Efficacy of Low-Dose Versus High-Dose Corticosteroid Injections for Soft Tissue Pathology of the Hand

Purpose This retrospective study evaluated the efficacy of high- versus low-triamcinolone injection doses to guide dosing for injections used in hand soft tissue pathologies. We hypothesized that there would be difference in efficacy between high-dose injections (40 mg) and low-dose injections (5–10 mg) used for trigger finger, carpal tunnel syndrome, and de Quervain tenosynovitis. The study compared rate of disease resolution, need for secondary injection, and conversion to surgery between low-dose and high-dose injections. Methods A retrospective chart review of patients from 2020 to 2023 included all patients who received a triamcinolone injection for trigger finger, carpal tunnel syndrome, de Quervain tenosynovitis. Patients were divided into high-dose (40 mg) and low-dose injection (5–10 mg) cohorts. The primary outcome was symptom resolution; secondary outcomes of interest were duration of symptom after the injection, rate of second injection, and rate of conversion to surgery. Results A total of 466 patients (649 injections) were included. Of 649 injections, 393 (61%) were given for trigger finger, 106 (17%) for carpal tunnel syndrome, and 139 (21%) for de Quervain tenosynovitis. High-dose injection had lower rates of repeat injection (18% vs 35%), lower conversion to surgery (12% vs 21%), fewer ongoing symptoms leading to return for follow-up (26% vs 46%), longer intervals between repeat injection (12.0 months vs 5.6 months), and longer estimated time to surgery (11.1 months vs 7.7 months) when compared with the low-dose group. No major complications were noted in either cohort. Conclusions High-dose triamcinolone injections outperformed low-dose injections across most metrics in this study including estimated time of relief, rate of repeat injection, and rate of surgery. Hand surgeons should consider the benefit of high-dose triamcinolone injections when deciding on a treatment modality for common hand conditions. Type of study/level of evidence Therapeutic IV.