PMID- 37083487 OWN - NLM STAT- MEDLINE DCOM- 20240227 LR - 20240227 IS - 1528-1132 (Electronic) IS - 0009-921X (Print) IS - 0009-921X (Linking) VI - 481 IP - 11 DP - 2023 Nov 1 TI - Are There Differences in Pain Reduction and Functional Improvement Among Splint Alone, Steroid Alone, and Combination for the Treatment of Adults With Trigger Finger? PG - 2281-2294 LID - 10.1097/CORR.0000000000002662 [doi] AB - 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. CI - Copyright (c) 2023 by the Association of Bone and Joint Surgeons. FAU - Atthakomol, Pichitchai AU - Atthakomol P AUID- ORCID: 0000-0001-9737-4110 AD - Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. AD - Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Wangtrakunchai, Vorathep AU - Wangtrakunchai V AD - Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Chanthana, Phongniwath AU - Chanthana P AD - Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Phinyo, Phichayut AU - Phinyo P AD - Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. AD - Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Manosroi, Worapaka AU - Manosroi W AD - Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. AD - Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20230420 PL - United States TA - Clin Orthop Relat Res JT - Clinical orthopaedics and related research JID - 0075674 RN - 0 (Steroids) RN - F446C597KA (Triamcinolone Acetonide) SB - IM CIN - Clin Orthop Relat Res. 2023 Nov 1;481(11):2295-2297. PMID: 37249341 MH - Adult MH - Humans MH - *Splints MH - *Trigger Finger Disorder/drug therapy MH - Pain MH - Steroids/therapeutic use MH - Triamcinolone Acetonide MH - Treatment Outcome PMC - PMC10566884 COIS- Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research(R) editors and board members are on file with the publication and can be viewed on request. EDAT- 2023/04/21 18:43 MHDA- 2024/02/27 06:44 PMCR- 2024/11/01 CRDT- 2023/04/21 14:37 PHST- 2023/01/03 00:00 [received] PHST- 2023/03/20 00:00 [accepted] PHST- 2024/11/01 00:00 [pmc-release] PHST- 2024/02/27 06:44 [medline] PHST- 2023/04/21 18:43 [pubmed] PHST- 2023/04/21 14:37 [entrez] AID - 00003086-202311000-00034 [pii] AID - CORR-D-23-00077 [pii] AID - 10.1097/CORR.0000000000002662 [doi] PST - ppublish SO - Clin Orthop Relat Res. 2023 Nov 1;481(11):2281-2294. doi: 10.1097/CORR.0000000000002662. Epub 2023 Apr 20.