Prospective Study Of Flexor Tendon Stenosing Tenosynovitis Non-surgical Treatment

ABSTRACT Objective: To compare the results of trigger fingers treated with diclofenac emulgel (DE, for external use),steroid injection(SI) and steroid injection with splinting(SIS) and to analyze changes of ultrasonography of the flexor tendons in trigger finger. Method: 131 patients(176 digits) with I -III grade TF were divided randomly into DE, SI and SIS group and were followed up 7 to 13 months. 47 patients(53 digits) with I -III grade TF were studied with ultrasonography. Results: The total successful rate of DE, SI and SIS were ~.81%, 76.27% and 92.06% respectively. Significant difference was found in the latter. In DE group, the successful outcome for I -m grade were 77.78%,71.43% and 40% respectively; In SI group it was 86.67%, 85.19% and 52.94% respectively; In SLS group it was 100%,100% and 68.75% respectively. The severity of the symptoms represented a positive correlation to the duration of the disease. The successful rate of DE, SI, SLS group in recurrent patients were 33.33%,65.52% and 81.25% respectively with significant difference and in multiple-digit involvement patients it was 56.0%, 65.63% and 78.57% respectively with no significant difference. The success rate of thumb was inferior to those of the other fingers. The successful rate in patients with single-digit involvement was superior to that in patients with multiple-digit involvement. Obvious changes of the disease in ultrasonography were noted (type I and type II) and the two types represented no direct correlation to the severity of the symptoms. Conclusion: In most of the cases, it was effective to treat the disease with the three nonoperative methods and SIS was the best one. Patients with multiple-digit involvement did not respond as well as those with single-digit involvement. The success rate was dependent of the digit involved and the results of 4 thumb were inferior to those of the other fingers. To grade the severity of the symptoms is contributed to treat the disease. DE is suitable for the patients with grade I or with multiple-digit involvement. SI is suitable for the patients with grade 11 and grade III or the recurrent patients. Ultrasonography is able to confirm the clinical diagnosis of the disease. But further investigations should be made to determine if ultrasonography is useful for our selecting the treatments.