Ding-Hao Liu1, Mei-Wun Tsai2, Shan-Hui Lin3, Chen-Liang Chou4, Jan-Wei Chiu3, Chao-Ching Chiang5, Chung-Lan Kao6. 1. Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. 2. Institute of Physical Therapy and Assistive Technology, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan. 3. Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan. 4. Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 5. Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 6. Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan; Institute of Physical Therapy and Assistive Technology, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: clkao@vghtpe.gov.tw.
Abstract
OBJECTIVES: To investigate the effects of ultrasound-guided injections of hyaluronic acid (HA) versus steroid for trigger fingers in adults. DESIGN: Prospective, double-blinded, randomized controlled study. SETTING: Tertiary care center. PARTICIPANTS: Subjects with a diagnosis of trigger finger (N=36; 39 affected digits) received treatment and were evaluated. INTERVENTIONS: Subjects were randomly assigned to HA and steroid injection groups. Both study medications were injected separately via ultrasound guidance with 1 injection. MAIN OUTCOME MEASURES: The classification of trigger grading, pain, functional disability, and patient satisfaction were evaluated before the injection and 3 weeks and 3 months after the injection. RESULTS: At 3 months, 12 patients (66.7%) in the HA group and 17 patients (89.5%) in the steroid group exhibited no triggering of the affected fingers (P=.124). The treatment results at 3 weeks and 3 months showed similar changes in the Quinnell scale (P=.057 and .931, respectively). A statistically significant interaction effect between group and time was found for visual analog scale (VAS) and Michigan Hand Outcome Questionnaire (MHQ) evaluation (P<.05). The steroid group had a lower VAS at 3 months after injection (steroid 0.5±1.1 vs HA 2.7±2.4; P<.001). The HA group demonstrated continuing significant improvement in MHQ at 3 months (change from 3wk: steroid -2.6±14.1 vs HA 19.1±37.0; P=.023; d=.78). CONCLUSIONS: Ultrasound-guided injection of HA demonstrated promising results for the treatment of trigger fingers. The optimal frequency, dosage, and molecular weight of HA injections for trigger fingers deserve further investigation for future clinical applications.
RCT Entities:
OBJECTIVES: To investigate the effects of ultrasound-guided injections of hyaluronic acid (HA) versus steroid for trigger fingers in adults. DESIGN: Prospective, double-blinded, randomized controlled study. SETTING: Tertiary care center. PARTICIPANTS: Subjects with a diagnosis of trigger finger (N=36; 39 affected digits) received treatment and were evaluated. INTERVENTIONS: Subjects were randomly assigned to HA and steroid injection groups. Both study medications were injected separately via ultrasound guidance with 1 injection. MAIN OUTCOME MEASURES: The classification of trigger grading, pain, functional disability, and patient satisfaction were evaluated before the injection and 3 weeks and 3 months after the injection. RESULTS: At 3 months, 12 patients (66.7%) in the HA group and 17 patients (89.5%) in the steroid group exhibited no triggering of the affected fingers (P=.124). The treatment results at 3 weeks and 3 months showed similar changes in the Quinnell scale (P=.057 and .931, respectively). A statistically significant interaction effect between group and time was found for visual analog scale (VAS) and Michigan Hand Outcome Questionnaire (MHQ) evaluation (P<.05). The steroid group had a lower VAS at 3 months after injection (steroid 0.5±1.1 vs HA 2.7±2.4; P<.001). The HA group demonstrated continuing significant improvement in MHQ at 3 months (change from 3wk: steroid -2.6±14.1 vs HA 19.1±37.0; P=.023; d=.78). CONCLUSIONS: Ultrasound-guided injection of HA demonstrated promising results for the treatment of trigger fingers. The optimal frequency, dosage, and molecular weight of HA injections for trigger fingers deserve further investigation for future clinical applications.
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