Effectivité et sécurité de l’injection à travers la peau dorsale dans le traitement du doigt et du pouce à ressaut: étude clinique prospective

Stenosing tenosynovitis of the fingers and thumb is one of the most common causes of hand pain and disability. Corticosteroid injection is the mainstay in initial management but the pain during the injection is an always-present side effect. The purpose of this study was to assess the effectiveness, safety and perceived pain during a subcutaneous corticosteroid injection for trigger finger and thumb performed through the dorsal skin. A total of 63 consecutive patients diagnosed of trigger finger or thumb were included in this study. They were 43 women and 20 men with a mean age of 61 years. A subcutaneous corticosteroid injection was performed through the dorsal web. In cases where triggering was not completely solved, a second injection was offered. Demographic data, DASH questionnaire, VAS for pain during the injection, success rate and complications were collected and analyzed. The mean DASH questionnaire was 48 points at diagnosis and 8.6 points at final follow-up. The mean VAS for pain during the injection was 3.84 and it was considered mild by most patients. Six patients were lost to follow-up. The success rate after a single injection was 31/57 (54.4 %). The overall success rate was 39/57 (68.4 %). The best result was achieved on the middle finger (19/22; 86 %), followed by the ring finger (10/12; 83 %). No complications were noted. No differences in the success rate between the diabetic and non-diabetic sample were found. The overall success rate of trigger fingers injections through the palmar skin has been reported between 47 % and 92 %. In our series, injecting subcutaneously through the dorsal skin, the overall success rate at final follow-up was 39/57 (68.4 %) what is consistent with the published data. The mean reported VAS for pain during a palmar injection has been reported to be 5.32 points. In our series, the perceived pain during the injection was 3.84 points. A prospective randomized study would be necessary to assess these differences. The subcutaneous corticosteroid injection through the dorsal web for trigger finger and thumb is safe and effective. It seems to be less painful than the reported scores for the palmar midline technique although it should be assessed in a prospective randomized study.