Effectiveness of proximal interphalangeal joint-blocking orthosis vs metacarpophalangeal joint-blocking orthosis in trigger digit management: A randomized clinical trial

Abstract

Study design: Patients with Green's classification grade 2 or 3 A1-pulley trigger digit (TD) were recruited and randomized to receive the proximal interphalangeal joint-blocking orthosis (PIPJ-BO) or metacarpophalangeal joint-blocking orthosis (MCPJ-BO).

Introduction: TD is a common hand condition that can affect one's performance in activities of daily living. Conservative management of TD involves prescription of orthoses to facilitate recovery. No studies have evaluated the effectiveness of PIPJ-BO, optimal orthosis wear regime, and other factors affecting orthotic effectiveness.

Purpose of the study: To compare the effectiveness of PIPJ-BO vs MCPJ-BO in TD management.

Methods: Outcome measures included pain numerical rating scale, Green's classification grading, and Quick Disability of the Arm, Shoulder and Hand. Orthosis wear duration was also collated. Patients were followed up for 2 months, and changes between initial and final assessment score within each group and between both groups were analyzed.

Results: Thirty-five patients with 43 TD were included in final analysis. Twenty-three TD were allocated PIPJ-BO while 20 with MCPJ-BO. Pain reduction was observed in both groups, but reduction was greater in PIPJ-BO group (P = .02). About 47.83% in PIPJ-BO group and 40% in MCPJ-BO group improved by at least 1 Green's classification grade. There was only significant improvement in Quick Disability of the Arm, Shoulder and Hand score for PIPJ-BO group (P = .0007), and duration of orthosis wear was significantly longer in the PIPJ-BO group (P = .0010). Advancing age was found to have higher rate of orthosis failure.

Discussion: Findings suggest that both orthoses are effective in reducing pain and disability and improve in triggering symptoms, with PIPJ-BO being more superior. Moreover, PIPJ-BO is less restrictive, has better cosmesis and allowed better functional performance than MCPJ-BO.

Conclusion: PIPJ-BO is more effective than MCPJ-BO in pain reduction and achieved better functional outcome. Orthosis wear of 24 hours for more than 8 weeks is recommended.

Keywords: Conservative management; Effectiveness; Orthosis/orthoses; Trigger digit/finger.