HbA1c Values Determine the Outcome of Intrasheath Injection of Triamcinolone for Diabetic Flexor Tenosynovitis

Abstract

Stenosing flexor tenosynovitis (FTS), commonly known as “trigger finger,” is caused by a disproportion between the flexor tendon and its surrounding tendon sheath, in which smooth gliding of the flexor tendon within its sheath is restricted. First annular pulley is the most affected lesion. Intrasheath injection of triamcinolone is commonly used as an initial treatment. FTS has a reported incidence ranging from 1.7 to 2.6% in the general population (1–4). However, the incidence of FTS in diabetes is reported to be between 10 and 20% (1–3,5,6). Diabetic FTS is not an established clinical entity. FTS with diabetes, however, is related to diabetic retinopathy (3,7,8). If FTS is regarded as a diabetes-induced complication, its clinical appearance should be related to the degree of glycemic control, the duration of diabetes, or the severity of associated diabetes complications. Since a number of other metabolic and anatomic disorders are associated with diabetes, we considered some of these in our assessment of FTS and its response to intrasheath injection of triamcinolone. The study comprised 179 patients with FTS (287 fingers) in diabetic conditions. Excluded patients were those with rheumatoid arthritis, gout, renal failure, and pyogenic tenosynovitis and those with a history of FTS for >1 year …