Tamara D Rozental1, David Zurakowski, Philip E Blazar. 1. Harvard Medical School, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA. trozenta@bidmc.harvard.edu
Abstract
BACKGROUND: Corticosteroid injections are commonly used in the treatment of flexor tenosynovitis in adults. The present study was performed in an attempt to identify prognostic indicators of symptom recurrence one year after corticosteroid injection for the treatment of trigger digits. METHODS: One hundred and thirty consecutive patients with trigger digits treated with corticosteroid injection were prospectively enrolled. Exclusion criteria were prior treatment and inflammatory arthritis. Demographic data and information on existing comorbidities were identified with a questionnaire. Patients were contacted at one year after treatment to determine symptom recurrence. Kaplan-Meier analysis and the Cox regression model were used to estimate recurrence rates and identify predictors. RESULTS: One hundred and twenty-four trigger digits in 119 patients (average age, 62.3 years) were included. The most commonly involved digits were the thumb (35% of the digits), ring finger (31%), and long finger (23%). Seventy digits (56%) had a recurrence of symptoms at a median of 5.6 months (range, 0.5 to 13.1 months) after the injection. Twenty-two digits (18%) underwent surgical release at a median of 7.4 months after the injection. According to the Kaplan-Meier analysis, the estimated rate of freedom from symptom recurrence was 70% (95% confidence interval, 63% to 77%) at six months and 45% (95% confidence interval, 36% to 54%) at twelve months and the estimated rate of freedom from surgical release was 95% (95% confidence interval, 92% to 98%) at six months and 83% (95% confidence interval, 77% to 89%) at twelve months. Insulin-dependent diabetes mellitus was identified as a strong predictor of symptom recurrence (p < 0.01). Younger age (p < 0.01), involvement of other digits prior to presentation (p < 0.01), and a history of other tendinopathies of the upper extremity (p = 0.02) were all independent predictors of a surgical release. The duration and severity of symptoms were not predictive of poor outcomes following injections. CONCLUSIONS: At one year following injection, 56% of the digits had a recurrence of symptoms. Younger age, insulin-dependent diabetes mellitus, involvement of multiple digits, and a history of other tendinopathies of the upper extremity were associated with a higher rate of treatment failure. Symptoms often recurred several months after the injection.
BACKGROUND: Corticosteroid injections are commonly used in the treatment of flexor tenosynovitis in adults. The present study was performed in an attempt to identify prognostic indicators of symptom recurrence one year after corticosteroid injection for the treatment of trigger digits. METHODS: One hundred and thirty consecutive patients with trigger digits treated with corticosteroid injection were prospectively enrolled. Exclusion criteria were prior treatment and inflammatory arthritis. Demographic data and information on existing comorbidities were identified with a questionnaire. Patients were contacted at one year after treatment to determine symptom recurrence. Kaplan-Meier analysis and the Cox regression model were used to estimate recurrence rates and identify predictors. RESULTS: One hundred and twenty-four trigger digits in 119 patients (average age, 62.3 years) were included. The most commonly involved digits were the thumb (35% of the digits), ring finger (31%), and long finger (23%). Seventy digits (56%) had a recurrence of symptoms at a median of 5.6 months (range, 0.5 to 13.1 months) after the injection. Twenty-two digits (18%) underwent surgical release at a median of 7.4 months after the injection. According to the Kaplan-Meier analysis, the estimated rate of freedom from symptom recurrence was 70% (95% confidence interval, 63% to 77%) at six months and 45% (95% confidence interval, 36% to 54%) at twelve months and the estimated rate of freedom from surgical release was 95% (95% confidence interval, 92% to 98%) at six months and 83% (95% confidence interval, 77% to 89%) at twelve months. Insulin-dependent diabetes mellitus was identified as a strong predictor of symptom recurrence (p < 0.01). Younger age (p < 0.01), involvement of other digits prior to presentation (p < 0.01), and a history of other tendinopathies of the upper extremity (p = 0.02) were all independent predictors of a surgical release. The duration and severity of symptoms were not predictive of poor outcomes following injections. CONCLUSIONS: At one year following injection, 56% of the digits had a recurrence of symptoms. Younger age, insulin-dependent diabetes mellitus, involvement of multiple digits, and a history of other tendinopathies of the upper extremity were associated with a higher rate of treatment failure. Symptoms often recurred several months after the injection.