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

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 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

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
• 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.

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

Who Is Running the Clinical Trial?

Kevin Zuo

Lead Sponsor

Trials

1

Recruited

60+

Findings from Research

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]

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]

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]

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]

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]

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]

References

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

Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study. [2021]

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]

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]

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

Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial. [2022]

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]

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

Study to outline the efficacy and illustrate techniques for steroid injection for trigger finger and thumb. [2018]