Cochrane for Clinicians
Putting Evidence into Practice
Trigger Finger: Safety and Effectiveness of NSAID vs. Steroid Injection Therapy
Am Fam Physician. 2021 Dec ;104(6):577-578.
Author disclosure: No relevant financial affiliations.
Clinical Question
Are nonsteroidal anti-inflammatory drug (NSAID) injections as safe and effective as steroid injections for the treatment of trigger finger?
Evidence-Based Answer
In patients with trigger finger, there is no significant difference in outcomes at 12 to 24 weeks— including resolution of symptoms, recurrence, total active motion, residual pain, patient satisfaction, or adverse events—when comparing treatment with NSAID injections vs. corticosteroid injections.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)
Practice Pointers
Trigger finger occurs when the motion of the flexor tendon of a digit through the first annular pulley becomes abnormal due to inflammation or swelling. With an estimated general prevalence of 2.6%, trigger finger is more common in women and people in their 40s and 50s. Individuals with arthritis or diabetes mellitus appear to be at increased risk. Conservative treatment options include physical therapy, topical or oral NSAIDs, splinting, and activity modification. Symptoms may also resolve without treatment.2 However, watchful waiting and other conservative measures may not be acceptable for some patients. Invasive treatment with injection or surgery is often reserved for cases that are more severe or do not respond to conservative measures.
Two prior Cochrane reviews focused on this subject.3,4 The first demonstrated that corticosteroid injection was superior to lidocaine injection at four weeks' follow-up3; the second review showed that surgery may have superior long-term outcomes to corticosteroid injection but was associated with more short-term pain.4 Both reviews indicated that their conclusions were based on limited, low-quality data.
The authors of this most recent Cochrane review looked for randomized controlled trials comparing topical, oral, or injected NSAIDs with placebo, corticosteroids, or alternate NSAID treatments (i.e., a different drug or different route of ad
References
show all references1. 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. McKee D, Lalonde J, Lalonde D. How many trigger fingers resolve spontaneously without any treatment? Plast Surg (Oakv). 2018;26(1):52–54.
3. 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.
4. Fiorini HJ, Tamaoki MJ, Lenza M, et al. Surgery for trigger finger. Cochrane Database Syst Rev. 2018;(2):CD009860.
5. Kosiyatrakul A, Loketkrawee W, Luenam S, et al. 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.
6. Huisstede BMA, Hoogvliet P, Coert JH, et al.; European HANDGUIDE Group. Multidisciplinary consensus guideline for managing trigger finger: results from the European HANDGUIDE study. Phys Ther. 2014;94(10):1421–1433.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.
A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.
Copyright © 2021 by the American Academy of Family Physicians.
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