In Reply

Abstract

We appreciate your compassion and interest in your patients' wellbeing: your curiosity about technical aspects of the injection that might make corticosteroid injection for trigger finger more comfortable, in particular. Trigger finger injections are so common in hand surgery practice that your hypothesis that a dorsal injection through the web might be less painful should be easy to test. To be sure that your impression is accurate, and that a dorsal injection technique is truly less painful, you would need to randomize patients and do everything you can to limit bias in the way that you obtain informed consent, execute the injections, and evaluate the results. It can be convincing that things are 1 way when they are actually another (consider the magic show—the lady is not sawed in half!). That's why humans invented science.Hand surgeons tend to focus on the technical aspects of our care. But as the quality of our scientific inquiry improves, we tend to find—as we did in our study—that the technical aspects of care and even the extent of pathophysiology are less important than factors such as culture, circumstances, and mindset in determining symptoms and disability. We appreciate your compassion and interest in your patients' wellbeing: your curiosity about technical aspects of the injection that might make corticosteroid injection for trigger finger more comfortable, in particular. Trigger finger injections are so common in hand surgery practice that your hypothesis that a dorsal injection through the web might be less painful should be easy to test. To be sure that your impression is accurate, and that a dorsal injection technique is truly less painful, you would need to randomize patients and do everything you can to limit bias in the way that you obtain informed consent, execute the injections, and evaluate the results. It can be convincing that things are 1 way when they are actually another (consider the magic show—the lady is not sawed in half!). That's why humans invented science. Hand surgeons tend to focus on the technical aspects of our care. But as the quality of our scientific inquiry improves, we tend to find—as we did in our study—that the technical aspects of care and even the extent of pathophysiology are less important than factors such as culture, circumstances, and mindset in determining symptoms and disability. Letter Regarding “Painful Corticosteroid Injections for Idiopathic Trigger Finger”Journal of Hand SurgeryVol. 37Issue 7PreviewAs reported in the article about painful corticosteroid injections for idiopathic trigger fingers in the February 2012, issue of The Journal of Hand Surgery,1 I also have noticed that trigger finger injections are among the most painful; therefore, a year or so ago, I changed from intrathecal injections as described in the article to injecting just proximal to the A1 pulley through the distal dorsal skin in the adjacent webspace. I have found the injection to be much less painful, easier to inject, and equally effective. Full-Text PDF