Scientific/Clinical Article| Volume 32, ISSUE 4, P444-451, October 2019

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Effectiveness of proximal interphalangeal joint–blocking orthosis vs metacarpophalangeal joint–blocking orthosis in trigger digit management: A randomized clinical trial


      • Pain reduction was greater in proximal interphalangeal joint–blocking orthosis (PIPJ-BO) than that in metacarpophalangeal joint–blocking orthosis (MCPJ-BO) group (2.65 vs 1.25, P = .0249).
      • Statistical significant improvement in Quick Disability of the Arm, Shoulder and Hand (8.81) in PIPJ-BO group (P = .0007).
      • 47.8% in PIPJ-BO group and 40% in MCPJ-BO group improved at least 1 trigger grade.
      • Duration of orthoses wear was 3.7 hours/day longer in the PIPJ-BO group (P = .001).
      • PIPJ-BO is more clinically time and cost-effective than MCPJ-BO.


      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).


      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.


      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.


      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.


      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.


      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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      JHT Read for Credit

      Quiz: # 635

      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 There is only one best answer for each question.
      • # 1.
        Subjects were diagnosed with trigger digit (aka trigger finger)
        • a.
          half (group one) involving the A1 pulley, and half (group 2) involving the A2 pully
        • b.
          all involving the A1 pulley
        • c.
          all involving the A2 pulley
        • d.
          all involving both the A1 and A2 pullies
      • # 2.
        Outcomes were measured by
        • a.
          Green’s classification rating
        • b.
          the Quick DASH
        • c.
          a pain assessment tool
        • d.
          all of the above
      • # 3.
        Determining which of the two different orthoses was to be worn was
        • a.
          based on severity of symptoms
        • b.
          by physician assignment
        • c.
          by random assignment
        • d.
          by therapist assignment
      • # 4.
        Patients were followed for
        • a.
          2 weeks
        • b.
          2 months
        • c.
          2 years
        • d.
          20 years
      • # 5.
        The authors preferred the PIP device and recommend wearing it for 24 hours a day for more than 8 weeks
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.