Treatment of Trigger Finger With Steroid Injection Versus Steroid Injection and Splinting

Stenosing tenosynovitis, or more commonly "trigger finger" is a disease that can severely
impact a patient's quality of life. Its incidence is said to be 28 persons per 100,000
annually. The disease is manifested in one or more fingers by finger locking in flexion or
extension, leading to pain, discomfort and at times, loss of function. Patients frequently
report having to snap their fingers back in position to alleviate symptoms. The
pathophysiology relates to thickening of the flexor tendon sheath, which can impair tendon
gliding within it.

Although multiple treatment strategies are available, it is not entirely clear which
treatment offers the best outcome, especially when the finger has not reached end stage
locking. In general, corticosteroid injection into the tendon sheath is offered as the first
line of treatment. Splinting alone has also been described as a reliable method treatment.
However, Patel and Bassini indicated that steroid injection results in fewer recurrences
than splinting alone. Surgery is typically reserved for recurrent triggering, cases
refractory to injection, or digits locked in flexion. The effects of steroid injection
followed by splinting however have not been reported in a comprehensive fashion. It may be
that this form of treatment could result in a synergistic effect, which can offer a
treatment modality superior to either injection or splinting alone. The purpose of this
research study is to determine whether steroid injection followed by splinting is superior
to injection alone.

Inclusion Criteria:

- Trigger finger in one or more trigger fingers, in stages 2 to 5 (inclusive)

- Adult patient aged over 18 years.

- No prior treatment (splinting, injection or surgery) to the involved finger OR at
least 1 year since last treatment of the involved finger.

Exclusion Criteria:

- Exclude Trigger thumbs because they appear to be respond very favorably or
unfavorably to treatment3

- Exclude locked digits because surgery is indicated in these cases

- Pregnant patients

- Prisoners

- Patients with impaired decision-making capacity

- Patients that do not speak English and cannot fill in English language
questionnaires.