Does Orthosis Improve Outcomes of Conservative Treatment in Trigger Fingers? A 3-Arm Prospective Randomized Controlled Trial.

Abstract

To evaluate whether the addition of an orthosis improved the efficacy of cortisone injection for the nonoperative management of trigger finger. Block randomized controlled trial. Outpatient hand clinic. Individuals presenting to our center with Green severity grade 1-3 trigger finger, aged 18-80, were eligible for inclusion (N=226). Exclusion criteria were previous treatment with either a splint or cortisone injection, trigger thumb, >2 digits involved, grade 4 trigger, or an allergy to cortisone (N=118). Patients' hands were randomized to nighttime extension orthosis, cortisone injection, or combined treatment, stratified by the Green severity score and comorbid diabetes. Patient-reported outcome measures and the number of triggering occurrences with 10 repeated grips were collected at 6 weeks and 3, 6, and 12 months. The study included 104 patients representing 122 trigger fingers in 115 hands, with an average follow-up of 29 months. At 6 weeks, there was no significant difference in the incidence of triggering, symptom relief, or the Patient-Reported Wrist and Hand Evaluation score between injection or combined treatment groups. The overall success rate with conservative treatment was high, with 68.9% experiencing resolution or improvement of their symptoms. Grade 3 trigger fingers had a significantly higher rate of surgical release compared with lower-grade trigger fingers (39.1% vs 22.4%, P=.05). Our study shows no significant benefit of adding an orthosis to cortisone injection in all trigger grades. Overall success with conservative treatment was high (68.9%) in this cohort. Conservative management of grade 1 and 2 triggers is successful in about 75% of patients, regardless of whether treatment is an orthosis, injection, or both, compared with a 60% success rate for grade 3.