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A Retrospective Review to Determine the Long-term Efficacy of Orthotics for Trigger Finger
Kristin A. Valdes, OTD, OT, CHT
Hand Works Therapy, Venice , FL

Purpose: To evaluate the use of orthotics designed to restrict composite digit flexion in an attempt to resolve isolated digit trigger finger, trigger thumb, and multiple incidence of trigger finger.

Background: Trigger fingers are a common finger ailment, thought to be caused by inflammation and subsequent narrowing of the A1 pulley.  

Methods: Data was extracted from 46 charts during a 5 year period from January 2005 to December 2010.  The information extracted included: age, gender, digits involved, co-existing diagnoses, triggering grade using the Stages of Stenosing Tenosynovitis (SST), VAS pain score, orthotic provided, and long term result following orthotic application. Two types of orthotics were used. Isolated trigger fingers wore a custom digit orthotic that prevented PIP flexion. Multiple trigger fingers wore a hand based orthotic that immobilized the MP joints of involved fingers in 10 degrees of flexion. One-year follow-up was performed to determine if the patients required further surgical intervention or steroid injection. The data was analyzed to determine the efficacy of splinting.

Results: Mean age of subjects was 68.48 years. 60% of the subjects were female and 40% were males.  63 trigger fingers were involved. Finger involvement was as follows: index 9.5%, long 41%, ring 27%, small 9.5%, and thumb 13%.  Seventeen patients (37%) had trigger finger of more than one digit. Twenty-nine patients (63%) had isolated incidence of trigger finger.  Mean pain score pre orthotic: 5.63, post orthotic 1.20.  Paired t-test on pain score demonstrated p<0.005 level of significance between pre and post scores. Mean SST score pre orthotic: 3.93, post orthotic 1.21.  Paired t-test performed on the SST score demonstrated p<0.005 level of significance between pre and post scores.  The Effect Size of the SST change score is 0.97 that demonstrates a large responsiveness effect. There was an 87% (40 patients) success rate with the orthotic intervention.  The estimate has reasonable precision.  The proportion is 85% and the width of the confidence interval is 10%. 4.3 (2 patients) had surgery and 8.5% (4 patients) received a steroid injection in the year following orthotic application.

Conclusion: This study demonstrated a clinically significant positive relationship between the use of a custom orthotic and the subjective reduction of pain and the objective SST outcome measure for patients who have isolated trigger finger, multiple trigger fingers, or trigger thumb.

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