Injection of Hyaluronic Acid Versus Corticosteroid for Treatment of Trigger Finger

Study Overview
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Brief Summary
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The aim of the study is to compare the therapeutic effects of hyaluronic acid versus steroid injections in treating trigger fingers using ultrasound guidance

Detailed Description
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A prospective randomized controlled study designed to compare the outcomes of injecting patients with trigger finger with hyaluronic acid versus corticosteroid under ultrasound guidance

Official Title
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Ultrasound-Guided Injection of Hyaluronic Acid Versus Corticosteroid for Treatment of Trigger Finger: Randomized Controlled Study

Conditions
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Trigger Finger

Intervention / Treatment
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* Drug: hyaluronic acid (20 mg/2 mL)
* Drug: Triamcinolone acetonide 10mg/ml


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult (>18 years) Patients with a clinical diagnosis of trigger finger grade 1-3 on the Quinnell grading scale and confirmed diagnosis by ultrasound. Exclusion Criteria: Quinnell's classification grade IV (contracture) Prior injection within 6 months Prior operation of the affected finger Presence of any contracture in the proximal interphalangeal or metacarpophalangeal joint, and History of diabetes, hypothyroidism, and Rheumatic or connective tissue disease Allergy to triamcinolone or hyaluronic acid Pregnancy Secondary triggering e.g. Trauma, infection Trigger finger symptoms duration >6 months

Ages Eligible for Study
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Minimum Age: 19 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 |
| --- | --- |
| Experimental: Hyaluronic acid<br>1mL of hyaluronic acid (20 mg/2 mL; Hyalgan, Fidia, Abano Terme, Italy) infiltration at A1-Pulley under ultrasound guidance after subcutaneous 2% lidocaine without epinephrine infiltration of the skin overlying the A1-pulley. | Drug: hyaluronic acid (20 mg/2 mL)<br>* A1-Pulley infiltration for trigger finger<br>* Other names: Hyalgan 20 mg in 2 ML Prefilled Syringe;|
| Active Comparator: Triamcinolone acetonide<br>1 mL of Triamcinolone acetonide 10mg/ml infiltration at A1-Pulley under ultrasound guidance after subcutaneous 2% lidocaine without epinephrine infiltration of the skin overlying the A1 pulley. | Drug: Triamcinolone acetonide 10mg/ml<br>* A1-Pulley infiltration for trigger finger<br>* Other names: Kenalog 10 mg/ml;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Quinnell trigger finger grading system: | Change in Quinnell grading overtime within 3 months after injection. Trigger fingers are rated as follows: Grade 0: normal finger movements, Grade 1: uneven finger movements, Grade 2: actively correctable triggering, Grade 3: passively correctable triggering, and Grade 4: locked digit. | 1 and 3 months post-injection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analogue scale (VAS) of pain | Change in pain Visual analogue scale will be recorded. The patient marks on the 100 mm in length line the point that he/she feels to represent his/her perception of pain at the current state. The VAS score is determined by measuring in millimetres from the left hand end of the line to the point that the patient marks ( a higher score indicates greater pain intensity). Categorization of none, mild, moderate and severe pain will be also used (none = 0, mild = 1-4, moderate = 5-6, and severe = 7-10). | 1 and 3 months post-injection | 
| Frequency of tender trigger nodules | Identifying the presence of tender nodules at A1-pulley of the affected finger by palpation | 1 and 3 months post-injection | 
| The Quick Disability of the Arm, Shoulder and Hand score | Patients will be asked to fill a questionnaire form. It is an 11-item form that assesses the upper limb function on a scale of 1-5, with scores ranging from 11 to 55, with the higher scores representing more disability and worse upper limb function. | 1 and 3 months post-injection | 
| Changes in Grip strength | Measured by the dynamometer strength test (Jamar grip dynamometer) | 1 and 3 months post-injection | 
| Patient satisfaction with therapy | Participating patients will be asked to classify their result into 1 of 4 categories: (1) complete resolution of symptoms, (2) improved result, but incomplete resolution of symptoms, not warranting further treatment, (3) partial response, but unsatisfactory, warranting further treatment, and (4) no response. | 1 and 3 months post-injection | 
| Ultrasound evaluation of A1-Pulley | Detailed ultrasonography evaluation of A1-Pulley. Comparing the A1-Pulley ultrasonographic parameters over 3 months after injection (at the follow-up appointment) | 1 and 3 months post-injection | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Trigger finger, Hyaluronic Acid, Corticosteroid, Ultrasound-guided injection