Choice of Corticosteroid Is Associated With the Possibility of Subsequent Surgery for Trigger Finger: A Retrospective Cohort Study.

Abstract

Introduction: Trigger finger is one of the most common conditions treated by hand surgeons. Although corticosteroid injection is a common first-line treatment, there is no consensus regarding the most effective type of steroid.

Methods: The authors performed a retrospective cohort study of patients with a diagnosis of trigger finger within Kaiser Permanente Northern California, a large, community-based, integrated health system with a comprehensive electronic medical record. Patients were potentially exposed to 4 different steroid regimens: betamethasone, dexamethasone, methylprednisolone, and triamcinolone. The primary outcome was the possibility of subsequent trigger finger surgery following initial corticosteroid treatment.

Results: Among 20,141 patients with an injection for trigger finger diagnosis, 1668 (8.3%) had a trigger finger release procedure following injection. Compared with patients injected with triamcinolone, dexamethasone patients had a hazard ratio of 4.12 for surgery (95% confidence interval [CI], 3.06-5.54), betamethasone patients had a hazard ratio of 2.40 (95% CI, 1.86-3.10), and methylprednisolone had a hazard ratio of 1.77 (95% CI, 1.32-2.37).

Discussion: This large, retrospective observational study suggests that the type of corticosteroid used for trigger finger may influence the possibility of subsequent surgery.

Conclusions: This information may inform corticosteroid choice for treating trigger finger, but findings should be confirmed in a prospective study.