Is platelet-rich plasma or hyaluronic acid better than corticosteroids in treating flexor stenosing tenosynovitis?

Introduction
The trigger finger is one of the frequent hand conditions. It may not respond to pharmaceutical treatment warranting injection in many cases. Classically, steroids had been used extensively. Recently emerging trends of using hyaluronic acid or platelet-rich plasma in the injection of soft tissue problems had acquired significant popularity despite being significantly more expensive than the steroids.


Aim
The study aims to prove a pragmatic comparison of hyaluronic acid, platelet-rich plasma, and steroids in the treatment of adult trigger fingers.


Patients and methods
Initially 362 patients were evaluated for possible inclusion in the study between August 2018 and January 2024. The condition was classified according to the modified Quinnell classification, and the patients completed the visual analog scale, and Michigan Hand Outcome score at the pre-injection visit, 2 weeks after injection, 6 weeks after injection, and 12 weeks after injection. One hundred ninety-seven patients (67 in the steroid group, 66 in the platelet-rich plasma group, and 64 in the hyaluronic acid group) were available for statistical analysis.


Results
In all groups, the 12 weeks post-injection visual analog score was better than the pre-injection visual analog score (P=0.001). The strongest statistical correlation with the final Michigan Hand Outcome score was with the grade of the inflammation before the injection as classified by Quinnell (P<0.001). Age, sex, whether the dominant hand was affected or not, occupational activity, and diabetic status did not affect the outcome. The duration of symptoms in the hyaluronic acid group had a moderate negative correlation with the outcome (P=0.001). None of the patients in either group suffered complications during the follow-up period.


Conclusion
The results of the current study speak to the safety and efficacy of the three injection materials in the short-term in grades II and III according to Quinnell’s. All patients in grades II and III improved significantly in the three groups. The duration of symptoms of less than 15 weeks was associated with better outcomes in the hyaluronic acid group, but the outcomes in the steroid or the platelet-rich plasma group were not affected by the duration of symptoms. Patients with grade IV improved significantly with steroid injection compared to the hyaluronic acid group and the platelet-rich plasma group. Patients with grade V did not improve with any injection. Both hyaluronic acid and platelet-rich plasma are significantly more expensive than steroids, with no added benefit in the short term.