RESEARCH - Local corticosteroid injections effective for trigger finger

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Local Corticosteroid Injections Effective for Trigger Finger

By Martha Kerr

NEW YORK (Reuters Health) Sept 12 - Local injections of triamcinolone

acetonide (TCA) for flexor tenosynovitis, or " trigger finger, " relieve

pain and inflammation while promoting healing, Dutch researchers

report in the August issue of the ls of the Rheumatic Diseases.

Dr. Cyriac s-Veluthamaningal and colleagues at the University

Medical Center Groningen conducted a randomized, controlled,

double-blind trial involving 50 patients who received 1 mL TCA or 0.9%

saline, injected once or twice around the thickened part of the

affected flexor tendon.

" Intra-sheath injection is not necessary and does not lead to better

results, " Dr. s-Veluthamaningal commented to Reuters Health, " and

injection directly into tendons might result in rupture of the

tendon. "

Sixteen of the 25 patients randomized to TCA reported immediate relief

compared with 5 of 25 patients receiving placebo. Reduction of

triggering occurred in 16 of 24 TCA patients and 6 of 22 placebo

patients.

On a pain perception scale with a top score of 6, the mean difference

in severity of pain was 4.2 in TCA patients compared with 0.9 in

placebo patients. Difference in Arthritis Impact Measurement Scale-2

(AIMS-2) score was 4.02 from baseline in the study group and 0.06 in

the placebo group.

Adverse effects were few and minor. " Side effects are steroid flare,

with temporary worsening of pain, subcutaneous fat atrophy and skin

depigmentation at the injection site, " Dr. s-Veluthamaningal

noted. " However, side effects are observed very rarely. "

Positive results with TCA were maintained over the 12 months of

follow-up. Long-term results were difficult to detect in patients

randomized to placebo, because of the high drop-out rate.

" Steroid effectiveness diminishes after each injection, especially

after the second and third injections, " Dr. s-Veluthamaningal

noted. " I would suggest no more than two injections. "

Steroids enhance the healing process, he added.

Ann Rheum Dis 2008;67:1262-1266.

http://www.medscape.com/viewarticle/580443

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