Steroid Injections for Trigger Finger

Recruiting in Palo Alto (17 mi)

Overseen by Kevin Zuo, MD, MASc

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Kevin Zuo

Disqualifiers: Multiple CSI, Past surgery, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

Trigger finger is a common disease of the hand involving swelling and inflammation of the tendon which flexes a finger, causing catching, locking, and/or pain. Trigger finger is typically treated by hand surgeons with a steroid injection through the front/palm side of the hand into the area near the tendon (i.e., at the base of the affected finger). This steroid injection is often combined with a local anesthetic (numbing agent) to help reduce short-term pain from the injection. However, the front/palm side of the hand is known to be very sensitive, and the steroid injection can be quite painful as the needle pierces the front/palm skin. To reduce the pain of steroid injections for trigger finger, a different approach involves performing the injection from the back/dorsal side of the hand, which is thought to be less sensitive (and therefore less painful) than the front/palm side of the hand. This technique is sometimes used and has been previously studied, but it is not clear if it can offer less injection-related pain than standard treatment. Accordingly, this study will be comparing short-term injection-associated pain between front/palm side and back/dorsal side steroid injections for trigger finger. The study will also seek to understand what area of the hand is numbed by the anesthetic when doing a front/palm side injection versus a back/dorsal side injection of the hand. Overall, the investigators hypothesize that back/dorsal side injections will be less painful than front/palm side injections for trigger fingers and that the area of numbing from the anesthetic will be equivalent between both types of injections.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Steroid Injections for Trigger Finger is an effective treatment?

The available research shows that steroid injections are effective for treating trigger finger. One study found that using a dorsal web space technique for the injection was less painful and had a 67% success rate, compared to a 56% success rate with the palmar midline technique. Another study indicated that using only the steroid without additional anesthetic resulted in less pain during the injection, making it a preferred method. Overall, these studies suggest that steroid injections are effective and can be administered with minimal pain. ^{1 2 3 4 5}

What safety data is available for steroid injections in treating trigger finger?

The available studies suggest that steroid injections for trigger finger, including techniques like the dorsal web space and palmar midline injections, are generally safe. A randomized controlled trial found no complications with the dorsal web space technique, which was also less painful and at least as effective as the palmar midline technique. Other studies focus on the effectiveness and pain management of these techniques, but do not report significant safety concerns. ^{1 2 3 5 6}

Is the drug used in steroid injections for trigger finger a promising treatment?

Yes, the drug used in steroid injections for trigger finger is promising. Research shows that injecting steroids through the dorsal web space is less painful and at least as effective as the traditional palmar method. The success rate for the dorsal method is 67%, compared to 56% for the palmar method. This makes it a good option for treating trigger finger. ^{1 2 3 4 6}

Research Team

Kevin Zuo, MD, MASc

Principal Investigator

University Health Network, Toronto

Eligibility Criteria

This trial is for individuals with trigger finger, a condition where a finger gets stuck in a bent position. Participants should be those who haven't had relief from other treatments and are suitable candidates for steroid injections.

Inclusion Criteria

I have been diagnosed with trigger finger.

I am 18 years old or older.

I am choosing to get a corticosteroid injection for my trigger finger.

Exclusion Criteria

I choose not to get a corticosteroid injection for my trigger finger.

Unable to communicate in English

I am getting several steroid injections for my trigger finger.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive corticosteroid injections using either the palmar or dorsal approach

1 day

1 visit (in-person)

Follow-up

Participants are monitored for pain and sensory changes post-injection

1 day

3 assessments (0, 4, and 24 hours post-injection)

Treatment Details

Interventions

• Dorsal webspace combined corticosteroid and anesthetic injection (Corticosteroid)
• Palmar combined corticosteroid and anesthetic injection (Corticosteroid)

Trial Overview The study compares two methods of administering steroid injections to treat trigger finger: one through the back/dorsal side of the hand, which may be less painful, and the standard front/palm side injection.

Participant Groups

Group I: Dorsal Webspace Approach Experimental Treatment 1 Intervention

A dorsal approach involves passing the needle with a 1:1 triamcinolone and lidocaine mixture in the dorsal webspace skin aiming just palmar to the proximal phalanx bone such that the needle is directed into the flexor tendon sheath at the A1 annular pulley.

Group II: Palmar Approach Active Control 1 Intervention

Standard approach for injecting the 1:1 triamcinolone and lidocaine mixture involves the needle passing through the cutaneous and subcutaneous layers of the palmar skin surface and into the flexor tendon sheath at the A1 annular pulley.

Dorsal webspace combined corticosteroid and anesthetic injection is already approved in United States, European Union for the following indications:

🇺🇸 Approved in United States as Dorsal webspace combined corticosteroid and anesthetic injection for:

• Trigger finger

🇪🇺 Approved in European Union as Dorsal webspace combined corticosteroid and anesthetic injection for:

• Trigger finger

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

University Health Network - Toronto Western Hospital Toronto, Canada

Who Is Running the Clinical Trial?

Kevin Zuo

Lead Sponsor

Trials

1

Patients Recruited

60+

References

1. Spain pubmed.ncbi.nlm.nih.gov

Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study. [2021] Corticosteroid injection is an effective treatment for trigger digits but the pain during the injection is an ever-present side effect. Since the palmar skin has a high density of sensitive receptors, injecting through dorsal skin could be less painful. Our aim was to assess whether a dorsal technique through the dorsal web is safe for extra-sheath injection of trigger fingers and thumb.

2. Spain pubmed.ncbi.nlm.nih.gov

Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study. [2022] Steroid injections are effective in the treatment of trigger digits but the pain during the injection is an always-present accompanying effect. The aim of this study was to assess the effectiveness and perceived pain during an out-of-sheath corticosteroid injection through the dorsal webspace in the treatment of trigger digits.

3. England pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of dorsal web space versus palmar midline injection of steroid in the treatment of trigger digits. [2021] One hundred and sixty patients were enrolled in a prospective randomized controlled trial to assess whether a steroid injection through the dorsal web space was less painful than the palmar midline technique in the treatment of trigger digits and whether they were equally effective. There were 116 women and 44 men with a mean age of 60 years. The mean visual analogue score for pain during the injection was 3.6 in the dorsal web space group and 5.4 in the palmar midline group on a scale of 0-10. The overall success of treatment in the dorsal group was 67%, whereas it was 56% in the palmar group. No complications were noted. We concluded from this study that the dorsal web space technique is less painful and at least as effective as the palmar midline technique.Level of evidence: I.

4. United States pubmed.ncbi.nlm.nih.gov

Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial. [2022] Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.

5. England pubmed.ncbi.nlm.nih.gov

The SToICAL trial: study protocol for the soft tissue injection of corticosteroid and local anaesthetic trial-a single site, non-inferiority randomised control trial evaluating pain after soft tissue corticosteroid injections with and without local anaesthetic. [2021] Corticosteroid injections are used in the treatment of hand and wrist conditions. The co-administration of a local anaesthetic and corticosteroid aims to reduce pain after the injection, although no studies have directly compared this with using corticosteroid alone. The aim is to determine whether pain experienced during the 24 h after a corticosteroid injection to the hand and wrist is no worse than (not inferior to) the pain experienced after a corticosteroid and local anaesthetic injection.

6. England pubmed.ncbi.nlm.nih.gov

Study to outline the efficacy and illustrate techniques for steroid injection for trigger finger and thumb. [2018] To outline the efficacy of a steroid injection in treating trigger finger. Our study defines the anatomy of the A1 pulley, and suggests methods for simple and safe flexor sheath injection for trigger finger and thumb.