Ultrasound-Guided Versus Blind Corticosteroid Injection for Trigger Finger: A Systematic Review

Purpose Trigger finger is the most common functional hand condition, affecting 3% of the general population and up to 17% of patients with diabetes. Corticosteroid injection is first-line treatment after failed conservative management and may be administered blindly or under ultrasound guidance (USG); however, the comparative clinical benefit of USG remains unclear. Methods A systematic search was conducted across PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library from inception to April 23, 2026, with an updated search through August 20, 2026, per PRISMA 2020 guidelines. Studies reporting outcomes following USG or blind corticosteroid injection for trigger finger were eligible. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomized trials and the Joanna Briggs Institute Critical Appraisal Checklist for Case Series for single-arm observational studies. This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261378220). Because of substantial heterogeneity, a narrative synthesis was performed. Results Six studies met the inclusion criteria, published between 2009 and 2026, encompassing 226 patients across the three studies reporting patient-level data and 223 fingers/digits across the three studies reporting digit-level data; these denominators are not directly summable given their differing units, with a female predominance and a mean age of 45–55 years. Ultrasound-guided injection was associated with faster early symptom resolution and lower visual analog scale/ Quick DASH (Disabilities of the Arm, Shoulder, and Hand) scores in one study ( P < .05 at 1–4 weeks), with this advantage attenuating by 12–24 weeks. The higher-quality randomized controlled trial demonstrated no significant difference in resolution rates between USG and blind injection (91% vs 83%, P > .05), a finding not consistently confirmed across comparative studies. Recurrence and surgical conversion findings were similarly inconsistent, and safety profiles were comparable between techniques, with no infections or tendon ruptures reported. Conclusions Ultrasound-guided corticosteroid injection may offer modest early symptomatic benefit over blind injection in the treatment of trigger finger, but current evidence is limited by substantial risk of bias and does not support its routine use over blind injection as first-line therapy. Type of study/level of evidence Therapeutic IV.