Efficacy of sonographically guided intra-flexoral sheath corticosteroid injection in the treatment of trigger thumb

Objective: The aim of this study was to determine the efficacy of sonographically guided intra-flexoral sheath corticosteroid injection in the treatment of trigger thumb.Methods: This study included 112 trigger thumbs of 104 patients (7 males, 97 females; mean age: 52.11 years) studied prospectively from 2009 to 2011. All patients experienced pain, tenderness, discomfort and/or triggering with flexion/extension of the thumb and palpable nodules at the level of the A1 pulley. Ultrasonographically guided corticosteroid injection was performed on all affected thumbs.Thumb improvement was evaluated using the Quinnell grading system and patients were followed up for one year.Results: All 112 thumbs received one ultrasonographically guided corticosteroid injection. Fifteen thumbs (13.4%) needed re-injection and/or surgery during their one year follow-up. Eight (53.3%) of these 15 cases, had a pre-treatment Quinnell Grade of 4, six (40%) thumbs were Grade 3 and one (6.7%) was Grade 2. Twelve were re-injected, two underwent surgery without re-injection and one underwent surgery after showing no improvement following re-injection. There was a significant reduction in the post-injection Quinnell grade (p 0.0001). One year after the initial injection, 108 thumbs (96.4%) were completely symptom-free.Conclusion: Sonographically guided intra-flexoral sheath corticosteroid injection is an effective method in the treatment of trigger thumb and reduces the need for surgery.