Comparative effectiveness of various treatment strategies for trigger finger by pairwise meta-analysis

Shen, Po-Chih; Chou, Shih-Hsiang; Lu, Cheng‐Chang; Fu, Yin‐Chih; Lu, Chun-Kuan; Liu, Wen-Chih; Huang, Peng‐Ju; Tien, Yin-Chun; Shih, Chia-Lung

doi:10.1177/0269215520932619

Cited by 9 publications

(15 citation statements)

References 31 publications

(53 reference statements)

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“…In our study, the effects of CI did not improve after 1 month, as it can be recognized in Figure 3. This is also compatible with the results of some other studies for the treatment of TF (Shen et al., 2020). Efficacy and the lack of important side effects for a single dose of CI had also been indicated in other studies (Fleisch et al., 2007; Schubert et al., 2013).…”

Section: Discussionsupporting

confidence: 93%

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The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial

Tajik

Shirzad

Rahimibarghani

et al. 2022

Musculoskeletal Care

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Background Trigger finger is the most common flexor tendinopathy affecting the general population. We evaluated the effects of adding a static metacarpophalangeal joint splint to corticosteroid injection for the management of trigger finger in the short term. Methods We carried out a randomized controlled trial with two parallel arms in Department of Physical Medicine and Rehabilitation at a university hospital. We randomly allocated 60 participants (34 women) with trigger fingers other than the thumb to two groups (both n = 30). The mean (SD) age was 41.5 (7.6) years. All participants received a single injection of 40 mg methylprednisolone plus 0.5 ml of lidocaine at the A1 pulley. Patients in the splint group wore a full time static splint for blocking the metacarpophalangeal joint for 3 months. The primary outcome was the Numerical Pain Rating Scale and the secondary outcomes were Boston questionnaire scores for symptom severity and functional status, grip strength, and the stages of stenosing tenosynovitis. We measured the outcomes at baseline, and in 1 and 3 months post‐intervention. Results Both interventions were effective; however, the splint group showed more reductions in pain (p = 0.013) and symptom severity (p = 0.047) and a larger decrease in the stages of tenosynovitis (p = 0.004) after 3 months. There was no significant difference in decreasing functional scores between the groups (p = 0.162). The splint group had a better (but not statistically significant) restoring grip strength (p = 0.056). Conclusion Wearing of a static metacarpophalangeal joint splint for 3 months following a single injection of corticosteroid increases and stabilises the benefits of the treatment for trigger finger.

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Section: Discussionsupporting

confidence: 93%

“…Trigger finger (TF) is the most common flexor tendinopathy affecting the general population, particularly middle‐aged women (Makkouk et al., 2008; Shen et al., 2020). It is a frequent symptom in rheumatoid arthritis (Stellbrink, 1971).…”

Section: Introductionmentioning

confidence: 99%

The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial

Tajik

Shirzad

Rahimibarghani

et al. 2022

Musculoskeletal Care

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“…A subgroup analysis from one meta-analysis of randomized trials found that corticosteroid injection was much more likely to relieve symptoms than other nonsurgical treatments, including NSAIDs, physiotherapy, extracorporeal shockwave, and placebo injection [21]. However, a recent meta-analysis found no differences in efficacy between steroid injection and physiotherapy or NSAID injection when the nonsurgical treatments were separated into physiotherapy and NSAID injection groups, with subgroup analyses at various follow-up periods [33]. A recent systematic review found that most studies showed relief of pain and reduction in triggering in 47% to 93% of patients who were treated with an orthosis for trigger finger [20].…”

Section: Introductionmentioning

confidence: 99%

Are There Differences in Pain Reduction and Functional Improvement Among Splint Alone, Steroid Alone, and Combination for the Treatment of Adults With Trigger Finger?

Atthakomol

Wangtrakunchai

Chanthana

et al. 2023

Clin Orthop Relat Res

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Background Steroid injection and splinting, which are commonly recommended nonsurgical treatments in adults with trigger finger, have been demonstrated to effectively relieve pain and improve function. However, to our knowledge, there have been no direct comparisons of pain relief and function improvement with splinting alone, steroid injection alone, or a combination of splinting and steroid injection in patients with this diagnosis. Question/purpose Are there differences in pain reduction and functional improvement in adults with trigger finger treated with splinting alone, steroid injection alone, and a combination of splinting and steroid injection at 6, 12, and 52 weeks after the intervention? Methods Between May 2021 and December 2021, we treated 165 adult patients for trigger finger at an academic university hospital. Based on prespecified criteria, all patients we saw during that period were eligible, but 27% (45 of 165) were excluded because they had received a previous local corticosteroid injection (n = 10) or they had concomitant carpal tunnel syndrome (n = 14), first carpometacarpal joint arthritis (n = 3), osteoarthritis of the hand (n = 6), de Quervain disease (n = 3), multiple-digit trigger finger (n = 6), or pregnancy during the study period (n = 3). After screening, 120 patients were randomized to receive either splinting (n = 43), steroid injection (n = 40), or splinting plus steroid injection (n = 37). Patients were randomly assigned to the different treatments using computer-generated block randomization (block of six). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. Both the allocator and the outcome assessor were blinded. Splinting involved the patient wearing a fixed metacarpophalangeal joint orthosis in the neutral position at least 8 hours per day for 6 consecutive weeks. Steroid injection was performed using 1 mL of 1% lidocaine without epinephrine and 1 mL of triamcinolone acetonide (10 mg/mL) injected directly into the flexor tendon sheath. No patients were lost to follow-up or had treatment failure (that is, the patient had persistent pain or triggering with the trigger finger treatment and requested additional medical management including additional splinting, steroid injection, or surgery) at 6 or 12 weeks after the intervention, and at 52 weeks, there was no difference in loss to follow-up among the treatment groups. An intention-to-treat analysis was performed with all 120 patients, and a per-protocol analysis was conducted with 86 patients after excluding patients who were lost to follow-up or had treatment failure. Primary outcomes evaluated were VAS pain reduction and improvement in Michigan Hand Outcomes Questionnaire (MHQ) scores at 6, 12, and 52 weeks after the intervention. The minimum clinically important difference (MCID) values were 1 and 10.9 for the VAS and MHQ, respectively. Results There were no clinically important differences in VAS pain scores among the three treatment groups at any timepoint, in either the intention-to-treat or the per-protocol analyses. Likewise, there were no clinically important differences in MHQ scores at any timepoint in either the intention-to-treat or the per-protocol analyses. Conclusion Splinting alone is recommended as the initial treatment for adults with trigger finger because there were no clinically important differences between splinting alone and steroid injection alone in terms of pain reduction and symptom or functional improvement up to 1 year. The combination of steroid injection and splinting is disadvantageous because the benefits in terms of pain reduction and symptom or functional improvement are not different from those achieved with steroid injection or splinting alone. Level of Evidence Level I, therapeutic study.

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“…The reported lifetime prevalence in the general population ranges from 2.5 to 3% [2]. The prevalence of the trigger thumb is modest in the general adult population, ranging from 3.3% per 1000 live births in the pediatric population [3].…”

Section: Introductionmentioning

confidence: 99%

Does shockwave therapy have a role on trigger thumb?—a single-case design

Verma¹,

Pradhan²,

Singh³

2022

Bull Fac Phys Ther

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Background The trigger thumb is a clinically unusual and rare phenomenon. The trigger finger is most observed on the ring or middle fingers. Clinical signs include reduced tendon excursion and the formation of nodules at the base of the metacarpals. As a result, grip strength may be reduced, making gripping tasks uncomfortable. Many treatments have been proposed to treat trigger finger symptoms; however, the effectiveness of shockwave therapy is still being contested. As a result, the purpose of this trigger thumb case study is to assess the effect of shockwave therapy on grip performance. Case presentation A 53-year-old housewife reported to the outpatient department with pain at the base of her right thumb, recurring locking episodes, morning pain and stiffness, and a 10-year history of diabetes. Based on the clinical presentation and physical examination of the patient, an orthopedic sports physician diagnosed it as a trigger thumb. Analgesics were initially administered, and the patient was then referred to physiotherapy for rehabilitation. All outcomes improved substantially during the follow-up after six sessions of physical therapy, which included shockwave therapy and an exercise program. Conclusion This study concluded that the protocol developed specifically for the treatment of the trigger thumb is efficacious. Therefore, future research with a larger number of participants is required to validate this approach.

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Comparative effectiveness of various treatment strategies for trigger finger by pairwise meta-analysis

Cited by 9 publications

References 31 publications

The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial

The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial

Are There Differences in Pain Reduction and Functional Improvement Among Splint Alone, Steroid Alone, and Combination for the Treatment of Adults With Trigger Finger?

Does shockwave therapy have a role on trigger thumb?—a single-case design

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