Which is better: Splinting the MCP or PIP joint when managing Trigger Finger?
Filed under Orthoses, Treatments
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
Leave a Comment
More To Read
A Hand Therapist’s Role in Nutrition Education for Wound Healing
By Brittany Day Role of nutrition in wound healing Nutrition plays an important function in the biological factors that contribute to normal wound healing (wound care nutrition). Patients without nutrient dense diets may experience diminished cell production, collagen synthesis, and wound contraction. There is sparse scientific evidence that explores the exact science behind nutrition and…
Read More
Intrinsic Hand Strengthening with Puttycise Tools
We are always looking for ways of the intrinsic hand strengthening. It is easy to overlook the importance of these small but mighty muscles. They are essential to performing functional grasps patterns. They can become weak in a short period of time due to their small size. So, How does intrinsic strengthening work?! The Basics…
Read More
Brachial Plexopathy Case Example in Hand Therapy
Brachial Plexopathy Case Example in Hand Therapy (plexopathy examples) One of the recent cases we have seen is a 13-year old with a brachial plexus injury. We are seeing the patient post-surgery for tendon transfers to increase functional use of his left upper extremity (LUE). Before the surgery, he could not extend the wrist and…
Read More
What to Know as a Hand Therapist When Choosing Thermoplastic Orthosis Material
By: Kelsey Melton Thermoplastic materials can have a variety of properties. Each supplier has a different version of each combination of variables for the therapist to choose from. The most common brands used for orthosis fabrication are Orfit, NorthCoast Medical (NCM), and Raylan. These brands all have their versions of thermoplastic material that vary in…
Read More
Sign-up to Get Updates Straight to Your Inbox!
Sign up with us and we will send you regular blog posts on everything hand therapy, notices every time we upload new videos and tutorials, along with handout, protocols, and other useful information.
This is great! Keep them coming!
really interesting- thanks
We’re glad you liked it. We will keep them coming.
Love this!!! Thank you.
Glad you liked it!
Thanks for sharing !
What about PIP range of motion ?
Typically we instruct the patient with prom and to avoid active if it is causing the triggering to occur.
Thanks for sharing!
Important to know.
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!
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