Trigger Finger Treatment

Study Overview
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Brief Summary
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Trigger finger is a common disorder of the hand which causes pain at the A1 pulley, inflammation, stiffness and/or snapping during movement. This observational study compared all of the possible treatments and combinations of treatments for trigger finger at the A1 pulley, including surgery, cortisone injections and hand therapy.

Detailed Description
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Trigger finger is a common disorder of the hand which causes pain at the A1 pulley, inflammation, stiffness or snapping during movement. This can be very debilitating. Current treatment includes local steroid injection, oral NSAIDS, resting orthoses, physical or occupational therapy and surgical intervention. The aim of this prospective study with an observational design was to determine the outcome between surgical, hand therapy rehabilitation, and corticosteroid injection interventions for trigger finger. There were 6 treatment groups: surgery, corticosteroid injection, 1 visit of hand therapy for orthosis fabrication and therapeutic exercise, hand therapy in combination with cortisone injection, Modality hand therapy alone (ongoing visits) or with corticosteroid injections.

Official Title
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Trigger Finger Treatment - An Outcomes Study. Comparing 6 Traditional Treatment Techniques

Conditions
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Trigger Finger, Trigger Digit, Stenosing Tenosynovitis

Intervention / Treatment
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* Procedure: surgery
* Procedure: corticosteroid injections
* Other: Hand Therapy
* Other: Modality Hand Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: trigger finger in digit 2-5 Exclusion Criteria: if prior treatment for trigger finger, or Trigger thumb

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Surgery<br>Patients who underwent surgical release of A1 pulley | Procedure: surgery<br>* A1 pulley release of finger<br>|
| corticosteroid injections only<br>Patients who underwent local corticosteroid injections only, and no other treatment | Procedure: corticosteroid injections<br>* corticosteroid injection to A1 pulley<br>|
| hand therapy only occupational/physical<br>1 visit: orthosis fabrication, range of motion, nodule and ice massage. | Other: Hand Therapy<br>* orthosis fabrication, therapeutic exercise for range of motion to digits, ice massage, nodule massage, patient education,<br>* Other names: occupational therapy;|
| Injection and Hand therapy<br>This group of participants received a combination of corticosteroid injection in the affected finger and one visit of hand therapy. | Procedure: corticosteroid injections<br>* corticosteroid injection to A1 pulley<br>Other: Hand Therapy<br>* orthosis fabrication, therapeutic exercise for range of motion to digits, ice massage, nodule massage, patient education,<br>* Other names: occupational therapy;|
| Modality Hand Therapy<br>Ongoing hand therapy treatment, which included the above plus modalities such as ultrasound or iontophoresis. | Other: Modality Hand Therapy<br>* orthosis fabrication, therapeutic exercise for range of motion to digits, ice massage, nodule massage, patient education, plus modalities such as ultrasound, iontophoresis<br>|
| Injection and Modality Hand Therapy<br>Ccombination of local cortiscosteroid injection to the affected digit and ongoing hand therapy with modalities. | Procedure: corticosteroid injections<br>* corticosteroid injection to A1 pulley<br>Other: Modality Hand Therapy<br>* orthosis fabrication, therapeutic exercise for range of motion to digits, ice massage, nodule massage, patient education, plus modalities such as ultrasound, iontophoresis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Functional use using Quick DASH 6 weeks | Change from baseline to 6 weeks Quick DASH | Day 1, 6 weeks | 
| Change in Functional use using Quick DASH 3 months | Change from baseline to 3 months Quick DASH | Day 1, 3 months | 
| Change in Functional use using Quick DASH 6 months | Change from baseline to 6 months Quick DASH | Day 1, 6 months | 
| Change in Edema 6 weeks | Baseline to 6 weeks Circumferential measurement in centimeters of the proximal phalanx | day 1, 6 weeks | 
| Change in Edema 3 months | Baseline to 3 months weeks Circumferential measurement in centimeters of the proximal phalanx | day 1, 3 months | 
| Change in Edema 6 months | Baseline to 6 months weeks Circumferential measurement in centimeters of the proximal phalanx | day 1, 6 months | 
| Change in Pain on a likert scale 6 weeks | Baseline to 6 weeks pain on a 0-10 scale | 1 day, 6 weeks | 
| Change in Pain on a likert scale 3 months | Baseline to 3 months pain on a 0-10 scale | 1 day, 3 months | 
| Change in Pain on a likert scale 6 months | Baseline to 6 months pain on a 0-10 scale | 1 day, 6 months | 
| Change in Range of motion 6 weeks | Baseline to 6 weeks flexion and extension range of motion at metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) using a finger goniometer. | 1 day, 6 weeks | 
| Change in Range of motion 3 months | Baseline to 3 months flexion and extension range of motion at metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) using a finger goniometer. | 1 day, 3 months | 
| Change in Range of motion 6 months | Baseline to 6 months flexion and extension range of motion at metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) using a finger goniometer. | 1 day, 6 months | 
| Change in Severity or Grade of triggering 6 weeks | Baseline to 6 weeks Using the scale by Patel and Bassini to measure the amount of triggering 1=normal joint, 6=locked in flexion | 1 day, 6 weeks | 
| Change in Severity or Grade of triggering 3 months | Baseline to 3 months Using the scale by Patel and Bassini to measure the amount of triggering 1=normal joint, 6=locked in flexion | 1 day, 3 months | 
| Change in Severity or Grade of triggering 6 months | Baseline to 6 months Using the scale by Patel and Bassini to measure the amount of triggering 1=normal joint, 6=locked in flexion | 1 day, 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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treatment outcome, hand therapy, physical therapy, occupational therapy