A proximal interphalangeal joint custom-made orthosis in trigger finger: Functional outcome

Relative motion splints versus metacarpophalangeal joint blocking splints in the management of trigger finger: Study protocol for a randomized comparative trial

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).

Orthosis vs. exercise for the treatment of adult idiopathic trigger fingers: A randomized clinical trial

OBJECTIVE

Trigger finger is a common clinical disorder that often results in pain and functional limitations. This study aimed to determine whether joint-blocking orthosis was effective in treating adult idiopathic trigger fingers.

METHODS

Fifty-five participants were randomly assigned to either a hand therapy group or an orthosis group that immobilized the proximal interphalangeal joint for 6 weeks. The Green classification of triggering; short-form version of the Disabilities of the Arm, Shoulder, and Hand; and numeric pain rating scale were used to assess participants' data.

RESULTS

The orthosis was "successful" in completely resolving the symptoms of trigger finger in 53.6% of the participants at 6 weeks postintervention, whereas the hand therapy control group did not result in any "successful" outcomes. The Green classification score for the orthosis group decreased from 2.68 (standard deviation = 0.47) at baseline to 0.93 (standard deviation = 1.12) at 6 weeks. The short-form version of the Disabilities of the Arm, Shoulder, and Hand disability score was significantly reduced after wearing the orthosis, F (2, 52) = 74.16 p < 0.001, and improved from baseline (M = 37.6) to 6 weeks (M = 20.26). The pain intensity score was also significantly decreased after wearing the orthosis, F (2, 52) = 52.17 p < 0.001, partial η2 = 0.67.

CONCLUSION

Using orthosis to immobilize the proximal interphalangeal joint, day and night, for 6 weeks, is an effective and reasonable option for treating idiopathic trigger fingers with Green grade 2 or 3. Hand therapy without orthosis did not result in significant improvements.

Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review

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.