Comparative Efficacy of Triamcinolone versus Dexamethasone in Local Injection for Stenosing Tenosynovitis of the Metacarpophalangeal Joint: A Retrospective Cohort Study.

BACKGROUND

Local glucocorticoid injection is first-line therapy for stenosing tenosynovitis. However, the comparative efficacy of lipophilic sustained-release triamcinolone versus hydrophilic short-acting dexamethasone remains underexplored. This study aimed to compare clinical outcomes of triamcinolone versus dexamethasone in metacarpophalangeal joint injection, with hypothesis-generating exploration of how differential pharmacokinetics may influence efficacy and recurrence.

METHODS

This retrospective cohort study included adult patients receiving first-time local injection for stenosing tenosynovitis ranging from February 2021 to January 2025. Patients were divided into triamcinolone (10-20 mg + lidocaine) and dexamethasone (4 mg + lidocaine) groups. Propensity score matching (1:1) controlled for confounding. The primary outcome was 3-month overall efficacy (Quinnell grade I). Secondary outcomes included recurrence, second injection rate, surgical conversion, and local adverse events.

RESULTS

After matching 97 patients per group, baseline characteristics were balanced. At 3 months, triamcinolone demonstrated superior efficacy (82.5% vs 63.9%, P=0.004). Triamcinolone also showed lower 6-month recurrence (12.5% vs 27.4%, P=0.009), second injection rate (8.2% vs 19.6%, P=0.021), and surgical conversion (4.1% vs 13.4%, P=0.024). Fat atrophy was numerically higher with triamcinolone (9.3% vs 3.1%, P=0.072). We hypothesize that the sustained-release depot effect of triamcinolone may enable prolonged modulation of the inflamed A1 pulley microenvironment, though this mechanistic interpretation requires prospective validation.

CONCLUSION

In this retrospective matched cohort, triamcinolone was associated with superior 3-month efficacy and lower recurrence compared to dexamethasone. These findings are hypothesis-generating and warrant prospective dose-controlled confirmation.