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Leong LX, Chai SC, Howell JW, Mohd Rasdi HF, Abdul Rahman NR. Relative motion splints versus metacarpophalangeal joint blocking splints in the management of trigger finger: Study protocol for a randomized comparative trial. PLoS One 2024; 19:e0307033. [PMID: 39137205 PMCID: PMC11321552 DOI: 10.1371/journal.pone.0307033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 05/15/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Evidence supports the use of hand-based metacarpophalangeal joint (MCPJ) blocking splints as an intervention for trigger finger (TF). In practice, finger-based relative motion (RM) splints are also implemented without evidence. PURPOSE This randomized comparative trial (RCT) aims to evaluate implementation of MCPJ blocking and RM splints for effectiveness, function, occupational performance and wearability after 6 weeks of TF management. METHODS AND ANALYSIS Priori analysis determined 36 individuals were needed for random assignment to the RM or MCPJ blocking splint groups. Individuals must be aged ≥21 years, and diagnosed with TF involving ≥1 finger. For blinding purposes, the primary author screens for eligibility, fabricates the splints and educates. Therapist A administers the primary outcome measures Week-1 and Week-6-stage of stenosing tenosynovitis and secondary outcome measures- number of triggering events in 10 active fists, visual analog scales (VAS) for pain, splint comfort and satisfaction, Disabilities of the Arm, Shoulder and Hand, and Canadian Occupational Performance Measure. Therapist B in Week-3 instructs participants in deep tissue massage and administers splint wearability VASs. The RM pencil test is used to determine the affected finger(s) MCPJ splint position i.e., more extension or flexion based on participant response. The MCPJ blocking splint holds the MCPJ in a neutral position. Analysis involves a mixed-effects ANOVA to compare Week-1 and Week-6 primary and secondary outcomes. RESULTS Recruitment and data collection are ongoing. DISCUSSION Biomechanically RM splints control tendon excursion and reduce passive tendon tension while allowing unencumbered finger motion and hand function. Hence clinicians use RM splints as an intervention for TF, despite the lack of implementation evidence. This RCT implements a function-focused as well as patient-centered approach with partial blinding of assessors and participants. CONCLUSION We anticipate that this study will provide evidence for the implementation of RM splints to manage adults with TF. TRIAL REGISTRATION Clinical trial registration This trial is registered with ClinicalTrials.gov (NCT05763017).
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Affiliation(s)
- Li Xian Leong
- Faculty of Health Sciences, Occupational Therapy Programme, Centre for Rehabilitation & Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Unit, Hospital Sultan Haji Ahmad Shah, Ministry of Health of Malaysia, Putrajaya, Malaysia
| | - Siaw Chui Chai
- Faculty of Health Sciences, Occupational Therapy Programme, Centre for Rehabilitation & Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Julianne W Howell
- Self-Employed Hand and Upper Extremity Therapy Consultant, Saint Joseph, Michigan, United States of America
| | - Hanif Farhan Mohd Rasdi
- Faculty of Health Sciences, Occupational Therapy Programme, Centre for Rehabilitation & Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nur Rahimawati Abdul Rahman
- Orthopaedic Department, Hospital Sultan Haji Ahmad Shah, Ministry of Health of Malaysia, Putrajaya, Malaysia
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Yendi B, Atilgan E, Namaldi S, Kuru CA. Treatment of trigger finger with metacarpophalangeal joint blocking orthosis vs relative motion extension orthosis: A randomized clinical trial. J Hand Ther 2024; 37:311-318. [PMID: 38302383 DOI: 10.1016/j.jht.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND 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. PURPOSE 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. STUDY DESIGN Randomized clinical study. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Burcu Yendi
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Esra Atilgan
- Istanbul Medipol University, Faculty of Health Sciences, Department of Orthotics-Prosthetics, Istanbul, Turkey
| | - Seda Namaldi
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Cigdem Ayhan Kuru
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
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Leong L, Chai SC, Howell JW, Hirth MJ. Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review. J Hand Ther 2023; 36:302-315. [PMID: 37391318 DOI: 10.1016/j.jht.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The design and efficacy of orthotic intervention to non-surgically manage adult and pediatric trigger finger vary widely. PURPOSE To identify types of orthoses (including relative motion), effectiveness, and outcome measurements used to non-surgically manage adult and pediatric trigger finger. STUDY DESIGN Systematic review. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Lixian Leong
- Occupational Therapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Occupational Therapy Unit, Hospital Sultan Haji Ahmad Shah, Pahang, Malaysia
| | - Siaw Chui Chai
- Occupational Therapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Julianne W Howell
- Self-employed Hand Therapy Consultant, Saint Joseph, MI, United States
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia
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Blough C, Najdawi J, Kuschner S. Patient preference for trigger finger treatment. World J Orthop 2022; 13:1006-1014. [PMID: 36439373 PMCID: PMC9685636 DOI: 10.5312/wjo.v13.i11.1006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/28/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trigger finger is a common disorder of the hand that can cause disabling symptoms. Treatment options range from conservative management with observation and splinting, to surgical release, but there is currently not a consensus on a treatment algorithm.
AIM To determine patient preference for the treatment of trigger finger using an online survey.
METHODS An online crowdsourcing platform, Amazon Mechanical Turk, was used to recruit participants for this study. Participants were led through a scenario in which they were diagnosed with trigger finger. They were then asked to rank their preference of treatment options from the following: Observation, splinting, corticosteroid injection, surgery. The results of the surveys were then analyzed using R software.
RESULTS Of 323 participants completed the survey. 7 participants were excluded because they failed to correctly answer the attention question, leaving 316 participants whose results were included. As a first choice for treatment 117 (37%) of the included participants chose observation, 86 (27%) chose splinting, 61 (19%) chose corticosteroid injection, and 52 (16%) chose surgery. The mean rank for observation was 2.26, for splinting was 2.30, for corticosteroid injection was 2.53, and for surgery was 2.91. The ranking of each treatment option was statistically different (P value < 0.05) from the others except for observation and splinting.
CONCLUSION The practice of shared decision making with patients is imperative to providing the best care possible. The results from this study, especially the preference for less invasive treatment, may help providers better frame discussion around treatment options of trigger fingers. This in turn, may increase patient satisfaction in the treatment of trigger finger.
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Affiliation(s)
- Christian Blough
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Jawad Najdawi
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Stuart Kuschner
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
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Pompeu Y, Aristega Almeida B, Kunze K, Altman E, Fufa DT. Current Concepts in the Management of Advanced Trigger Finger: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202109000-00002. [PMID: 35417430 DOI: 10.2106/jbjs.rvw.21.00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» While the majority of patients with trigger finger obtain excellent outcomes from nonoperative treatment or release of the A1 pulley, a subset of patients with advanced trigger finger, defined as trigger finger with loss of active or passive range of motion, may have incomplete symptom relief and warrant specific attention. » Advanced trigger finger is more refractory to complete symptom resolution from corticosteroid injection, and particular attention should be paid to incomplete improvement of flexion contractures. » Unlike simple trigger finger, the pathology in advanced trigger finger involves not only the A1 pulley but also the flexor tendon, including thickening and degeneration. » Progression toward surgical intervention should not be delayed when nonoperative measures fail, and specific attention should be paid to persistent inability to achieve full extension following A1 pulley release. » Facing substantial residual flexion contracture, reduction flexor tenoplasty and partial or complete resection of the superficialis tendon followed by hand therapy and splinting may be needed to allow patients to regain reliable full range of motion.
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Affiliation(s)
- Yuri Pompeu
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
| | - Bryan Aristega Almeida
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
- Cornell University Weill Cornell Medical College, New York, NY
| | - Kyle Kunze
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
| | - Emily Altman
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
| | - Duretti T Fufa
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
- Cornell University Weill Cornell Medical College, New York, NY
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Pataradool K, Lertmahandpueti C. A proximal interphalangeal joint custom-made orthosis in trigger finger: Functional outcome. HAND THERAPY 2021; 26:85-90. [PMID: 37904880 PMCID: PMC10584048 DOI: 10.1177/17589983211018717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/29/2021] [Indexed: 11/01/2023]
Abstract
Introduction Trigger finger is a common and functionally limiting disorder. Finger immobilization using an orthotic device is one of the conservative treatment options for treating this condition. The most common orthosis previously described for trigger finger is metacarpophalangeal joint immobilization. There are limited studies describing the effectiveness of proximal interphalangeal joint orthosis for treatment of trigger finger. Methods This study was a single group pretest-posttest design. Adult patients with single digit idiopathic trigger finger were recruited and asked to wear a full-time orthoses for 6 weeks. The pre- and post-outcome measures included Quick-DASH score, the Stages of Stenosing Tenosynovitis (SST), the Visual Analogue Scale (VAS) for pain, the number of triggering events in ten active fists, and participant satisfaction with symptom improvement. Orthotic devices were made with thermoplastic material fabricated with adjustable Velcro tape at the dorsal side. All participants were given written handouts on this disease, orthotic care and gliding exercises. Paired t-tests were used to determine changes in outcome measures before and after wearing the orthosis. Results There were 30 participants included in this study. Evaluation after the use of PIP joint orthosis at 6 weeks revealed that there were statistically significant improvements in Quick-DASH score from enrolment (mean difference -29.0 (95%CI -34.5 to -23.4); p < 0.001), SST (mean difference -1.4 (95%CI -1.8 to -1.0); p < 0.001) and VAS (mean difference -3.4 (95%CI -4.3 to -2.5); p < 0.001). There were no serious adverse events and patient satisfaction with the treatment was high. Conclusions Despite our small study size, the use of proximal interphalangeal joint orthosis for 6 weeks resulted in statistically significant improvements in function, pain and triggering, and also high rates of acceptance in patients with isolated idiopathic trigger finger.
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Affiliation(s)
- Kawee Pataradool
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Effectiveness of proximal interphalangeal joint-blocking orthosis vs metacarpophalangeal joint-blocking orthosis in trigger digit management: A randomized clinical trial. J Hand Ther 2020; 32:444-451. [PMID: 30030005 DOI: 10.1016/j.jht.2018.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/03/2018] [Accepted: 02/17/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Patients with Green's classification grade 2 or 3 A1-pulley trigger digit (TD) were recruited and randomized to receive the proximal interphalangeal joint-blocking orthosis (PIPJ-BO) or metacarpophalangeal joint-blocking orthosis (MCPJ-BO). INTRODUCTION TD is a common hand condition that can affect one's performance in activities of daily living. Conservative management of TD involves prescription of orthoses to facilitate recovery. No studies have evaluated the effectiveness of PIPJ-BO, optimal orthosis wear regime, and other factors affecting orthotic effectiveness. PURPOSE OF THE STUDY To compare the effectiveness of PIPJ-BO vs MCPJ-BO in TD management. METHODS Outcome measures included pain numerical rating scale, Green's classification grading, and Quick Disability of the Arm, Shoulder and Hand. Orthosis wear duration was also collated. Patients were followed up for 2 months, and changes between initial and final assessment score within each group and between both groups were analyzed. RESULTS Thirty-five patients with 43 TD were included in final analysis. Twenty-three TD were allocated PIPJ-BO while 20 with MCPJ-BO. Pain reduction was observed in both groups, but reduction was greater in PIPJ-BO group (P = .02). About 47.83% in PIPJ-BO group and 40% in MCPJ-BO group improved by at least 1 Green's classification grade. There was only significant improvement in Quick Disability of the Arm, Shoulder and Hand score for PIPJ-BO group (P = .0007), and duration of orthosis wear was significantly longer in the PIPJ-BO group (P = .0010). Advancing age was found to have higher rate of orthosis failure. DISCUSSION Findings suggest that both orthoses are effective in reducing pain and disability and improve in triggering symptoms, with PIPJ-BO being more superior. Moreover, PIPJ-BO is less restrictive, has better cosmesis and allowed better functional performance than MCPJ-BO. CONCLUSION PIPJ-BO is more effective than MCPJ-BO in pain reduction and achieved better functional outcome. Orthosis wear of 24 hours for more than 8 weeks is recommended.
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Lunsford D, Valdes K, Hengy S. Conservative management of trigger finger: A systematic review. J Hand Ther 2020; 32:212-221. [PMID: 29290504 DOI: 10.1016/j.jht.2017.10.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review INTRODUCTION: Trigger finger (TF) is a common condition in the hand. The primary purpose of this systematic review was to evaluate the current evidence to determine the efficacy of orthotic management of TF. A secondary purpose was to identify the characteristics of the orthotic management. The tertiary purpose of this study was to ascertain if the studies used a patient-reported outcome to assess gains from the patient's perspective. METHODS All studies including randomized controlled trials, prospective, and retrospective cohort studies were included in this review due to limited high-level evidence. RESULTS Four authors demonstrated moderate to large effect sizes ranging from 0.49 to 1.99 for pain reduction after wearing an orthotic device. Two authors demonstrated a change in the stages of stenosing tenosynovitis scale scores showing a clinically important change with a large effect size ranging from 0.97 to 1.63. Seven authors immobilized a single joint of the affected digit using a variety of orthoses. CONCLUSION All authors reported similar results regardless of the joint immobilized; therefore for orthotic management of the TF, we recommend a sole joint be immobilized for 6-10 weeks. In assessing TF, most authors focused on body structures and functions including pain and triggering symptoms, 2 authors used a validated functional outcome measure. In the future therapists should use a validated patient report outcome to assess patient function that is sensitive to change in patients with TF. Furthermore, more randomized controlled trials are needed.
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Abstract
BACKGROUND This study assessed nighttime splinting for 6 weeks as treatment for recent onset idiopathic trigger fingers. METHODS Patients over 18 years with a Quinnell grade 1 or 2, idiopathic trigger finger or thumb causing symptoms for less than 3 months were eligible for a custom-made hand-based orthoplast night orthotic. Improvement of symptoms and/or resolution of triggering were recorded. Patients also completed the short version of the Disabilities of the Arm, Shoulder and Hand and a numerical rating scale for pain at the initial visit, after 6 to 8 weeks, and after 3 months. RESULTS Thirty-four patients wore a night orthotic for at least 6 weeks. At final evaluation, there was a substantial reduction in disability and pain. Symptoms of triggering resolved completely in 18 patients (55%). Sixteen patients did not resolve their triggering after splinting and therefore underwent a steroid injection. CONCLUSION Night splinting is a noninvasive treatment option for idiopathic trigger fingers/thumb with symptoms for less than 3 months.
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Affiliation(s)
| | | | | | | | - Chaitanya S. Mudgal
- Massachusetts General Hospital, Boston, USA,Chaitanya S. Mudgal, Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Amirfeyz R, McNinch R, Watts A, Rodrigues J, Davis TRC, Glassey N, Bullock J. Evidence-based management of adult trigger digits. J Hand Surg Eur Vol 2017; 42:473-480. [PMID: 28488453 DOI: 10.1177/1753193416682917] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of this systematic review was to develop an evidence-based guideline to assist clinicians in the treatment of adult trigger digits. There is moderate evidence to suggest that local corticosteroid injection is a safe and effective short-term treatment and it may, therefore, be recommended as an initial treatment for this condition. However, when compared with surgery, there is strong evidence that corticosteroid injection is associated with increased rates of ongoing or recurrent symptoms at 6 months after intervention. There is strong evidence suggesting that trigger digit can be managed safely by surgical release. There is weak evidence to support the use of splinting or other non-operative modalities. Hence a single corticosteroid injection may be offered as the first line in treatment of adult trigger digits, but percutaneous release is a safe alternative. Surgery should be the next line if the injection fails, symptoms recur or the patient chooses. LEVEL OF EVIDENCE I.
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Affiliation(s)
- R Amirfeyz
- 1 Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK
| | - R McNinch
- 1 Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK
| | - A Watts
- 2 Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - J Rodrigues
- 3 Plastics and Reconstructive Surgery, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - T R C Davis
- 4 Trauma and Orthopaedics, Queen's Medical Centre, Nottingham, UK
| | - N Glassey
- 5 Hand Unit, Queen's Medical Centre, Nottingham, UK
| | - J Bullock
- 5 Hand Unit, Queen's Medical Centre, Nottingham, UK
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Lapègue F, André A, Meyrignac O, Pasquier-Bernachot E, Dupré P, Brun C, Bakouche S, Chiavassa-Gandois H, Sans N, Faruch M. US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases. Radiology 2016; 280:493-9. [PMID: 26919442 DOI: 10.1148/radiol.2016151886] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate the efficacy of ultrasonographically (US)-guided percutaneous treatment of the trigger finger by releasing the A1 pulley with a 21-gauge needle. Materials and Methods This two-part study was approved by the ethics committee, and written consent was obtained from all patients. The first part consisted of 10 procedures on cadaver digits followed by dissection to analyze the effectiveness of the A1 pulley release and detect any collateral damage to the A2 pulley, interdigital nerves, or underlying flexor tendons. The second part was performed during an 18-month period starting in March 2013. It was a prospective clinical study of 60 procedures performed in 48 patients. Outcomes were evaluated through a clinical examination at day 0 and during a 6-month follow-up visit, where the trigger digit was evaluated clinically and the Quick Disabilities of the Arm, Shoulder and Hand outcome measure, or QuickDASH, and patient satisfaction questionnaires were administered. Results No complications were found during the cadaver study. However, the release was considered "partial" in all fingers. In the clinical study, the trigger finger was completely resolved in 81.7% (49 of 60) of cases immediately after the procedure. Moderate trigger finger persisted in 10 cases, and one thumb pulley could not be released. A US-guided corticosteroid injection was subsequently performed in these 11 cases. At 6-month follow-up, only two cases still had moderate trigger finger and there were no late complications. The mean QuickDASH questionnaire score was 4; all patients said they were satisfied. Conclusion US-guided treatment of the trigger finger by using a 21-gauge needle is feasible in current practice, with minimal complications. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Franck Lapègue
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Aymeric André
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Olivier Meyrignac
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Etienne Pasquier-Bernachot
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Pierre Dupré
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Céline Brun
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Sarah Bakouche
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Hélène Chiavassa-Gandois
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Nicolas Sans
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
| | - Marie Faruch
- From the Service d'Imagerie (F.L., O.M., E.P.B., P.D., C.B., S.B., H.C.G., N.S., M.F.) and Institut de l'Appareil Locomoteur, Unité de Chirurgie de la Main et Chirurgie Réparatrice des Membres (A.A.), CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, TSA 40031-31059 Toulouse, France; Centres d'Imagerie du Languedoc, Narbonne, France (F.L.); and Laboratoire d'Anatomie, Faculté de Médecine de Toulouse, Toulouse, France (A.A.)
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Abstract
Trigger fingers are common tendinopathies representing a stenosing flexor tenosynovitis of the fingers. Adult trigger finger can be treated nonsurgically using activity modification, splinting, and/or corticosteroid injections. Surgical treatment options include percutaneous A1 pulley release and open A1 pulley release. Excision of a slip of the flexor digitorum superficialis is reserved for patients with persistent triggering despite A1 release or patients with persistent flexion contracture. Pediatric trigger thumb is treated with open A1 pulley release. Pediatric trigger finger is treated with release of the A1 pulley with excision of a slip or all of the flexor digitorum superficialis if triggering persists.
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Affiliation(s)
- Juan M Giugale
- Department of Orthopaedic Surgery, University of Pittsburgh, Suite 1010, Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - John R Fowler
- Department of Orthopaedic Surgery, University of Pittsburgh, Suite 1010, Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
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14
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Langer D, Luria S, Maeir A, Erez A. Occupation-based assessments and treatments of trigger finger: a survey of occupational therapists from Israel and the United States. Occup Ther Int 2014; 21:143-55. [PMID: 24821018 DOI: 10.1002/oti.1372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to describe the reported evaluation and treatment methods commonly administered by occupational therapy (OT) specialists in hand therapy for patients with trigger finger (TF). Sixty-one therapists from Israel and the United States completed an electronic survey. Sixty-nine per cent of the therapists reported evaluating TF symptoms (body function level) as part of their assessment protocol; however, only 25% reported the use of occupation-based measures for the assessment of people with TF. All therapists reported using orthoses to treat TF, yet significant differences were found between the groups regarding the frequency of using physical agent modalities, exercise and activity modifications. The results of the study point to the limited use of occupation-based assessments and to a lack of consensus regarding treatment guidelines for TF. The study is limited by a restricted sample size and a low response rate from US therapists, which warrant caution in generalization of the findings. Further research is needed to study the broad implications of TF in order to inform the assessment of TF in OT and to establish the foundations for future treatment efficacy studies.
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Affiliation(s)
- Danit Langer
- Occupational Therapy, Hebrew University, Mount Scopus, PO Box 24026, 31reuven St, Jerusalem, 91240, Israel
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15
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Tarbhai K, Hannah S, von Schroeder HP. Trigger finger treatment: a comparison of 2 splint designs. J Hand Surg Am 2012; 37:243-9, 249.e1. [PMID: 22189188 DOI: 10.1016/j.jhsa.2011.10.038] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 10/20/2011] [Accepted: 10/20/2011] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Kauser Tarbhai
- University of Toronto Hand Program, Toronto Western Hospital, Toronto, Ontario, Canada
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17
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Abstract
Trigger finger is a common finger aliment, thought to be caused by inflammation and subsequent narrowing of the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger. Although it can occur in anyone, it is seen more frequently in the diabetic population and in women, typically in the fifth to sixth decade of life. The diagnosis is usually fairly straightforward, as most patients complain of clicking or locking of the finger, but other pathological processes such as fracture, tumor, or other traumatic soft tissue injuries must be excluded. Treatment modalities, including splinting, corticosteroid injection, or surgical release, are very effective and are tailored to the severity and duration of symptoms.
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18
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Brito JL, Rozental TD. Corticosteroid injection for idiopathic trigger finger. J Hand Surg Am 2010; 35:831-3. [PMID: 20381976 DOI: 10.1016/j.jhsa.2010.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/03/2010] [Indexed: 02/02/2023]
Affiliation(s)
- Jorge L Brito
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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19
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Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of splinting for the treatment of trigger finger. J Hand Ther 2009; 21:336-43. [PMID: 19006759 DOI: 10.1197/j.jht.2008.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 05/02/2008] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the efficacy of custom thermoplastic splinting designed to limit metacarpalphalangeal (MCP) joint flexion for trigger finger as a first treatment option. This study was a single group, prepost design with 28 participants fit with a low-profile custom thermoplastic MCP blocking (ring) splint. The pre- and post outcome measures included: stages of stenosing tenosynovitis (SST), grip strength, Numeric Pain Rating Scale (NPRS), the number of triggering events in ten active fists, and participant perceived improvement in symptoms. These measures were taken at the time of initial assessment before splint fabrication and after six weeks of continuous splint wear. Participants were given an educational handout on trigger finger and exercises to complete independently. After the use of a splint, there were statistically significant improvements in the SST, NPRS, the number of triggering events in ten active fists, and in the participant perceived improvement in symptoms. Grip strength did not significantly change. This study demonstrated a benefit from the use of a custom thermoplastic splint for an isolated incidence of trigger finger based on chosen outcome measures.
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Akhtar S, Bradley MJ, Quinton DN, Burke FD. Management and referral for trigger finger/thumb. BMJ (CLINICAL RESEARCH ED.) 2005. [PMID: 15994689 DOI: 10.1136/bmj.331.7507.30.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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