Differential efficacy of corticosteroid solutions for nonoperative treatment of trigger fingers: a double-blind prospective randomized trial

Background: Trigger fingers, a common cause of hand pain and dysfunction, are routinely treated with injected corticosteroids; however, the most efficacious formulation remains unknown. We conducted a randomized, double-blind trial and hypothesized that a 0.5 mL injection of triamcinolone (40 mg/mL) would be the most efficacious injection compared with dexamethasone (4 mg/mL) or triamcinolone (10 mg/mL) for preventing escalation to surgery. Methods: Ninety-five digits from 85 adult patients were assigned to receive 0.5 mL lidocaine plus 0.5 mL of triamcinolone (40 mg/mL), triamcinolone (10 mg/mL), or dexamethasone (4 mg/mL). Patients with continued triggering at 6 weeks received a second injection. At 12 weeks, patients who remained symptomatic were offered surgery. Final assessment occurred at 6 months. The primary outcome was treatment success, defined as no need for a second injection or surgery during the study period. Secondary outcomes included PROMIS Upper Extremity, Green Classification of Trigger Finger, QuickDASH, and VAS pain scores. Results: There were no significant differences in the groups’ demographic characteristics, grade of trigger finger, or outcome scores at baseline ( P >0.05). At 6 months, treatment success did not differ between groups ( P =0.82). The dexamethasone group had more patients with full relief by Green grade at 6 weeks ( P =0.02); however, this was not reflected in patient-reported outcomes or pain scores. There were no significant differences in secondary outcome measures by 12 weeks ( P >0.05). Conclusions: There was no statistically significant difference in treatment success between treatment groups. Hand surgeons may confidently use their preferred corticosteroid formulation.