Efficacy of steroid injection versus physiotherapy treatment in work related trigger finger

Abstract

Stenosing tenosynovitis or trigger finger is a common problem among patients seeking treatment in the orthopaedic clinic. Trigger finger is characterized by locking or painful snapping when flexing the finger. Multiple approaches can be used to treat a patient with trigger finger. It can be divided into two major groups, either conservative or operative treatment. Conservative treatment varies in modalities. It includes non-steroidal anti-inflammatory drugs, ice packing, extension splint, physiotherapy, or corticosteroid injection. Operative treatment release the annular A1 pulley percutaneously or open. This study to compare the functional outcome of steroid injection versus physiotherapy between service and professional workers. We use observational cohort study. Evaluating the functional outcome of treatment physiotherapy and steroid injection among professional and service workers for trigger finger grade I, II, and III. We also assess the recurrence of the affected finger. Malaysia Standard Classification of Occupation 2013 (MASCO) has been used to classify 2 working groups: professional and service worker. Michigan Hand Outcomes Questionnaire (MHQ) used for the finger assessment. Patient was observed with 3 separated visits; pre-treatment visits, 6 months and 12 months. Patient was divided into two group of steroid injection and physiotherapy for evaluation of functional outcome and recurrence. The total number of patients recruited is 149 with 75 in the professional group and 74 in the service & sales group. Out of the 149 patients, 80 were treated with physiotherapy and 69 were with steroid injection. There was no association between the occupation and the grading of trigger finger and the affected finger itself. Functional outcome using MHQ score for steroid group shows a good 12 months outcome (P values <0.01) comparing with physiotherapy group. Functional outcome in terms of physiotherapy was lower compared to steroid injection at 6 months and 12 months. The recurrence rate in physiotherapy was higher than in the steroid injection group. Single steroid injection had better functional outcome after 6 months and 12 months post intervention compared with physiotherapy. Physiotherapy treatment can be suggested to patients with grade 1, 2, and 3 of trigger finger who refused any steroid injection.