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Assessing Injection Techniques in the Treatment of Trigger Finger

Trigger finger, also known as stenosing tenosynovitis or stenosing tendovaginitis, is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon. It occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. And if the trigger finger is severe, the finger may become locked in a bent position. Commonly, IT is difficult to straighten out without pulling on it by the other hand.

Based on research, it has been found that it can be treated by non-surgical management, such as activity modification, non-steroidal anti-inflammatory medications, and corticosteroid injection. Due to corticosteroid injection can be delivered via two techniques: palmar and midaxial approaches, the authors in this paper compared the accuracy of these two approaches for delivery of corticosteroids into the flexor tendon sheath in a cadaver model.

In the experiment, a total of 50 injections were performed, 25 via midaxial technique and 25 via palmar technique. A one inch, 25-gauge needle was used to inject 1 mL of Isovue contrast dye into the flexor tendon sheath under live fluoroscopy. The fluoroscopic images were examined after injection to determine intrasheath versus extrasheath delivery of the dye, with visualization of contrast filling the sheath defining a successful injection. After experiment, the authors analyzed and discussed the findings. The findings showed that the midaxial approach had a success rate of 52% compared to the conventional palmar approach success rate of 36%, p = 0.5. The ring finger was the most common location of trigger finger and the rates of success were equal between groups for this digit (80%).

In conclusions: based on the research findings, there was no statistical difference in the accuracy of intrasheath injection between the midaxial technique and palmar technique. The midaxial technique could be considered as an alternative to the palmar technique for trigger finger injection.

Article by John R. Fowler, et al, from USA.

Full access: http://mrw.so/2PX21R   

Image by epiclectic, from Flickr-cc.

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