Steroid Injections for Trigger Finger

Overseen By Kevin Zuo, MD, MASc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Kevin Zuo

Disqualifiers: Multiple CSI, Past surgery, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 1 day

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if steroid injections for trigger finger cause less pain when administered from the back of the hand rather than the front. Trigger finger, which causes finger pain and locking, is often treated with a steroid injection. Researchers seek to compare the pain levels of injections from both sides of the hand and assess if the numbing effect remains consistent. Individuals diagnosed with trigger finger and planning to receive a steroid injection may be suitable candidates for this trial. As an unphased trial, it offers participants the chance to contribute to research that could enhance treatment comfort for future patients.

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 prior data suggests that this technique is safe for reducing pain in trigger finger injections?

Research has shown that both the palmar (front) and dorsal (back) approaches for steroid injections to treat trigger finger are generally safe. Studies indicate no harmful effects or complications arise from either method. The dorsal approach, involving steroid injection from the back of the hand, is reported to be less painful and just as effective as the usual palmar method. This dorsal method appears to be a good option for reducing pain during the injection. Overall, these findings suggest that both methods are well-tolerated and safe for patients. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for trigger finger because they explore different injection approaches that could potentially enhance patient comfort and treatment effectiveness. The dorsal webspace approach is unique as it targets the flexor tendon sheath from the back of the hand, which might reduce pain associated with the needle passing through the sensitive palmar skin. Additionally, both methods use a combination of triamcinolone and lidocaine, which could offer rapid relief of symptoms by combining anti-inflammatory and numbing effects. This trial aims to determine if these approaches can offer better outcomes compared to the traditional palmar approach typically used in current treatments.

What evidence suggests that this trial's treatments could be effective for reducing injection-related pain in trigger finger?

This trial will compare two methods of steroid injections for treating trigger finger. The Palmar Approach, which participants may receive, involves injecting the steroid mixture into the palm. Studies have shown that this method can ease symptoms for up to 10 years in some people. The Dorsal Webspace Approach, another method under study, involves injecting at the back of the hand and is considered equally effective. Some evidence suggests that this back-of-the-hand method might cause less pain. Both methods aim to reduce the pain and finger locking caused by trigger finger by calming the swelling around the finger tendons. ^{1 2 3 4 5}

Who Is on the Research Team?

Kevin Zuo, MD, MASc

Principal Investigator

University Health Network, Toronto

Are You a Good Fit for This Trial?

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 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.

Timeline for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

Interventions

• Dorsal webspace combined corticosteroid and anesthetic injection
• Palmar combined corticosteroid and anesthetic injection

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.

How Is the Trial Designed?

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

Who Is Running the Clinical Trial?

Kevin Zuo

Lead Sponsor

Trials

1

Recruited

60+

Published Research Related to This Trial

This study aims to determine if pain after a corticosteroid injection alone is no worse than pain after a combination of corticosteroid and local anesthetic, specifically in patients with conditions like trigger finger and carpal tunnel syndrome.

The trial will involve 100 patients and assess pain levels at multiple time points after injection, providing a rigorous comparison of pain management strategies in hand and wrist treatments.

NCBI (Pubmed)

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. Jones, M., Evans, J., Fullilove, S., et al.[2021]

In a study of 73 patients with trigger finger, those receiving corticosteroid injections with lidocaine and epinephrine reported significantly higher pain levels immediately after the injection compared to those receiving corticosteroids with a placebo (VAS 3.5 vs 2.0).

The findings suggest that omitting the local anesthetic (lidocaine with epinephrine) from corticosteroid injections can reduce injection-associated pain, making the treatment simpler, more efficient, and safer for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial. Patrinely, JR., Johnson, SP., Drolet, BC.[2022]

In a study of 160 patients with trigger digits, the dorsal web space technique for steroid injection was significantly less painful (mean pain score of 3.6) compared to the palmar midline technique (mean pain score of 5.4).

The dorsal web space technique also demonstrated a higher overall treatment success rate of 67% compared to 56% for the palmar technique, indicating it is at least as effective while being less painful.

NCBI (Pubmed)

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. Jiménez, I., Garcés, GL., Marcos-García, A., et al.[2021]

The dorsal injection technique for corticosteroid treatment of trigger digits was found to have a mean distance of 1.77mm from the needle to the neurovascular bundle, indicating a relatively safe approach with a low risk of injury.

Out of 112 injections, only two neurovascular injuries occurred, suggesting that while the technique is generally safe, further clinical studies are needed to confirm its efficacy and safety in practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study. Jiménez, I., Garcés, GL., Caballero-Martel, J., et al.[2021]

Steroid injections into the flexor sheath at the A1 pulley level are effective in treating trigger finger, with evidence suggesting success in most patients based on a systematic review of the literature.

The study provides detailed anatomical guidance and techniques for safely administering the injection, minimizing the risk of injury to surrounding structures, making it a preferred treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Study to outline the efficacy and illustrate techniques for steroid injection for trigger finger and thumb. Akhtar, S., Burke, FD.[2018]

The study of 126 patients showed that out-of-sheath corticosteroid injections through the dorsal webspace for treating trigger digits are effective, achieving a 68% overall success rate and a 54% success rate after a single injection.

The average pain level during the injection was reported as 3.8 on a visual analog scale, indicating that this method may be less painful compared to traditional techniques, with no complications noted.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study. Jiménez, I., Medina, J., Marcos-García, A., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12488611/

Dorsal Approach for Corticosteroid Injection in Trigger Finger ... Outcomes included pain, anesthesia (if applicable), efficacy, and adverse outcomes or complications. Studies were excluded if they involved ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06476977

Intrasynovial Digital Anesthesia in Trigger Finger Accordingly, it is hypothesized that injecting corticosteroids into the synovial sheath of the flexor tendon will result in less pain over 24 hours if performed ...

3. researchgate.net researchgate.net/publication/396084826_Dorsal_Approach_for_Corticosteroid_Injection_in_Trigger_Finger_Management_A_Scoping_Review

Dorsal Approach for Corticosteroid Injection in Trigger ... Conclusion: Current evidence suggests a dorsal approach for CSI in trigger finger management is noninferior to a palmar approach in terms of ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S1888441522001060

[Translated article] Out-of-sheath corticosteroid injections ... 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 ...

5. mdpi.com mdpi.com/2411-5142/9/3/146

A Practical Guide to Injection Therapy in Hand ... Therefore, the extra-sheath corticosteroid injection through the dorsal web space is less painful and at least as effective as the palmar midline technique.