A Comparison Between Sonoguided Injection Corticosteroid and Hyaluronic Acid Injection in Treatment of Trigger Finger

Study Overview
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Brief Summary
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The study is to compare the effect between steroid injection and Hyaluronic acid in treatment trigger finger. Using sonoguided injection technique achieves more accurate injection location and therapeutic effect. We hypothesize hyaluronic acid has both lubricant and anti-inflammation effect in treatment of trigger finger, and can provide better outcome and lower adverse effect than steroid injection.

Detailed Description
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This is a prospective, randomized, double-blinded controlled study. Patients with the diagnosis of trigger finger will be recruited and enrolled from Taipei Veteran General Hospital PM&R outpatient clinic. Subjects will be randomized into two groups; hyaluronic acid and triamcinolone acetonide injections, both via ultrasound-guided with one injection only.We hypothesize that through the anti-inflammatory property of the hyaluronate acid, the treatment effects will be as effective as the traditionally used steroid injections with equal or even lower recurrence rate for treatment of trigger finger. We expect that injections of hyaluronate into tendon sheath could become a new treatment option for trigger finger.

Official Title
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Steroid Versus Hyaluronic Acid Ultrasound-guided Injection for Trigger Finger: A Comparative Study of Outcomes

Conditions
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Trigger Finger

Intervention / Treatment
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* Drug: triamcinolone acetonide
* Drug: Hyaluronic Acid


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients with trigger digits and patients without previous treatment of the trigger digit Exclusion Criteria: patients with prior treatment of the trigger digit (eg, splinting, injection, or therapy), patients less than 20 years old, patients with allergy or contraindication to hyaluronic acid, patients with trigger digits due to rheumatoid arthritis, and patients with infection at the site of injection.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: steroid<br>used ultrasound-guided inject 1c.c triamcinolone acetonide 10mg/mL (Shincort®, YSP, Taiwan)into the sheath of the flexor tendons, penetrated to the A1 pulley. One injection only | Drug: triamcinolone acetonide<br>* used ultrasound-guided inject 1c.c triamcinolone acetonide 10mg/mL (Shincort®, YSP, Taiwan)into the sheath of the flexor tendons, penetrated to the A1 pulley. One injection only Steroid<br>* Other names: triamcinolone acetonide 10mg/mL (Shincort®, YSP, Taiwan);|
| Experimental: Hyaluronic acid<br>used ultrasound-guided inject 1c.c Hyaluronic acid (Artz®, Seikagaku, Japan)into the sheath of the flexor tendons, penetrated to the A1 pulley. One injection only | Drug: Hyaluronic Acid<br>* used ultrasound-guided inject 1c.c Hyaluronic acid (Artz®, Seikagaku, Japan)into the sheath of the flexor tendons, penetrated to the A1 pulley. One injection only<br>* Other names: Hyaluronic acid (Artz®, Seikagaku, Japan);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quinnell classification | he Quinnell system grades trigger fingers as: 0 - normal movement - uneven movement - locking can be corrected with active motion - locking corrected with passive motion - unable to correct deformity | Pre-injection; 3-weeks and 3-months post-injections | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| hand functional evaluation | using the Michigan Hand Outcome Questionnaire (MHQ) | Pre-injection; 3-weeks and 3-months post-injections | 
| visual analog scale |  | Pre-injection; 3-weeks and 3-months post-injections | 
| total active motion (TAM) | Deﬁ ned as the total ROM achieved when all three joints-metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) of a digit are actively ﬂ exed or extended simultaneously, minus any extension deﬁ cit at any of the three joints | Pre-injection; 3-weeks and 3-months post-injections | 
| grip strength | dynamometer strength test (JAMAR grip) | Pre-injection; 3-weeks and 3-months post-injections | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hyaluronic acid, trigger finger