Comparing the Intensity of Pain and Incidence of Flare Reaction Following Trigger Finger Injections Using Betamethasone and Methylprednisolone: A Double-Blinded, Randomized Controlled Trial.

BACKGROUND: Considerable evidence supports corticosteroid injection as an effective treatment for trigger finger. One common side effect, the flare reaction, is a well-documented phenomenon of increased pain following steroid injections. Its incidence and intensity may be related to steroid composition. The purpose of this study was to determine whether betamethasone and methylprednisolone injections for trigger fingers have differing intensity of pain or incidence flare reaction. METHODS: Patients with symptomatic trigger finger were recruited during their hand surgery visits. Patients were randomized into 2 treatment groups: betamethasone (40 mg) and methylprednisolone (6 mg) mixed with lidocaine 1%. Treatment group assignment was blinded to the patients and investigators. Visual analog scale pain measurements were taken prior to injection, 5 minutes postinjection, and daily thereafter for 7 days. RESULTS: Sixty-four patients were randomized into the 2 treatment groups. Patients in the betamethasone group reported slightly higher baseline pain compared with the methylprednisolone group, but lower pain on day 1. None of the following days showed a statistically significant difference. CONCLUSIONS: The incidence of flare and severe flare reactions of betamethasone injections for trigger finger management was roughly double that of methylprednisolone, but this difference was not statistically significant. Further studies are required to evaluate the relative course of nonflare postinjection pain for different corticosteroid injections for trigger finger injections.

Simultaneous Bilateral Carpal and Cubital Tunnel Releases: Quadruple Tunnel Release.

The authors retrospectively reviewed the first 30 patients who underwent bilateral simultaneous carpal and cubital releases (quadruple tunnel release). Patients were asked to complete a questionnaire over the phone regarding their satisfaction with the procedures and willingness to make the same choice of bilateral carpal and cubital releases simultaneously, as well as the time to return to unrestricted use. Of 24 patients who responded to the questionnaire, 23 (95.8%) were satisfied or highly satisfied with their care, and 23 (95.8%) would again choose to have release of the 4 tunnels simultaneously. Time to unrestricted use in this patient cohort averaged 27 days. Quadruple tunnel release is technically feasible and well tolerated. This procedure has the potential to save considerable amounts of recuperation time and is less expensive than performing 4 individual procedures for patients who have bilateral carpal and bilateral cubital tunnel syndrome. [Orthopedics. 2020;43(6):e592-e594.].