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

trigger finger orthosis

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

Leave a Reply Cancel Reply






More To Read

Assessments Seen in the Hand Therapy World 

May 15, 2022

By: Dalton Busch  Below I have created a list of some of the common assessments that are seen in the hand therapy world. Keep in mind that this list is not inclusive of all the assessments you might come across in this setting. With each assessment, I describe what it is, who the assessment is…

Read More

Peripheral nerve injury: A hand therapist’s assessment of sensory return.

June 26, 2022

Sensory return after a hand injury specifically a peripheral nerve injury  After a peripheral nerve injury, there are often times impairments in sensory function and/or motor function.  The rate of recovery varies based on the degree of injury, the overall health of the patient, and the patient’s age.   After an injury, it is important…

Read More

What is the real job of the Lumbricals?

February 14, 2021

Crowley, J. S., Meunier, M., Lieber, R. L., & Abrams, R. A. (2020). The Lumbricals Are Not the Workhorse of Digital Extension and Do Not Relax Their Own Antagonist. The Journal of Hand Surgery. The Skinny: What do the lumbricals do? There is a long-standing belief that the lumbricals act as a counterforce to the…

Read More
Envelope_1

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.