Transtendinous corticosteroid with contrast injection in trigger finger: a radiological and clinical study

INTRODUCTION: The aim of this study was to evaluate the distribution of a corticosteroid solution following transtendinous injection at the level of the proximal phalanx. Secondary aims were to explore the patient reported outcomes and analgesic use day-by-day for 6 weeks. METHODS: Twenty trigger digits in 19 patients were injected with a mixture of corticosteroid and radiopaque contrast using a standardized transtendinous technique. Frontal and lateral radiographs obtained immediately after injection were independently assessed by three observers to classify the spread of the solution as intra-sheath, mixed intra-and extra-sheath, or solely extra-sheath. RESULTS: All 20 digits demonstrated intra-sheath spread of the solution. Thirteen digits showed mixed intra- and extra-sheath distribution, and seven digits demonstrated isolated intra-sheath spread. In eight digits, the solution extended throughout the entire tendon sheath from the palm to the level of the distal phalanx. No cases of isolated extra-sheath injection were observed. Fourteen digits reported total relief of symptoms within 6 weeks. Median number of days to total symptom alleviation was 7 for pain, 8 for triggering and 9 for stiffness. The use of analgesics was low, and 11 patients took none. CONCLUSION: Transtendinous injection at the level of the proximal phalanx provides reliable deposition of corticosteroid within the tendon sheath, supporting its use as an acceptable technique for treating trigger finger. LEVEL OF EVIDENCE: III prospective cohort study.