From the Research
For trigger finger involving the proximal interphalangeal (PIP) joint, the recommended steroid dose is 20 mg of triamcinolone acetonide, as it has been shown to have a significantly higher success rate compared to lower doses. This recommendation is based on the most recent and highest quality study available, which compared the efficacy of different dosages of triamcinolone acetonide for the treatment of trigger finger 1. The study found that at 6-month follow-up, injections were still effective in 79% of the 20-mg group, compared to 62% of the 10-mg group and 52% of the 5-mg group.
Key Considerations
- The injection should be delivered into the flexor tendon sheath at the level of the A1 pulley, which is located at the palmar crease of the metacarpophalangeal joint, even though the symptoms are manifesting at the PIP joint.
- The needle should be inserted at approximately a 30-45 degree angle, and the medication should be injected slowly to avoid excessive pressure.
- Patients should be advised that they may experience temporary pain at the injection site and that full therapeutic effect may take 1-2 weeks to develop.
- If symptoms persist after 4-6 weeks, a second injection may be considered, though it's generally recommended to limit steroid injections to no more than three per digit due to potential side effects including tendon weakening, skin atrophy, and depigmentation.
Supporting Evidence
- A randomized controlled trial published in 2024 found that a 20-mg dose of triamcinolone acetonide had a significantly higher success rate at 6-month follow-up compared to 5-mg and 10-mg doses 1.
- Another study published in 2018 also found a dose-related pattern in the treatment of trigger finger with triamcinolone acetonide, with the 20-mg group having a significant higher success rate at 3 and 6 months compared to the 5-mg and 10-mg groups 2.
- A study published in 2021 found that corticosteroid injections with or without local anesthetic were effective in treating trigger finger, but the use of local anesthetic was associated with more injection-related pain 3.