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

Abstract

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.

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

“…The splint-added group had greater reduction in pain (as measured by the Numeric Rating Scale for pain) and symptom severity (according to the Persian-translated Boston Carpal Tunnel Syndrome Questionnaire) at 3 months. There was no difference in reduction in functional scores between the groups [35]. Pain reduction at 3 months in the splint-added group of that study differs from our study, which found no differences in VAS score reduction between the steroid injection and combination treatment groups.…”

“…Pain reduction at 3 months in the splint-added group of that study differs from our study, which found no differences in VAS score reduction between the steroid injection and combination treatment groups. The difference might have been because of less-severe trigger finger presentations; for example, they excluded patients with underlying diabetes mellitus, a factor strongly associated with failure of local corticosteroid injection [4,15] and the prolonged splint protocol (full-time for 3 months) in the previous study [35]. Additionally, that previous study used the Boston Carpal Tunnel Syndrome Questionnaire to evaluate pain and function.…”