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Conservative management of trigger finger: A systematic review

Published:December 28, 2017DOI:https://doi.org/10.1016/j.jht.2017.10.016

      Highlights

      • Symptom reduction was noted by using an orthosis for 6-10 weeks continually.
      • Various orthosis may be used, limiting excursion by immobilizing MP, PIP, or DIP.
      • Use validated patient outcome measures and high level studies for best practice.

      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.

      Keywords

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      JHT Read for Credit

      Quiz: # 609

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
      • #1.
        The study design is
        • a.
          RTCs
        • b.
          qualitative
        • c.
          prospective cohort
        • d.
          a systematic review
      • #2.
        The recommended immobilization time is
        • a.
          2 weeks
        • b.
          4-6 weeks
        • c.
          6-10 weeks
        • d.
          12 weeks
      • #3.
        A discrepancy in size between the flexor tendon and the __________ pulley is felt to be a primary cause of trigger finger
        • a.
          A1
        • b.
          A2
        • c.
          C1
        • d.
          C2
      • #4.
        _________________ were found to be ineffective in managing trigger finger
        • a.
          steroid injections
        • b.
          NSAIDs
        • c.
          surgical releases
        • d.
          resting orthotics
      • #5.
        There was a sufficient enough number of RCTs to limit this study to only RCTs
        • a.
          true
        • b.
          false
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.