Date of Award

9-29-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Jonathan Grauer

Abstract

HYPOTHESIS: The purpose of this retrospective chart review was to quantify the effectiveness of steroid injections have in treating new trigger fingers in patients with a history of injection resistant trigger finger. METHODS: 43 study subjects were defined as those patients who presented with trigger finger, underwent at least one steroid injection followed by surgical release of the A1 pulley, and subsequently represented with another trigger finger in a distinct digit and compared to a group of 40 control subjects presenting with first trigger fingers. Demographic data, PMH, and treatments for trigger finger were recorded. Subjects were surveyed to assess any residual symptoms and level of satisfaction with injection treatment. The control and study groups were then compared by students T test for any statistically significant differences in measured outcomes. Decision Tree Analysis of cost for treatment of repeat trigger finger was employed using Precision Tree Software. RESULTS: The study group had higher proportion of injection resistant trigger finger than control group with 49% (21/43) of patients and 38% (35/91) of digits proceeding to surgery vs 23% (9/31) of patients and 22% (11/38) of digits in the control group (p values 0.01 and 0.05 respectively). There were no significant differences in number of injections before surgery or resolution of symptoms, the duration of symptoms before first injection or before surgery, patient satisfaction with injection treatment, or patient willingness for future injection treatment. 87% (26/30) study group digits had complete resolution of symptoms on survey vs 57% (16/39) digits in the control group (p value 0.011) with the most common side effect being stiffness. There were no significant differences in gender, age, and medical comorbidites between the two groups including diabetes. The study group had statistically significant higher incidence of carpal tunnel syndrome (p value 0.0001), Dupuytrens disease (p value 0.026) and occupational exposure (p value 0.012).The distribution of affected fingers differed with trigger thumbs being more prevalent in the control group (p value 0.0044). Precision Tree Software revealed that injection treatment was a cost efficient method of treating trigger digits in patients with previous injection resistant trigger finger. SUMMARY POINTS: Patients returning for with a new trigger finger after having required surgery for another finger can still respond to non operative treatment, specifically a steroid injection. It is our clinical recommendation that steroid injection treatment should be considered for initial or repeat presentation of trigger finger.

Comments

This is an Open Access Thesis.

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