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Hypothesis: Treatment of trigger finger by corticosteroid injection and splinting is superior to corticosteroid treatment alone.
Stenosing tenosynovitis, or more commonly "trigger finger" is a disease that can severely impact a patient's quality of life. Its incidence is said to be 28 persons per 100,000 annually. The disease is manifested in one or more fingers by finger locking in flexion or extension, leading to pain, discomfort and at times, loss of function. Patients frequently report having to snap their fingers back in position to alleviate symptoms. The pathophysiology relates to thickening of the flexor tendon sheath, which can impair tendon gliding within it.
Although multiple treatment strategies are available, it is not entirely clear which treatment offers the best outcome, especially when the finger has not reached end stage locking. In general, corticosteroid injection into the tendon sheath is offered as the first line of treatment. Splinting alone has also been described as a reliable method treatment. However, Patel and Bassini indicated that steroid injection results in fewer recurrences than splinting alone. Surgery is typically reserved for recurrent triggering, cases refractory to injection, or digits locked in flexion. The effects of steroid injection followed by splinting however have not been reported in a comprehensive fashion. It may be that this form of treatment could result in a synergistic effect, which can offer a treatment modality superior to either injection or splinting alone. The purpose of this research study is to determine whether steroid injection followed by splinting is superior to injection alone.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Corticosteroid injection | Active Comparator | Standard corticosteroid injection. |
|
| Corticosteroid Injection and Trigger Splint | Experimental | Corticosteroid Injection + Trigger Splint + Education + Home Exercises |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Corticosteroid injection + Trigger Splint+ Education and Home exercises | Procedure | Standard corticosteroid injection. Hand based, single digit trigger splint will be applied. Education and instructions about home exercises. |
| Measure | Description | Time Frame |
|---|---|---|
| Stage of finger triggering | Trigger Finger Stage:
| 1, 2, 4-6, and 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Failed treatment: surgical intervention required | Failed treatment OR Successful treatment | 1,2, 4-6, 12months |
| Patient rated functional outcome | Quick Disabilities of the Arm, Shoulder and Hand questionnaire Patient Specific Functional Scale |
| Measure | Description | Time Frame |
|---|---|---|
| Compliance with splint and hand exercises | For patients who are assigned to injection and splint group, home exercise and splint compliance will be assessed by patients maintaining a case log. | 1, 2 months |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sidney Jacoby, MD | The Philadelphia and South Jersey Hand Center | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Philadelphia and South Jersey Hand Center | Philadelphia | Pennsylvania | 19107 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18406955 | Background | Ring D, Lozano-Calderon S, Shin R, Bastian P, Mudgal C, Jupiter J. A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger. J Hand Surg Am. 2008 Apr;33(4):516-22; discussion 523-4. doi: 10.1016/j.jhsa.2008.01.001. | |
| 269967 | Result | Strom L. Trigger finger in diabetes. J Med Soc N J. 1977 Nov;74(11):951-4. No abstract available. |
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| Corticosteroid injection | Procedure | Standard trigger finger corticosteroid injection. |
|
| 1, 2, 4-6, 12months |
| Pain | Visual Analog Scale | 1, 2, 4-6, 12 months |
| 19006759 | Result | Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of splinting for the treatment of trigger finger. J Hand Ther. 2008 Oct-Dec;21(4):336-43. doi: 10.1197/j.jht.2008.05.001. Epub 2008 Aug 22. |
| 1538090 | Result | Patel MR, Bassini L. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am. 1992 Jan;17(1):110-3. doi: 10.1016/0363-5023(92)90124-8. |
| ID | Term |
|---|---|
| D052582 | Trigger Finger Disorder |
| D053682 | Tendon Entrapment |
| ID | Term |
|---|---|
| D052256 | Tendinopathy |
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
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| ID | Term |
|---|---|
| D000305 | Adrenal Cortex Hormones |
| ID | Term |
|---|---|
| D006728 | Hormones |
| D006730 | Hormones, Hormone Substitutes, and Hormone Antagonists |
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