Dorsal Approach for Corticosteroid Injection in Trigger Finger Management: A Scoping Review.

Abstract

Introduction: Stenosing tenosynovitis (trigger finger) is a common condition caused by inflammation and hypertrophy of flexor tendons. Corticosteroid injection (CSI) is an effective and safe treatment option. A palmar approach for CSI is typically used; however dorsal injection, which may be less painful, is not well-studied. Methods: A 6-stage scoping review was conducted to characterize outcomes associated with dorsal CSI for trigger finger management. We searched Ovid MEDLINE, EMBASE, and Web of Science for eligible articles in English from inception to July 2024. Data regarding study characteristics and CSI outcomes were synthesized. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools. Results: Four articles were included in the review, comprising 1 case series, 2 cohort studies, and 1 randomized controlled trial (RCT). Symptom resolution rates following dorsal CSI ranged from 54% to 73.5%, comparable to a palmar approach. Two studies compared dorsal and palmar injections and found no significant differences in effectiveness. Pain scores for dorsal injections were similar or significantly lower than those for palmar injections in 2 studies. No adverse effects or complications were reported with either injection technique. Conclusion: Current evidence suggests a dorsal approach for CSI in trigger finger management is noninferior to a palmar approach in terms of efficacy and safety, with potential benefits in reducing injection-associated pain. However, more high-quality studies, including RCTs, are needed. Future research should assess anesthetic distribution and patient-reported outcomes to better understand the clinical implications of a dorsal CSI approach.