Effectiveness of conservative management in treating trigger finger in Diabetic patients: Prospective Cohort of Diabetic patients
Alexandra B Munn, MD, MSc1, Kathryn Minkhorst, BSc1, Joy MacDermid, BScPT, MSc, PhD2 and Ruby Grewal, MD, MSc3, (1)Western University, London, ON, Canada, (2)Hand and Upper Limb Center, University of Western Ontario, Roth124;MacFarlane Hand and Upper Limb Centre, London, ON, Canada, (3)Hand and Upper Limb Center, Western University, London, ON, Canada
Trigger finger is a common condition that affects approximately 3% of adults but can affect as high as 10% of adults with diabetes. The conservative measures (i.e. orthoses, injections) typically used to treat trigger fingers are not felt to be as effective in diabetics. The goal of this study was to report the effectiveness of conservative management of trigger finger in patients with diabetes.
A cohort of 43 patients with diabetes were extracted from a larger randomized control trial where patients were stratified by Green Score to one of three conservative treatment arms. Patients had Green severity grade 1-3 trigger finger and had never received treatment for trigger finger. Treatment was either a custom-fit night time extension orthosis, cortisone injection, or both. Patient reported outcome measures (perceived recovery, pain, function, and patient-reported wrist and hand evaluation score) and presence of triggering with 10 repeated grip were assessed at 6-week, 3-, 6-, and 12-month intervals. At 6-weeks patients were eligible to receive whatever treatment was deemed appropriate by the patient and surgeon. Side effects, complications, and additional interventions were tracked.
Between 2017-2021, 43 diabetic patients with trigger fingers were recruited by two surgeons with an average follow-up of 29 months. Treatment assignment included 15 patients receiving a night time splint, 14 patients receiving injections and 14 patients receiving both injections and splinting. At baseline, 62.8% of patients had Greenâ€™s grade 3 disease, 34.9% Grade 2 disease and 2.3% Grade 1 disease. From these, 30% had two digits involved. At 6 weeks, 60.5% of patients had either complete resolutions of symptoms or some improvement while only 23.3% had no relief of symptoms with conservative management. At baseline, 39.5% of patients had 10 episodes of triggering with 10 repeated grips. After 6 weeks of conservative management this was reduced to only 14% of patients. The PRWHE scores improved, on average, 25 points 6 weeks of conservative treatment. Of this group, only 32.6% of patients required surgical release of the trigger finger regardless of conservative management on average by 36.1 weeks.
Diabetic patients presenting for their first treatment of trigger finger at a hand clinic present with significant disease severity. Conservative treatment resulted in benefit for 60% of patients, but often was incomplete resolution. One third of patients in our cohort still required surgery but conservative management remains a successful option for patients with no previous treatment.
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