Plastic Surgery Research Council

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Trigger Finger Corticosteroid Injections With And Without Local Anesthetic; A Randomized, Double Blind Controlled Trial - A Preliminary Data Analysis
James R. Patrinely, Jr., BS, Brian C. Drolet, MD.
Vanderbilt University, Nasvhille, TN, USA.

PURPOSE: Trigger finger (stenosing tenosynovitis) occurs in 2-5% of general population and in up to 10% diabetic patients. First-line treatment involves injection of a corticosteroid, and prior studies have shown cure rates better than 65% with a single injection. Although many surgeons mix local anesthetic with their corticosteroid, the effect of this anesthetic is not clear on the outcomes in treating trigger digits. We conducted a study to compare corticosteroid injections with and without local anesthetic.
METHODS: In this double-blinded, prospective randomized controlled trial patients were treated with either 1 mL triamcinolone combined with 1 mL of 1% lidocaine or 1 mL of corticosteroid with 1 mL of 0.9% saline. To date, 10 patients have been enrolled with 5 receiving corticosteroid-alone and 5 receiving corticosteroid with lidocaine. Pain was the primary outcome, and it was measured using the visual analog scale (VAS) immediately following the injection, and then at 6 hours, 24 hours, and 72 hours after the injection. The efficacy of treatment was also monitored and defined by the need for a repeat injection at 6 weeks.
RESULTS: The two study groups had similar demographics. The injection containing lidocaine with epinephrine had a higher average VAS compared triamcinolone-only at 1 minute (2.4 vs 1.8) and 6 hours (1.4 vs 1.2), and the same pain score at 72 hours (0.4 vs 0.4) intervals. However, there was no statistical significance in this preliminary analysis. There were no adverse outcomes from the injections.
CONCLUSION: There is no significant difference in pain outcomes between the injection approaches. However, the single agent injection has a lower cost and risk by involving only one medication. Based on these initial findings, we recommend the use of an injection without lidocaine to treat trigger finger.


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