Corticosteroid injection for trigger finger in adults
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 28 APR 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Peters-Veluthamaningal C, van der Windt DAWM, Winters JC, Meyboom- de Jong B. Corticosteroid injection for trigger finger in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005617. DOI: 10.1002/14651858.CD005617.pub2.
- Publication Status: New
- Published Online: 21 JAN 2009
Trigger finger is a disease of the tendons of the hand leading to triggering (locking) of affected fingers, dysfunction and pain. Available treatments include local injection with corticosteroids, surgery, or splinting.
To summarize the evidence on the efficacy and safety of corticosteroid injections for trigger finger in adults using the following endpoints: treatment success, frequency of triggering or locking, functional status of the affected fingers, and severity of pain of the fingers.
The databases CENTRAL, DARE, MEDLINE (1966 to November 2007), EMBASE (1956 to November 2007), CINAHL (1982 to November 2007), AMED (1985 to November 2007) and PEDro (a physiotherapy evidence database) were searched.
We selected randomized and controlled clinical trials evaluating efficacy and safety of corticosteroid injections for trigger finger in adults.
Data collection and analysis
The databases were searched for titles of eligible studies. After screening abstracts of these studies, full text articles of studies which fulfilled the selection criteria were obtained. Data were extracted using a predefined electronic form. The methodological quality of included trials was assessed by using items from the checklist developed by Jadad and the Delphi list. We planned to extract data regarding information on the primary outcome measures: treatment success, frequency of triggering or locking, and functional impairment of fingers, severity of the trigger finger; and the secondary outcome measures: proportion of patients with side effects, types of side effects, and patient satisfaction with injection.
Two randomized controlled studies were found that involved 63 participants: 34 were allocated to corticosteroids and lidocaine, and 29 were allocated to lidocaine alone. Corticosteroid injection with lidocaine was more effective than lidocaine alone on treatment success at four weeks (relative risk 3.15, 95% CI 1.34 to 7.40). The number needed to treat to benefit was 3. No adverse events or side effects were reported.
The effectiveness of local corticosteroid injections was studied in only two small randomized controlled trials of poor methodological quality. Both studies showed better short-term effects of corticosteroid injection combined with lidocaine compared to lidocaine alone on the treatment success outcome. In one study the effects of corticosteroid injections lasted up to four months. No adverse effects were observed. The available evidence for the effectiveness of intra-tendon sheath corticosteroid injection for trigger finger can be graded as a silver level evidence for superiority of corticosteroid injections combined with lidocaine over injections with lidocaine alone.
Plain language summary
Local corticosteroid injection for trigger finger
This summary of a Cochrane review presents what we know from research about the effect of corticosteroid injection for trigger finger.
Pain and symptoms of people with trigger finger may improve with a corticosteroid injection.
What is trigger finger and corticosteroid injection?
Trigger finger is a disease of the tendons of the finger, which makes the finger difficult to straighten. It causes snapping or locking of the affected finger when flexing or stretching. Sometimes it can cause the hand to become painful.
Corticosteroid injections are shots with a needle into a joint (such as your finger) or a tendon. Corticosteroids work by reducing the inflammation of the finger. The injection itself might also help to relieve the pressure on the tendon.
Best estimate of what happens after a corticosteroid injection:
37 out of 100 people benefited from corticosteroid injection combined with a painkiller; compared to 17 out of 100 people who benefited following injection with a painkiller only.
搜尋包括CENTRAL, DARE, MEDLINE (1966 to Novembe 007), EMBASE (1956 to November 2007), CINAHL (1982 to November 2007), AMED (1985 to November 2007) and PEDro (a physiotherapy evidence database)。
兩位作者進行資料摘錄於先設定之電子格式中，並對每篇試驗研究的品質進行評估(checklist developed by Jadad and the Delphi list)。主要測量指標為：治療成功，手指卡住的頻率，影響手指的功能，及疼痛的嚴重度。次要指標為：副作用病患百分比、副作用型態、病患滿意度。
2個研究包含63例病患於分析中，其中34位為類固醇加lidocaine注射，29位為lidocaine注射。4週時，類固醇注射比lidocaine注射有效，治療成功相對風險3.15, 95% CI 1.34 to 7.40，NNT = 3。未有副作用報告。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
局部類固醇注射治療板機指：這篇考科藍回顧由研究中呈現出注射類固醇治療板機指的療效。類固醇局部注射可能對於改善板機指所帶來的疼痛與症狀有幫助。 ■板機指與類固醇注射是什麼?板機指是手肌腱病變造成手指卡住、無法伸直。它會造成患處彎曲或伸展時發出聲響無法活動，有時候會造成手部疼痛。類固醇注射是以針頭注入軟骨或肌腱。類固醇的效用在於減少手指發炎；而注射這個動作本身也許對於釋放肌腱的壓力有也幫助。 注射類固醇效用之最佳估計值：每100人當中有37位因同時服用止痛藥與注射類固醇而受益；相較之下，注射後才服用止痛藥者每100人當中只有17人因此受益。