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Comparing Finger Splints for Trigger Finger

There is nothing more annoying than having your finger lock up on you and not being able to open your hand. Your hand gets stuck inside pants pockets. You can't reach into your pocket and pull out your wallet. Even taking care of business in the bathroom can become a challenge.

Trigger finger is a condition affecting the movement of the tendons as they move the finger(s) toward or away from the palm of the hand. In the early stages of this condition, there is pain, swelling, and a clicking sensation when moving the affected finger. But as the problem gets worse, the finger can get stuck or locked in a bent or straight position.

Treatment most often begins with conservative (nonoperative) care. Usually patients are put on antiinflammatory medications and given a splint. The finger splint is meant to help reduce symptoms. It is a fairly inexpensive means of treatment. In some cases, cortisone injections are prescribed or a combination of injection with splinting is recommended.

There are many different types of finger splints available. Some block movement of the metacarpophalangeal (MCP) joint closest to the palm. Others block movement of the tip of the finger (the distal interphalangeal (DIP) joint). Some splints are custom made (designed and molded specifically to each patient) while others are premade. Ready made splints are taken off the shelf with more of a one-size-fits-all approach.

In this study, hand therapists from the University of Toronto Hand Program compare two different types of finger splints in the treatment of trigger finger. Thirty (30) people with trigger finger participated in the study. The purpose of the study was two-fold. First, to find out if splinting for trigger finger is even helpful. And second, to see if one type of splint works better than another.

Patients were randomly assigned to one of the two splint groups. One group had the metacarpophalangeal (MCP) joint blocking splint. This splint wraps around the MCP joint and extends down two-thirds of the way across the palm below the affected finger. It also forms a ring around the proximal phalanx (middle bone of the finger).

The second type of splint was a distal interphalangeal (DIP) blocking splint that wrapped around the tip of the finger. There were three different types of DIP blocking splints to choose from. The hand therapist selected the one that best suited each patient in this group. Patient comfort was a key feature in the selection process.

They wore the splints as much as possible 24/7 (24 hours of each day, every day) for six weeks. Then they were allowed to keep wearing the splint or gradually lessen the amount of time on the finger until stopping its use altogether.

Results were measured by comparing range-of-motion, grip strength, frequency of triggering, and function. These measures were taken before treatment began and again one week, three weeks, and six weeks after the start of splinting. Patients were asked to comment on the level of difficulty in performing daily activities while wearing the splint. They also rated the splint as either comfortable or uncomfortable.

Results showed better responses to the metacarpophalangeal (MCP) joint blocking splint. Three-fourths of the patients wearing the MCP splint reported positive results. This was compared with only 50 per cent effectiveness in the group using the distal interphalangeal (DIP) joint splint.

In both groups, patients with diabetes or carpal tunnel syndrome were more likely to experience failure (no improvement in triggering). All patients also noticed increased stiffness and decreased grip strength after wearing their splints. Once they stopped wearing their splints, these symptoms went away.

In terms of function, everyone noted that it was awkward when trying to use the hand or work with the finger splint on. It took longer to get things done. Some patients reported the edges of the MCP splint were digging into their skin. In the DIP splinting group, there were instances where the splint would slip off the finger too easily.

On the plus side, once the finger splint was removed or discontinued in use, the benefits (reduced triggering, less pain) remained for the full six weeks. Many patients experienced continued improvements that were maintained for a full year. Some patients continued wearing the splint after the six-week study period but most had abandoned its use by the end of 12-weeks.

Experts in the area of hand function and disease believe that resting the soft tissues of the finger give time for the trigger finger to resolve on its own. By changing the way the tendons pull around the joints, there is less inflammation and a chance for the tendon sheath to heal and recover fully.

The authors of this study conclude that the more comfortable MCP joint splint may be the best way to begin treatment for trigger finger. Factors to consider in selecting the best choice for each patient include symptoms, required work-related activities, and preferred leisure-time activities.

If the patient does not get enough pain relief using this splint, then the more restrictive DIP joint splint can be used instead. The hand therapist is advised to keep an eye on joint stiffness for these patients.

Reference: Kauser Tarbhai, BScOT, et al. Trigger Finger Treatment: A Comparison of 2 Splint Designs. February 2012. Vol. 37A. No. 2. Pp. 243-249.

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