No added clinical benefit when lidocaine is combined with steroid injection for trigger finger: study

Priscilla K. Cavanaugh et al conducted a study to report pain during and following injection for trigger finger as well as failure to resolve triggering. They hypothesized that a corticosteroid injection alone would be equally or less painful compared with the standard combination of corticosteroid and lidocaine for the treatment of trigger fingers, and there would be no difference in the resolution of triggering.

This study was a prospective, single-blinded, randomized controlled trial at a single institution, comprising 76 patients with a diagnosis of trigger finger. Each treatment group consisted of 38 patients. Patients were randomized to receive either a betamethasone (1 mL, 6 mg) injection without lidocaine or a betamethasone injection (1 mL, 6 mg) with 1% lidocaine (1 mL). Patients were assessed during injection and at 1 hour, 6 hours, 2 days, and 6 weeks after the injection. The primary outcome was pain measured using a numerical rating scale. The secondary outcome was the rate of failure to resolve symptoms at 6 weeks.

Key findings of the study were:

• There was a statistically significant difference in pain scores between the lidocaine and betamethasone versus betamethasone-only injections during administration (4.6 vs 6.2) and after 1hour (1.3 vs 2.5).

• There was no statistically significant difference in pain scores after 6 hours (1.5 vs 2.0) and 2 days (0.7 vs 0.6) or in failure rate at the 6-week time point (21% vs 18%).

The authors concluded - “Overall, we found no clinical benefit in short-term pain relief when a steroid and lidocaine combined injection was administered compared with steroid alone. This finding may challenge the often-cited reason for lidocaine coadministration, which is the benefit of short-term post injection anesthesia. Therefore, it may be reasonable to use a steroid-only injection for the treatment of trigger finger, especially given the ongoing nationwide shortage of lidocaine in the United States after the discontinued production by several companies in recent years. Our findings support the use of steroid-only injections for the treatment of trigger finger.”

Type of study/level of evidence Therapeutic II.

Further reading:

Corticosteroid Injection With and Without Local Anesthetic for the Treatment of Trigger Finger: A Randomized Clinical

J Hand Surg Am. 2025;50(5):581-586.

https://doi.org/10.1016/j.jhsa.2024.05.016