Lin Huang, Jiabao Wei, Qinci Xie, Xiaofeng Chen, Jinying Wang, Junjie Zheng, Shiqiang Zhuo, Yongfeng Li, Zhixiao Yao, Gaofeng Huang
In this retrospective matched cohort, triamcinolone was associated with superior 3-month efficacy and lower recurrence compared to dexamethasone. These findings are hypothesis-generating and warrant prospective dose-controlled confirmation.
BACKGROUND: Local glucocorticoid injection is first-line therapy for stenosing tenosynovitis. However, the comparative efficacy of lipophilic sustained-release triamcinolone versus hydrophilic short-acting dexamethasone remains underexplored. This study aimed to compare clinical outcomes of triamcinolone versus dexamethasone in metacarpophalangeal joint injection, with hypothesis-generating exploration of how differential pharmacokinetics may influence efficacy and recurrence.
METHODS: This retrospective cohort study included adult patients receiving first-time local injection for stenosing tenosynovitis ranging from February 2021 to January 2025. Patients were divided into triamcinolone (10-20 mg + lidocaine) and dexamethasone (4 mg + lidocaine) groups. Propensity score matching (1:1) controlled for confounding. The primary outcome was 3-month overall efficacy (Quinnell grade I). Secondary outcomes included recurrence, second injection rate, surgical conversion, and local adverse events.
RESULTS: After matching 97 patients per group, baseline characteristics were balanced. At 3 months, triamcinolone demonstrated superior efficacy (82.5% vs 63.9%, P=0.004). Triamcinolone also showed lower 6-month recurrence (12.5% vs 27.4%, P=0.009), second injection rate (8.2% vs 19.6%, P=0.021), and surgical conversion (4.1% vs 13.4%, P=0.024). Fat atrophy was numerically higher with triamcinolone (9.3% vs 3.1%, P=0.072). We hypothesize that the sustained-release depot effect of triamcinolone may enable prolonged modulation of the inflamed A1 pulley microenvironment, though this mechanistic interpretation requires prospective validation.
CONCLUSION: In this retrospective matched cohort, triamcinolone was associated with superior 3-month efficacy and lower recurrence compared to dexamethasone. These findings are hypothesis-generating and warrant prospective dose-controlled confirmation.