Clinical Sciences/Health Conditions
Kyung Joon Mun, MD
Resident Physician
University of Toronto
Toronto, Ontario, Canada
Kevin R. Murray, MD
Resident Physician
University of Toronto
Toronto, Ontario, Canada
Jordan Farag, MD
Physiatrist, Assistant Professor
Toronto Rehabilitation Institute, University of Toronto
Toronto, Ontario, Canada
Nimish Mittal, MD, FRCPC (he/him/his)
Associate Professor
University of Toronto
Toronto, Ontario, Canada
Trigger finger (TF) is one of the most common causes of hand pain and disability. Corticosteroid injections (CSI) are an effective treatment, but several injection techniques have been described in the literature. The objective of this systematic review was to determine the impact of CSI technique on effectiveness and injection pain in adults with TF.
A systematic search was performed using EMBASE, PubMed, Scopus, and Web of Science databases from their inception to May 2025 for any randomized controlled trials that evaluated CSI for TF. The primary outcome of interest was treatment effectiveness (i.e. decrease or resolution in symptoms). The secondary outcome was injection pain. Quality appraisal was performed using the Cochrane Risk of Bias 2.0 tool.
The search yielded 1400 unique studies, of which 7 studies met all inclusion and exclusion criteria. All studies used different injectate solutions consisting of a corticosteroid and anesthetic. Three studies evaluated intra-sheath versus extra-sheath injections, two of which were performed under ultrasound guidance. The remaining four studies compared landmark-based proximal phalanx (2), mid-axial (1), or dorsal webspace (1) approaches to the conventional palmar technique. Overall, there were no statistically significant differences in effectiveness between comparison groups. There were statistically significant differences in injection pain favouring the landmark-based dorsal webspace, volar proximal phalanx and dorsal mid-axial techniques compared to the conventional palmar technique. Three studies were deemed to be low risk of bias while four studies were high risk of bias.
There is some evidence to suggest that there are no differences in effectiveness between the studied CSI techniques to treat TF. Some techniques may be useful for decreasing pain upon injection to increase tolerability. Additional research with standardized injection protocols and outcome measures are needed to directly compare different injection techniques and inform clinical practice.
