From the Research
I strongly advise against proceeding with the scheduled steroid injection for the patient's trigger thumb symptoms due to the potential risk of tendon rupture, as highlighted in the study by 1. The patient presents with symptoms consistent with steganosis of the flexor pollicis longus tendon, causing a jumping sensation at the distal interphalangeal (DIP) joint of the right thumb, though without complete locking. While the pain has diminished since March, the mechanical symptoms persist. Considering the potential risks associated with steroid injections, such as tendon rupture, as reported in the study by 1, alternative treatment options should be explored. A study published in 2023 by 2 found that splinting alone is recommended as the initial treatment for adults with trigger finger, as there were no clinically important differences between splinting alone and steroid injection alone in terms of pain reduction and symptom or functional improvement up to 1 year. Additionally, the study by 3 suggests that a lower dose of triamcinolone acetonide (20mg) may be more effective in reducing symptoms, but the risk of tendon rupture still exists. The patient has been appropriately counseled on the risks and benefits of the injection, and the two-week waiting period is reasonable to see if symptoms resolve spontaneously. However, given the potential risks, I recommend exploring alternative treatment options, such as splinting, before proceeding with the steroid injection, as supported by the study by 2. If the symptoms persist, surgical release of the A1 pulley may be considered as a definitive treatment option, as described in the study by 4.