Medicine by the Numbers

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Nonsteroidal Anti-Inflammatory Drug Injections for Trigger Finger

 

Am Fam Physician. 2021 Nov ;104(5):online.

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NSAID INJECTION VS. CORTICOSTEROID INJECTION FOR TRIGGER FINGER

BenefitsHarms

No difference between the groups in resolution of symptoms, residual pain after treatment, or patient-reported treatment success

No one was harmed (pain at injection site was similar between the groups)

In 1 out of 5 patients, symptom recurrence was prevented with NSAID injection (very low-certainty evidence)


NSAID = nonsteroidal anti-inflammatory drug.

NSAID INJECTION VS. CORTICOSTEROID INJECTION FOR TRIGGER FINGER

BenefitsHarms

No difference between the groups in resolution of symptoms, residual pain after treatment, or patient-reported treatment success

No one was harmed (pain at injection site was similar between the groups)

In 1 out of 5 patients, symptom recurrence was prevented with NSAID injection (very low-certainty evidence)


NSAID = nonsteroidal anti-inflammatory drug.

Details for This Review

Study Population: Adults (older than 18 years) with a clinical diagnosis of trigger finger, ranging from uneven movement without triggering to a locked or fixed deformity using Quinnell grading criteria1,2

Efficacy End Points: Resolution of symptoms, continued moderate to severe symptoms, recurrence of symptoms 12 to 24 weeks after treatment; total active finger motion after treatment; residual pain after treatment; patient-reported treatment success

Harm End Points: Adverse events 12 to 24 weeks after treatment (e.g., pain at the injection site)

Narrative: Trigger finger is a common condition caused by abnormal movement of an inflamed, thickened, or swollen flexor tendon as it glides within its tendon sheath through the first annular pulley, which may also be narrow due to thickening.1,3 Trigger finger can lead to pain, catching, or locking of the affected digit. Management is typically conservative, including rest, immobilization, and oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs).1,3

Corticosteroid injections are usually implemented when conservative management is not effective or function is impaired.1,3 Although effective, corticosteroid injections may cause unwanted adverse effects, such as fat atrophy and hypopigmentation of the skin and elevated blood glucose levels in patients with diabetes mellitus.46 An injectable NSAID at the level of the first annular pulley could avoid these adverse effects and may be more

Author disclosure: No relevant financial affiliations.


The views expressed in this material are those of the authors and do not reflect the official policy or position of the U.S. government, the Department of Defense, the Department of the Air Force, or the Uniformed Services University of the Health Sciences.

Copyright © 2021 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

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1. Leow MQH, Zheng Q, Shi L, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger. Cochrane Database Syst Rev. 2021;(4):CD012789....

2. Quinnell RC. Conservative management of trigger finger. Practitioner. 1980;224(1340):187–190.

3. Gil JA, Hresko AM, Weiss APC. Current concepts in the management of trigger finger in adults. J Am Acad Orthop Surg. 2020;28(15):e642–e650.

4. Peters-Veluthamaningal C, van der Windt DAWM, Winters JC, et al. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev. 2009;(1):CD005617.

5. Leow MQH, Hay ASR, Ng SL, et al. A randomized controlled trial comparing ketorolac and triamcinolone injections in adults with trigger digits. J Hand Surg Eur Vol. 2018;43(9):936–941.

6. Shakeel H, Ahmad TS. Steroid injection versus NSAID injection for trigger finger: a comparative study of early outcomes. J Hand Surg Am. 2012;37(7):1319–1323.

7. Kosiyatrakul A, Loketkrawee W, Luenam S. Different dosages of triamcinolone acetonide injection for the treatment of trigger finger and thumb: a randomized controlled trial. J Hand Surg Asian Pac Vol. 2018;23(2):163–169.

 

 

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