Injections for Back Pain ReliefBy continuing to browse this site you agree to us using cookies as described in About Cookies. To review the benefits and safety of oxymetholone vs oxandrolone anti-inflammatory drugs NSAIDs for trigger finger. We will compare the effectiveness of topical, oral and injectable NSAIDs with placebo or corticosteroid. Trigger finger is a common condition that occurs when the gliding movement of an inflamed and swollen flexor tendon is obstructed by the narrowed osteofibrous non steroidal injections of the first annular A1 pulley, resulting in pain, clicking, catching, and loss of motion injectionz the innections non steroidal injections Choudhury The A1 pulley is located at the metacarpal phalangeal MCP joint.
Steroid Injection and Nonsteroidal Anti-inflammatory Agents for Shoulder Pain
By continuing to browse this site you agree to us using cookies as described in About Cookies. To review the benefits and safety of non-steroidal anti-inflammatory drugs NSAIDs for trigger finger. We will compare the effectiveness of topical, oral and injectable NSAIDs with placebo or corticosteroid.
Trigger finger is a common condition that occurs when the gliding movement of an inflamed and swollen flexor tendon is obstructed by the narrowed osteofibrous canal of the first annular A1 pulley, resulting in pain, clicking, catching, and loss of motion of the affected finger Choudhury The A1 pulley is located at the metacarpal phalangeal MCP joint.
It is a common hand condition with a prevalence of 2. Trigger finger is found more commonly in women than in men, and affects people in their 5th and 6th decade Choudhury Trigger finger occurs at different levels of severity. The most characteristic complain of trigger finger is the locking of a finger in a flexed position and a subsequent difficulty in achieving a full extension Choudhury However, it can eventually be released with a snap or has to be forced open passively. In milder cases, patients may have uneven finger movements, or experience discomfort and stiffness in moving the digits, particularly after periods of rest.
In more severe cases, patients experience fixed deformity. Quinnell used a five-point grading system to assess the severity of the trigger finger: Grade 0 — mild crepitus in the non-triggering finger, Grade 1 — no triggering, uneven movement, Grade 2 — triggering is actively correctable, Grade 3 — usually correctable by the other hand, Grade 4 — the digit is looked. The first line of treatment for trigger finger is conservative management, which involves activity modification, non-steroidal anti-inflammatory drugs NSAIDs topical and oral and splinting Patel People with mild trigger finger or who have declined injections and surgery are prescribed the first-line treatment.
If the first line of treatment is ineffective, or in severe trigger finger grades 3 or 4 , patients will be prescribed corticosteroid injection or surgery. A Cochrane Review has summarised the efficacy of corticosteroid injections for trigger finger Peters-Veluthamaningal , and a Cochrane Review of surgery for trigger finger is in progress Ventin Corticosteroid injection is used to treat trigger finger by reducing inflammation.
The injection is given locally at the affected A1 pulley via the palmar or lateral approaches, to infiltrate the flexor tendon sheath. It is hypothesised that the use of NSAIDs injection such as diclofenac sodium can be an effective alternative to corticosteroids, as both drugs serve to reduce inflammation by counteracting the effects of prostaglandins. Corticosteroids have a larger immunosuppressive effect compared with NSAIDs, as they work at the hormonal level and suppress the inflammatory process through numerous pathways Barnes NSAIDs will be especially relevant in situations where corticosteroids are contraindicated.
Adverse effects that have been reported with the use of NSAIDs include alterations in renal function, effects on blood pressure, hepatic injury and platelet inhibition which may result in increased bleeding Ong A review of 16 studies found that NSAID users had approximately a three times greater relative risk of developing serious gastrointestinal events Gabriel NSAIDs are subdivided into 2 classes, i.
Some examples are ibuprofen, ketoprofen, naproxen, indomethacin and diclofenac. COX-2 drugs inhibit COXdependent prostanoids in cells such as macrophages, leukocytes and fibroblasts. Some examples are celecoxib, etoricoxib, meloxicam and paracoxib Waller However, other oral NSAIDs can be used clinically and include ibuprofen, naproxen, celecoxib and etoricoxib.
Few studies have reported the use of NSAID injection for trigger finger; one study reported the use of diclofenac injection Shakeel Topical and oral NSAIDs combined with hand therapy and splinting is commonly used for conservative treatment Ryzewicz We are also currently conducting a prospective study to evaluate the effectiveness and one-year recurrence rate with NSAIDs injection ketorolac compared to corticosteroid injection for people with trigger finger.
Trigger finger is one of the most common hand problems. In people where the first line of treatment has failed, or in more severe trigger finger, corticosteroid injection is prescribed. However treatment may fail, resulting in recurrence of pain, and mechanical and inflammatory symptoms.
In addition, possible risks of injection include increased risks of infection, tendon rupture and attenuation, deranged blood glucose levels especially among people with diabetes , hypopigmentation of the skin and immunosuppression Baumgarten Hence, corticosteroid injections are less suitable for people with uncontrolled diabetes or who are on immune-suppressing drugs.
When corticosteroid injections have failed, patients have to proceed to surgery. Surgery is an effective treatment for trigger finger, but it is invasive, time-consuming and expensive. NSAID injection could be an alternative to corticosteroid injection. Our review will summarise the available evidence on the effectiveness, safety, and benefits of topical, oral, and injectable NSAIDs, and will evaluate its effectiveness as an alternative to corticosteroid.
We will include randomised controlled trials RCTs or quasi-randomised trials. Quasi-random methods of assignment to interventions are systematic methods that are not truly random, such as allocation by date of birth, hospital record number, or alternation.
We will include studies reported as full text, those published as abstract only, and unpublished data. For published abstracts, one of our review authors will contact the authors to obtain full data for the study. There will be no language restriction. We will include studies involving adults older than 18 years with a clinical diagnosis of trigger finger triggering with or without locking of a finger or pain at the A1 pulley , irrespective of the duration of symptoms.
We will exclude studies of trigger finger of infectious origin. We will not include any other drug comparators. Comparisons will be by the same delivery route, i. Functional status of the hand can be measured using Quinnell's grading or by validated instruments such as the Disability of the Arm Shoulder and Hand questionnaire DASH.
However, we will not limit the review to these measures. We will extract outcome data at 4 weeks, 12 weeks, 24 weeks, 38 weeks, and 52 weeks. For recurrence after treatment, long-term follow up is used to monitor the outcomes of the treatment. These are common time points used to assess treatment outcomes for trigger finger. Resolution of trigger finger: Recurrence of trigger finger: Severity of trigger finger at each time point, using functional measures such as Quinnell grading or DASH score;.
Range of motion of the finger after treatment range of motion of the joints, which is an objective measure of trigger finger resolution, especially in the case of extensor lag.
Severity of pain or tenderness at the base of the digit on the palm of the hand assessed using visual analogue scale VAS or any other pain scales ;. Participant assessment of treatment success: Adverse effects of the treatment: We will also conduct a search of www. We will impose no restriction on language of publication. We will adapt this search strategy and language as appropriate for the other electronic databases. We will check reference lists of all primary studies and review articles for additional references.
When necessary, we will also contact other researchers and experts in the field for information on additional trials, including unpublished or ongoing studies. We will identify and exclude duplicates, and collate multiple reports of the same study, so that each study, rather than each report, is the unit of interest in the review.
We will use a standard predefined data collection form for extraction of data from the study reports.
Two review authors ML and QZ will extract study characteristics from included studies, including:. N, mean age, age range, sex, disease duration, severity of condition, diagnostic criteria, medical history of participants; inclusion criteria, and exclusion criteria. Effectiveness of the study drug can be measured using severity of the trigger finger e.
Quinnell's grading or functional outcomes e. If more than one outcome measure is reported in the study, we will preferentially extract severity of the trigger finger. Other measures of severity of trigger finger include Green's classification Green Major outcomes specified and collected i. For function, we will prefer the Quinnell grading, as it is more specific for measuring severity of trigger finger compared with the DASH score.
We will extract data from the baseline values, and at every time point. We will report the change in scores over every time point in individual tables. We will base data extraction on intention-to-treat samples. We prefer ITT data, as it is a conservative. Unless most of the RCTs reported adjusted values, we will extract unadjusted values, even if the RCTs report both versions. Data collection time point: The time points of interest are baseline, 4 weeks, 12 weeks, 24 weeks, 38 weeks, and 52 weeks.
If the time points in the study fall outside these data collection points, we will extract the data closest to these specified time points. We will note in the 'Characteristics of included studies' table if outcome data were not reported in a usable way, and when data were transformed or estimated from a graph.
We will resolve disagreements by consensus or by involving a third person. We will resolve any disagreements by discussion or by involving another review author LS. We will assess the risk of bias according to the following domains:. Blinding of outcome assessment we will assess this separately for objective outcomes resolution of trigger finger, recurrence of trigger finger, range of motion of the finger, and adverse effects and self-reported subjective outcomes severity of pain or tenderness, functional outcome, participant assessment of treatment success ;.
Other potential bias, such as major baseline imbalance, and risk of bias associated with delivery of intervention. We will grade each potential source of bias as high, low or unclear risk, and provide a quote from the study report together with a justification for our judgement in the 'Risk of bias' table. The review authors will resolved any disagreements by discussion. We will summarise the 'Risk of bias' judgements across different studies for each of the domains listed. Where information on risk of bias relates to unpublished data or correspondence with a trialist, we will note this in the 'Risk of bias' table.
We will enter data presented as a scale with a consistent direction of effect across studies. When different scales are used to measure the same conceptual outcome e. We will back-translate SMDs to a typical scale e.