Comparative effectiveness of corticosteroid injections for trigger finger: A systematic review of randomized controlled trials.

Abstract

Trigger finger is a common condition marked by painful catching or locking of a digit during motion. Although corticosteroid injections (CSIs) are widely used, there is limited consensus on the optimal corticosteroid type, dose, injection technique, or use of adjunctive therapies. This systematic review examined the effectiveness and safety of methylprednisolone and triamcinolone in achieving symptom remission. A systematic search was conducted across PubMed, Embase, and MEDLINE from inception to May 2024. Inclusion criteria focused on randomized controlled trials (RCTs) evaluating methylprednisolone or triamcinolone in adults with trigger finger. The primary outcome was symptom remission, defined as the resolution of triggering and functional impairment. Data extraction and risk-of-bias assessments were performed in duplicate using the Revised Cochrane Risk-of-Bias Tool. Thirteen RCTs, including 1116 patients (1153 digits), were analyzed. Methylprednisolone showed higher overall remission (83.6%) than triamcinolone (44.8%), with consistent efficacy across doses and techniques. Although higher doses of triamcinolone improved outcomes, a statistically significant dose-response relationship was not found. Injection technique (ultrasound-guided vs blind; intra-sheath vs extra-sheath) did not significantly influence outcomes. Secondary injections improved outcomes in partial responders. Adverse events occurred in 2.8% of triamcinolone patients (e.g., skin atrophy, steroid flare) and were not reported for methylprednisolone. Methylprednisolone appeared more effective and better tolerated than triamcinolone in trigger finger treatment. Injection technique and adjunctive therapies, such as splinting, had a limited impact on outcomes. Further research is needed to tailor treatment to individual patient characteristics. Systematic review Level I.