Trigger Finger Treatment: A Comparison of 2 Splint Designs

doi:10.1016/j.jhsa.2011.10.038

The Journal of Hand Surgery

Volume 37, Issue 2, February 2012, Pages 243-249.e1

https://doi.org/10.1016/j.jhsa.2011.10.038 Get rights and content

Purpose

To compare the effectiveness of 2 splint designs in treating trigger finger.

Methods

This prospective, randomized study of 30 subjects evaluated splinting efficacy for trigger finger, comparing 2 splint designs: a custom metacarpophalangeal (MCP) joint blocking splint and a distal interphalangeal (DIP) joint blocking splint. We evaluated range of motion, grip strength, severity and frequency of triggering, functional impact, and performance measure scores. Subjects recorded frequency of splint use, splint comfort, and functional impact of the splint. We undertook statistical analysis of splint effectiveness before and after treatment and of differences between the 2 splint groups. We evaluated qualitative data to identify trends in subjective preference toward splint design.

Results

Both groups showed quick and significant improvement of triggering; however, the MCP joint blocking splint was successful in providing at least partial relief of triggering and pain in 10 of 13 trigger finger subjects, whereas the DIP joint blocking splint provided at least partial relief of triggering and pain in 7 of 15 subjects after 6 weeks of treatment. Data showed statistically significant improvement in both groups at 6 weeks, which was maintained in a minority of the cohort for 1 year. There was little difference between the 2 splint groups for impact on function. Subjects who wore the MCP joint blocking splint reported higher rates of comfort compared with those who wore the DIP joint blocking splint.

Conclusions

Subject comfort with the MCP joint blocking splint allowed for longer periods of usage. Selection of a splint design depends on clinical presentation, vocation, and leisure activities. Initiating conservative treatment with the MCP joint blocking splint has value for patients with trigger finger and positive outcomes in 77% of subjects, whereas use of the DIP joint splint was effective in about half of subjects.

Type of study/level of evidence

Therapeutic I.

Section snippets

Materials and Methods

We conducted the study at a university-affiliated teaching hospital in a large urban setting. A hand surgeon assessed subjects, all of whom had trigger finger but had never been treated, for triggering at the A1 pulley and obtained informed consent. We gathered associated medical information as well as demographic data. We excluded subjects if they did not speak English, had a trigger thumb, or had involvement of more than 1 digit in the same hand. A priori power analysis determined that 13

Results

A total of 30 subjects who met the inclusion criteria agreed to participate in this study; none refused. Two subjects had bilateral involvement: one was in the MCP joint group with both hands, and the other was in both the MCP joint group for 1 hand and the DIP joint group for the other hand, as determined by randomization. In all, we treated 15 digits in the MCP group and 17 digits in the DIP group. One subject with bilateral involvement dropped out of the MCP joint group, which left 13 digits

Discussion

Statistical analysis of the quantitative data showed quick reduction or relief of symptoms in both splint groups, which were maintained over 6 weeks and in some subjects for over 1 year. Overall, the 2 groups responded favorably to splinting, but the long-term data included only those that continued with the splint and were therefore self-selected.

Descriptive analysis found that in both the splint groups there was awkwardness with respect to the subject's use of the hand during daily

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Cited by (44)

Treatment of trigger finger with metacarpophalangeal joint blocking orthosis vs relative motion extension orthosis: A randomized clinical trial
2024, Journal of Hand Therapy
The metacarpophalangeal joint blocking orthosis (MCPJ-BO) is one of the first-line orthotic treatment for patients with trigger finger (TF). Relative motion extension orthosis (RME-O) has recently emerged as a treatment option for various hand disorders involving TF.
The primary objective of this study was to compare the effectiveness of 6 weeks of orthotic treatment with the MCPJ-BO and the RME-O for pain relief. Function and satisfaction with the orthosis were assessed as secondary objectives.
Randomized clinical study.
Thirty patients with an average age of 50 years with Froimson stage 1-3 A1 pulley triggering participated in the study. They were randomly assigned to either the MCPJ-BO (n = 15; 10 females, five males) or the RME-O group (n = 15; 12 females, three males). The orthoses were worn full time for 6 weeks. All patients received patient education, activity modification, and flexor tendon gliding exercises as part of the rehabilitation program. Pre- and post-assessments included Numeric Pain Rating Scale, Disability of the Arm, Shoulder, and Hand questionnaire, and Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. The Mann-Whitney U test was conducted to analyze the difference between the two groups.
There were no significant differences between the two groups in pain and function before treatment (p < 0.05). Within-group comparisons indicated that both orthoses relieved pain, but the MCPJ-BO group achieved greater pain relief (p = 0.001). There was a significant improvement in function in the MCPJ-BO group, with a mean change of 12.7 (p = 0.0001). The overall success rates for the MCPJ-BO group and RME-O group were 60% and 27%, respectively. Patients in both groups had high satisfaction with the orthosis.
MCPJ-BO and RME-O could be used for pain relief in the treatment of TF. The MCPJ-BO appears to be more effective than the RME-O in improving function.
Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review
2023, Journal of Hand Therapy
The design and efficacy of orthotic intervention to non-surgically manage adult and pediatric trigger finger vary widely.
To identify types of orthoses (including relative motion), effectiveness, and outcome measurements used to non-surgically manage adult and pediatric trigger finger.
Systematic review.
The study was undertaken according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement and registered with the International Prospective Register of Systematic Reviews Registry, number CRD42022322515. Two independent authors electronically and manually searched, and screened 4 databases; selected articles following pre-set eligibility criteria; assessed the quality of the evidence using the Structured Effectiveness for Quality Evaluation of Study; and extracted the data.
Of the 11 articles included, 2 involved pediatric trigger finger and 9 adult trigger finger. Orthoses for pediatric trigger finger positioned finger(s), hand, and/or wrist of children in neutral extension. In adults, a single joint was immobilized by the orthosis, blocking either the metacarpophalangeal joint or the proximal or distal interphalangeal joint. All studies reported positive results with statistically significant improvements and medium to large effect size to almost every outcome measure, including the Number of Triggering Events in Ten Active Fist 1.37, Frequency of Triggering from 2.07 to 2.54, Quick Disabilities of the Arm, Shoulder and Hand Outcome Measure from 0.46 to 1.88, Visual Analogue Pain Scale from 0.92 to 2.00, and Numeric Rating Pain Scale from 0.49 to 1.31. Severity tools and patient-rated outcome measures were used with the validity and reliability of some unknown.
Orthoses are effective for non-surgical management of pediatric and adult trigger finger using various orthotic options. Although used in practice, evidence for the use of relative motion orthosis is absent. High-quality studies based on sound research questions and design using reliable and valid outcome measures are needed.
Use of relative motion orthoses from the perspective of hand-injured patients: A qualitative study
2023, Journal of Hand Therapy
Relative motion (RM) orthoses have gained popularity with therapists as their versatility lends to “protective,” “exercise,” and “adaptive” uses.
To ask for comments from patients wearing RM orthoses for protective or exercise reasons.
Interpretive descriptive qualitative study.
Semi-structured face-to-face interviews comprised of nine open-ended questions were conducted with 20 hand injured patients who were advised to wear a protective or exercise RM orthosis for at least 4 weeks.
Twenty patients participated in the interviews. Thirteen patients wore the protective RM orthoses had a mean age of 28 years (range,16-54) and the mean age was 34 years (range, 20-51) for 7 patients using exercise RM orthoses. Interviews generated 4 major themes: physical characteristics of the orthoses, challenges in daily living activities, emotional response to orthotic wear, and impact of social environment.
Comments from both groups of patients suggested the small size of the orthosis contributed to wearing the orthosis as advised. Most found the orthosis comfortable, when not, comments were related to rubbing of the orthosis causing pain and rigidity of the orthosis resulting in finger swelling. A few were impacted by the orthosis drawing attention to their injured hand. Those wearing the exercise RM orthosis often removed it instead of using it for nonintentional exercise.
Comments obtained from the limited structured interview of 20 patients wearing protective or exercise RM orthosis may offer therapists with some understanding from the patient's perspective. Additional study is worthwhile.
Externally applied force helps reduce bowstring effect of flexors in patients with carpal tunnel release surgery
2022, Musculoskeletal Science and Practice
Patients with severe carpal tunnel syndrome (CTS) undergo carpal tunnel release (CTR) surgery to alleviate pressure in the carpal tunnel. However, the subsequent lack of the transverse carpal ligament (TCL) causes the bowstring phenomenon of the flexor tendons and increases the potential incidence of trigger finger.
This study aimed to investigate the effects of various compressive forces on the flexor tendon and identify the appropriate force needed to mitigate the bowstring effect of those flexors.
Cross-sectional repeated measures comparison.
Thirteen CTS patients who underwent CTR surgery were asked to flex the middle finger while applying different external compressive forces, just contact, 4N, and 8N force, over the carpal tunnel. Images of the flexor tendon within the carpal tunnel and at the metacarpal phalangeal (MCP) joint were recorded via ultrasound.
Results show that the compression force limited the volar migration of the flexor tendon under maximal voluntary contraction (MVC) conditions. Entrance angles between the flexor tendon and metacarpal bone also decreased as the external compressive force increased.
Findings of this study may indicate that applying compression force on the carpal tunnel is useful for CTS patients and can inhibit the volar shift of the flexor digitorum superficialis (FDS) tendon after surgery, which may further prevent trigger finger.
Extracorporeal Shockwave Therapy in the Treatment of Trigger Finger: A Randomized Controlled Study
2021, Archives of Physical Medicine and Rehabilitation
To determine the efficacy of extracorporeal shockwave therapy (ESWT) and to determine the ideal energy flux density of wide-focused ESWT in the treatment of trigger finger (TF).
Double-blind randomized controlled trial.
A university hospital.
A total of 60 patients (N=60) with grade II TF according to the Quinnell classification were randomly and evenly allocated to 3 treatment groups.
Three treatment groups included a high-energy ESWT (HS) group (energy flux density of 0.01 mJ/mm², 5.8 bar, 1500 impulses, once per week for 4wk), a low-energy ESWT (LS) group (energy flux density of 0.006 mJ/mm², 3 bar, 1500 impulses, once per week for 4wk), and a sham intervention group (sham group). All participants received 6 months of follow-up after intervention when only painkillers were allowed as concomitant treatment.
Clinical outcomes were followed at baseline and 1, 3, and 6 months after intervention, including pain score, frequency of triggering, severity of triggering, functional impact of triggering, and quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH).
All groups showed significant improvements from baseline in all clinical parameters, except for functional impact of triggering, 6 months after the interventions. However, the HS group demonstrated a higher magnitude of improvement than the LS and sham groups. In addition, the HS group reported significantly lower pain (P=.01) and lower qDASH (P=.008) than the sham group 6 months after the interventions. No adverse effects were reported in the HS and LS groups within 6 months of follow-up.
Wide-focused ESWT is a safe and effective but dose-dependent alternative facilitating pain relief and functional improvement in the treatment of grade II TF according to the Quinnell classification.
Physical modalities for the conservative treatment of wrist and hand's tenosynovitis: A systematic review
2020, Seminars in Arthritis and Rheumatism
Objectives: The management of wrist and hand's tenosynovitis remains challenging and needs to be individualized. Physical modalities are accepted among conservative treatments, but there is currently no systematic assessment of their role and efficacy. The aim of this review is to analyze the literature including studies dealing with the use of physical modalities in De Quervain disease, Dupuytren disease and trigger finger, in order to obtain indications for everyday clinical practice.
Methods: A systematic literature search of the following databases was conducted: MEDLINE (through PubMed), Cochrane Library, PEDro and Scopus. All kind of papers, except for case reports and case series, were included, due to the small amount of scientific evidence in literature about this topic. The inclusion criteria were papers regarding the effectiveness of conservative treatment with physical modalities of adult humans affected by De Quervain disease, Dupuytren disease and trigger finger. The review included articles in English language published before 10 May 2020. The exclusion criteria were papers whose topic were surgery or conservative treatment with therapeutic tools different from physical modalities for hand and wrist's tenosynovitis.
Results: The literature search identified 2422 papers, but only 15 were included in this review. While 10 of the 15 studies (66.6%) were RCTs, only 2 had a lower risk of bias according to the Cochrane library assessment tool. For the conservative treatment of De Quervain disease 7 papers were found, studying ultrasound therapy, low level laser therapy, phonoporesis, and anodyne therapy, alone or associated. For Dupuytren disease 3 papers were found, studying extracorporeal shock wave therapy (ESWT), temperature controlled high energy adjustable multi-mode emission laser, electron beam therapy and radiofrequency. For trigger finger 5 papers were found, studying ESWT and ultrasound therapy.
Conclusions: Laser therapy and therapeutic ultrasound were the most used and effective physical therapies for De Quervain tenosynovitis. ESWT was found the most efficient and safe therapy for Dupuytren disease; radiotherapy, electron beam therapy, targeted radiofrequency and laser therapy could be promising therapeutic options at Dupuytren's onset. ESWT turned out to be the most frequent physical mean used for functional improvement and pain control in trigger finger. However, more high-quality studies are still needed to further define evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.

View all citing articles on Scopus

: Research funding was provided by the University Health Network Allied Health research fund.

: No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

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Scientific articleTrigger Finger Treatment: A Comparison of 2 Splint Designs

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

J Hand Surg

J Hand Ther

J Hand Surg

J Hand Ther

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Scientific article
Trigger Finger Treatment: A Comparison of 2 Splint Designs