Abstract
Abstract
Introduction
Corticosteroid injections are widely used as first-line treatment for trigger finger, but their comparative efficacy against other non-surgical and surgical interventions remains unclear. While previous meta-analyses have explored this topic, many were limited by a narrow scope or methodological constraints. This systematic review and meta-analysis aims to comprehensively evaluate the effectiveness and safety of corticosteroid injections in adult trigger finger management compared with alternative treatment modalities, using robust methodology and updated evidence to guide clinical decision-making.
Methods and analysis
A systematic search will be conducted to identify the articles published on PubMed, Embase, Scopus and the Cochrane Library. All randomised controlled trials that compared (1) corticosteroid injection with alternative non-surgical modalities and (2) corticosteroid injection with surgical intervention in adults diagnosed with trigger finger will be included for the review. Two reviewers will independently perform the processes of study inclusion, data extraction and quality assessment. The primary outcome will be assessed by improvement in triggering and pain symptoms. Secondary outcomes will be assessed through safety assessment. The risk of bias and meta-analysis will be conducted using by RevMan V.5.4.
Ethics and dissemination
Ethical approval is not required for this study as it is a review based on published studies. The results will be disseminated through peer-reviewed publications and conference presentations. The findings of this systematic review and meta-analysis results are expected to provide valuable information for clinicians to choose an optimal strategy for the management of trigger finger.
PROSPERO registration number
CRD42024547312.
Keywords: Hand & wrist, Musculoskeletal disorders, Adult orthopaedics
STRENGTHS AND LIMITATIONS OF THIS STUDY.
Rigorous Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be applied.
A broad search across four major databases maximises completeness of evidence retrieval.
Only randomised controlled trials in adult populations are included, which strengthens internal validity but excludes paediatric evidence.
The overall certainty of findings may be constrained by the quality of individual studies.
INTRODUCTION
Trigger finger is a common hand condition characterised by painful clicking or locking of a digit during flexion and extension movement. It is also known as stenosing tenosynovitis. The condition arises when the gliding motion of the flexor tendon is impeded by inflammation and swelling at the first annular (A1) pulley, leading to narrowing of the osteofibrous canal.1 In more advanced stages, affected individuals may have a fixed flexion deformity or require passive force to extend the finger. The prevalence of trigger finger is estimated at approximately 2.6%,2 with a higher incidence observed in women, mainly in the fifth to sixth decades of life.1 The condition is more frequently associated with diabetes mellitus and rheumatoid arthritis, where the prevalence ranges between 5% and 36%.3 4 Emerging evidence suggests that long-term statin use may be associated with trigger finger, potentially due to drug-induced changes in tendon collagen metabolism.5 Early symptoms may include stiffness, discomfort or uneven finger movement, particularly after rest, while more severe forms may lead to persistent locking or loss of range of motion, impacting day today function and hence affecting quality of life.
Various treatment options are available for trigger finger, ranging from non-surgical to surgical modalities. Non-surgical treatments include steroid injections, non-steroidal anti-inflammatory drug injections, hyaluronic acid injections, platelet-rich plasma (PRP) injection, physiotherapy, splinting and extracorporeal shock wave therapy. Surgical treatments involve percutaneous or open A1 pulley release. Among these, steroid injections are widely adopted as a first-line therapy due to their minimally invasive nature and generally favourable outcomes.6 However, the comparative efficacy of steroid injections versus other non-surgical modalities or surgical treatments remains uncertain.
Previous systematic reviews have attempted to evaluate treatment efficacy, but limitations persist. Ma et al broadly compared steroid injections with surgical and non-surgical interventions without adequately distinguishing among individual treatments.7 Fiorini et al examined specific treatment comparisons but did not compare with other non-surgical treatments, and in surgical comparison, it remains uncertain whether the efficacy of one treatment is better than another.8 Shen et al presented more granular comparisons over varying follow-up intervals. However, the limited number of included studies reduced the robustness of their conclusions.9 Thus, uncertainty remains regarding the relative effectiveness of various treatments for trigger finger.
A recent literature review revealed that additional randomised controlled trials (RCTs) were not included in prior reviews, offering an opportunity to strengthen the evidence. This systematic review and meta-analysis aimed to evaluate the functional outcomes of steroid injections in comparison with both non-surgical and surgical treatments for adult trigger finger. The findings will be used to inform clinical decision-making by assessing the most effective management strategies.
METHODS
Design and registration
The study protocol, including the objectives of the review, inclusion criteria and methods of analysis, was prospectively registered on PROSPERO (CRD42024547312). This protocol has been prepared and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines,10 and the checklist is enclosed as online supplemental file 1. The final systematic review will be conducted according to Cochrane methodological standards and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. This review will be conducted from July 2025 to March 2026.
Search strategy
Three steps will be used: (1) a preliminary search of PubMed will be conducted to identify keywords, (2) peer-reviewed publications will be sought in the MEDLINE, Embase, Scopus and Cochrane Library and (3) the reference lists of all eligible studies will be manually searched for additional papers.
The search strategy has been developed in collaboration with an expert librarian. All studies published from inception to 7 July 2025 will be considered for review, either published in peer-reviewed journals or published ahead-of-print. No language limitations have been applied. The search included a combination of the following terms: “trigger finger”, “trigger thumb”, “trigger digit”, “stenosing tenosynovitis”, “corticosteroid”, “steroid”, “dexamethasone”, “triamcinolone”, “methylprednisolone”, “betamethasone”, “injection”. The detailed search strategy is available in the online supplemental material 2.
Eligibility criteria
The review’s eligibility criteria will be identified based on the following elements of the PICO framework:
Types of studies
We will include RCTs that compared steroid injection with other non-surgical interventions (non-steroidal anti-inflammatory drug injection, hyaluronic acid injection, PRP injection, physiotherapy, splinting, extracorporeal shock wave therapy and placebo injection) and surgical intervention (percutaneous release and open surgery).
Types of patients
We will include studies involving adults (older than 18 years) with a clinical diagnosis of trigger finger, irrespective of the duration of symptoms. Patients with diabetes were excluded since corticosteroid injections are associated with transient hyperglycaemia and higher complication risks in this population, potentially affecting both safety and efficacy outcomes.
Types of interventions
We will include patients who received steroid injections and studies involving combined interventions (eg, corticosteroid injection with splinting) will be excluded to minimise confounding and isolate the specific effects of corticosteroid injection. This approach aims to preserve internal validity and reduce heterogeneity.
Type of controls
The comparison intervention includes other non-surgical interventions, namely non-steroidal anti-inflammatory drug injection, hyaluronic acid injection, PRP injection, physiotherapy, splinting, extracorporeal shock wave therapy, placebo injection and surgical intervention, namely percutaneous release and open surgery.
Types of outcome measures
The primary outcome of the review will focus on the improvement in pain symptoms and finger activity. All studies reporting validated clinical, functional or patient-reported outcome measures (eg, visual analogue score (VAS), disabilities of the arm, shoulder, and hand (DASH) or Quinnell’s grading) will be included to ensure comprehensive evidence synthesis. The secondary outcomes will include relapse and safety assessment, as judged by adverse events.
Selection of studies
Two review authors (PKN and NMG) will use Rayyan.ai (Rayyan Systems, Doha, Qatar) to manage the trials that have been searched. Duplicates will be detected by the AI tool and manually checked and removed by the reviewers. First, the title and abstract will be evaluated independently and then the full text of potentially eligible studies will be examined for compliance with the inclusion criteria. Any disagreements will be resolved by the senior author (AKB).
Data extraction and management
Two reviewers (PKN and NMG) will independently extract data from the included studies. This will include study characteristics (study design and duration, funding sources and trial registration details), participant characteristics (country or setting, number of participants randomised and analysed, inclusion and exclusion criteria, demographic details such as age and gender, laterality, affected digits and clinical grading/classification of trigger finger), intervention characteristics (timing and duration of intervention, type and dosage of corticosteroid injection, details of conservative or surgical comparators and any cointerventions used) and outcome characteristics (duration of follow-up, loss to follow-up and outcomes reported, including symptom resolution, pain, recurrence, adverse events and neurovascular complications). If extracted data are missing, incomplete or unclear, the review team will contact study authors for clarification.
Assessment of risk of bias
Two review authors (PKN and NMG) will independently assess risk of bias for each study, using the Cochrane Risk of Bias tool (ROB 1), as it provides a validated, standardised and widely used framework for evaluating methodological quality and potential sources of bias in RCTs. Although the updated ROB 2 tool is available, ROB 1 was chosen because of its established use in similar reviews, ease of application across multiple domains and its ability to ensure consistency and comparability with earlier systematic reviews in this field. We will resolve any disagreements by discussion or by involving the senior author (AKB). This tool includes random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data and selective outcome reporting. We will grade each potential source of bias as high, low or unclear risk and provide a quote from the study report together with a justification for our judgement in the “Risk of bias” table. The review authors will resolve any disagreements by discussion.
Statistical analysis
Measurement of treatment effect
As for dichotomous data analysis, risk ratios with 95% CIs will be used. Mean difference with 95% CIs will be used for continuous data analysis. If scales are the same, weighted mean differences will be used for the data measured. Otherwise, standardised mean differences will be used.
Assessment of heterogeneity
We will assess clinical and methodological diversity in terms of participants, interventions, outcomes and study characteristics for the included studies to determine whether a meta-analysis is appropriate. We will assess statistical heterogeneity by using the Cochrane χ2 test and I2 statistic. An I2 value of 0–40% ‘might not be important’, 30–60% may represent ‘moderate’ heterogeneity, 50–90% may represent ‘substantial’ heterogeneity, and 75–100% represents ‘considerable’ heterogeneity.
The fixed-effects or random-effects models will be opted based on the type of data being considered for the meta-analysis. If substantial statistical heterogeneity is found, a random-effects model will be chosen. Data synthesis will be performed using RevMan V.5.4 software developed by the Cochrane Collaboration.
Certainty of evidence
The certainty of evidence for each outcome will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence will be rated as high, moderate, low or very low certainty based on the following domains: risk of bias, inconsistency, indirectness, imprecision and publication bias. Summary of findings tables will be prepared to present the certainty of evidence for key outcomes, ensuring transparency and clarity in interpretation for clinical decision-making.
Patient and public involvement
Patients and/or the public are not involved in this research’s design, conduct, reporting or dissemination plans.
Ethics and dissemination
Ethical approval is not required for this study as it is a review based on published studies. The results will be disseminated through peer-reviewed publication and conference presentations. The findings of this systematic review and meta-analysis are expected to provide valuable information for clinicians to choose an optimal strategy in the management of trigger finger.
Supplementary material
Acknowledgements
We would like to thank Dr Shivananda Bhat, Chief Librarian, and Mrs Saritha, Deputy Librarian, for their assistance with the search strategy. We also acknowledge Mr Elstin Anbu Raj S from the Prasanna School of Public Health, MAHE, for his collaborative contribution in developing the analytic framework for this protocol, reviewing the statistical methodology and providing valuable feedback.
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2025-110059).
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient consent for publication: Not applicable.
Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
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