit was in 45% of patients, with a 56% success rate in females (vs 35% in males), and approx 38% in males and females with multiple trigger fingers.<\/p>\n

–Of the treatment failures, 64% got another injection, 33% had surgical release<\/p>\n

–84% of treatment failures were in the first 2 years after injection (ie, those who lasted 2 years did well longterm)<\/p>\n

–Other studies have found even higher longish term\u00a0success rates (one with 92% for trigger thumbs, another with 72%)<\/p>\n

So, a few comments:<\/p>\n

–These are really easy injections. I use just 1\/2 cc of triamcinolone 40mg\/cc plus 1\/2 cc of lidocaine 1% and inject with a 30\u00a0gauge short needle (though it still hurts: thick skin and too many nerves), injecting where I palpate the nodule, which is right at the A1 pulley entrance, close to\u00a0the MCP joint on the volar surface). and, though I have not looked at the success rate rigorously, I am confident that in the dozens I\u00a0have injected, at least\u00a0\u00a090% have had really good responses and it is pretty rare that patients come back for more. and, even if the injection lasted\u00a0only 1 year, that’s a lot of relief for the patient, and re-injections (done rarely by me) have also been successful. \u00a0after 2 injections, I\u00a0would\u00a0suggest surgical intervention.<\/p>\n

–The injections take about 3 minutes and are the easiest of my patient visits (a thousand times easier than the more frequent patient with uncontrolled diabetes, hypertension, depression, domestic violence…….). And, as an aside, an orthopedic surgeon doing this injection probably gets as much $$ as my health center collects for 5 visits\u00a0of my\u00a0more difficult\u00a0patients…<\/p>\n","protected":false},"excerpt":{"rendered":"

Trigger Finger Injections […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-513","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/513","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=513"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/513\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=513"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=513"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=513"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}