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Experience from a 'one-stop' trigger finger clinic : a report of outcomes following corticosteroid injection

Divecha, Hiren M and Clarke, Jon and Coyle, Angela and Barnes, Steven (2012) Experience from a 'one-stop' trigger finger clinic : a report of outcomes following corticosteroid injection. The Internet Journal of Hand Surgery, 3 (2). ISSN 1937-8203

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Abstract

Background:Steroid injections can be used safely to treat trigger fingers. We aimed to determine the accuracy of referring General Practitioner (GP) diagnoses of trigger finger made to an upper limb surgeon. We also aimed to determine the efficacy of a serial two steroid injection then surgery technique in the management of trigger fingers. Methods:Data was collected prospectively from a “one-stop” trigger finger clinic (based in a district general hospital). 200 trigger fingers identified from September 2005 to November 2008, giving a minimum 1 year follow-up. Data was analysed for correct referring diagnosis, resolution/ recurrence rate following injection and the effect of age, injector grade, diabetes on the rate of recurrence. Results: GP diagnoses were correct in 94% of referrals. Recurrence free resolution after one steroid injection was achieved in 74% of cases, rising to 84% after a second injection. The grade of injector did not influence the rate of resolution (p=0.967) or recurrence (p=0.818). Age was the only statistically significant factor, with recurrences being 8.3 years younger (95% CI 4.1 – 12.6yrs; p=0.0002). 15% required surgical release after failure of two steroid injections. Conclusions: Steroid injection for trigger finger is a safe, easily performed technique that can give recurrence free resolution in up to 84% using a serial two steroid injection technique. This is an easily acquired technique that has obvious potential to be performed in the primary care setting, thus reducing the burden on hospital based specialist upper limb services, as only 15% required surgical intervention.