Does Orthosis Improve Outcomes of Conservative Treatment in Trigger Fingers? A 3-Arm Prospective Randomized Controlled Trial.
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OBJECTIVE: To evaluate whether the addition of an orthosis improved the efficacy of cortisone injection for the nonoperative management of trigger finger. DESIGN: Block randomized controlled trial. SETTING: Outpatient hand clinic. PARTICIPANTS: 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). INTERVENTIONS: Patients' hands were randomized to nighttime extension orthosis, cortisone injection, or combined treatment, stratified by the Green severity score and comorbid diabetes. MAIN OUTCOME MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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.
