Which is better: Splinting the MCP or PIP joint when managing Trigger Finger?

Teo, S. H., Ng D. C., Wong, Y.K.(2018).  Effectiveness of proximal interphalangeal joint blocking orthosis vs metacarpophalangeal joint blocking orthosis in trigger digit: A randomized clinical trial. Journal of Hand Therapy, 1-7.

The Skinny- This study compared PIP joint immobilization via an Oval-8TM with a custom MCP blocking trigger finger orthosis treatment

In the Weeds – Patient (n=35) with Trigger Finger (n=43) were analyzed.  Twenty-three patients were allocated to the PIP joint splinting group and 20 patients were in the MCP splinting group.  Patients wore the orthosis for eight weeks – these were MCP splint for trigger finger, MCP blocking splint and pip joint splint.   

Pain
reduction was observed in both groups, but pain reduction was greater with PIP
joint splinting compared to the MCP joint splinting group. There was only
significant improvement in QuickDASH for the PIP splinting Group.  Patients wore the pip joint splint
significantly longer during the day compared to the MCP splinting group, most
likely due to improved comfort. 

Bringing it Home- Findings suggests both orthoses are effective in reducing QuickDASH scores, reducing pain and improving overall trigger finger symptoms based on Green’s Classification.  However, the pip joint immobilization splint was better for improved function and improved compliance. 

Rationale for rating. Small sample size. All patients with comorbidities were excluded limiting the generalizability of finding.  Immobilizing the PIP joint compared to the MCP allows more function and improved compliance.  When immobilizing the MCP you limit intrinsic grasp which is a necessity for function. The authors recommend wearing the orthosis for a 4 week duration for 24 hours in order to reduce triggering symptoms followed by night-time splint wear for another 3-4 weeks. 

10 Comments

  1. Elizabeth Carter on June 3, 2019 at 8:18 am

    This is great! Keep them coming!

  2. kate martin on June 3, 2019 at 4:26 pm

    really interesting- thanks

    • Josh MacDonald on June 5, 2019 at 6:20 am

      We’re glad you liked it. We will keep them coming.

  3. Nicole on June 3, 2019 at 7:46 pm

    Love this!!! Thank you.

    • Josh MacDonald on June 5, 2019 at 6:17 am

      Glad you liked it!

  4. Mesplie on June 6, 2019 at 10:33 pm

    Thanks for sharing !
    What about PIP range of motion ?

    • Miranda Materi on June 9, 2019 at 11:07 am

      Typically we instruct the patient with prom and to avoid active if it is causing the triggering to occur.

  5. Masha Pinsky on November 20, 2021 at 9:54 am

    Thanks for sharing!
    Important to know.

  6. Justine on January 24, 2023 at 1:47 pm

    This is great – curious if there was a time frame of symptoms present for inclusion criteria and or for splinting to be effective? ie if the patient had triggering for less than 3 months splinting was found to be effective; or were patients who had symptoms for longer than x-amount of weeks/months were not included, etc etc? I have always been under the impression if symptoms are too severe/present for more than 4 weeks cortisone injection is kind of the gold standard as splinting is less effective at that point? Thank you!

    • Miranda Materi on February 3, 2023 at 5:27 pm

      Yes, the longer the condition goes on the more difficult it is to treat. From personal experience, I have had patients resolve their symptoms for trigger fingers that have been going on for 6 months

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