Efficacy of Low-Dose Versus High-Dose Corticosteroid Injections for Soft Tissue Pathology of the Hand.

PURPOSE: This retrospective study evaluated the efficacy of high- versus low-triamcinolone injection doses to guide dosing for injections used in hand soft tissue pathologies. We hypothesized that there would be difference in efficacy between high-dose injections (40 mg) and low-dose injections (5-10 mg) used for trigger finger, carpal tunnel syndrome, and de Quervain tenosynovitis. The study compared rate of disease resolution, need for secondary injection, and conversion to surgery between low-dose and high-dose injections.

METHODS

A retrospective chart review of patients from 2020 to 2023 included all patients who received a triamcinolone injection for trigger finger, carpal tunnel syndrome, de Quervain tenosynovitis. Patients were divided into high-dose (40 mg) and low-dose injection (5-10 mg) cohorts. The primary outcome was symptom resolution; secondary outcomes of interest were duration of symptom after the injection, rate of second injection, and rate of conversion to surgery.

RESULTS

A total of 466 patients (649 injections) were included. Of 649 injections, 393 (61%) were given for trigger finger, 106 (17%) for carpal tunnel syndrome, and 139 (21%) for de Quervain tenosynovitis. High-dose injection had lower rates of repeat injection (18% vs 35%), lower conversion to surgery (12% vs 21%), fewer ongoing symptoms leading to return for follow-up (26% vs 46%), longer intervals between repeat injection (12.0 months vs 5.6 months), and longer estimated time to surgery (11.1 months vs 7.7 months) when compared with the low-dose group. No major complications were noted in either cohort.

CONCLUSIONS

High-dose triamcinolone injections outperformed low-dose injections across most metrics in this study including estimated time of relief, rate of repeat injection, and rate of surgery. Hand surgeons should consider the benefit of high-dose triamcinolone injections when deciding on a treatment modality for common hand conditions.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.