Orthotic Devices for the Conservative Treatment of Trigger Finger: A Critical Appraisal
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Presenter(s)
Kennedy Bican
Abstract
Orthotic Devices for the Conservative Treatment of Trigger Finger: A Critical Appraisal
Kennedy Bican, ATS
Department of Health, Exercise, and Rehabilitative Sciences, Winona State University.
Clinical Question: In middle aged individuals with trigger finger, what is the treatment effect related to using an orthotic device versus no device on pain and triggering events?
Clinical Scenario: Currently, there is a limited number of published articles that examine how to best manage trigger finger. Furthermore, the existing evidence doesn’t provide conclusive support for one treatment strategy over another. The purpose of this critical appraisal is to explore whether trigger finger is best treated with orthotic devices, or if alternative options such as surgery or steroidal injection provide better outcomes.
Search Strategy: Seven articles were included in the appraisal from a comprehensive literature search of the PubMed, CINAHL, Cochrane, and ProQuest databases. Key search terms included: trigger finger, orthotic, device, conservative, treatment, and non-surgical. Studies were included if they were either a randomized control trial or cohort study, utilized participants aged 18 years and older diagnosed with trigger finger, and evaluated either pain levels or the number of triggering events experienced.
Evidence Quality Assessment: The quality of the seven articles was assessed using the PEDRO scale, with scores ranging from 2/10 to 7/10. The Oxford Level of Evidence of this appraisal was Level 2b, meaning the appraisal was compromised of cohort studies and lower quality randomized control trials.
Results and Summary of Search: The main outcomes analyzed in this appraisal included the Visual Analogue Pain Scores (VAS), Stage of Stenosing Tenosynovitis (SST), and number of triggering events. Limitations identified in the appraised literature included patient non-adherence to orthotic splinting, orthotic type variation, and attrition. Four studies evaluating triggering events all found that compared to not wearing an orthotic, orthotic usage decreased the number of triggering events for participants (p<0.05). Pain as measured by VAS scores was reduced by orthotic usage in all three studies (p<0.05). One study found that splinting alone, corticosteroid injection, and splinting (with injection) were equally effective in reducing pain and improving hand function. Two studies evaluating SST both found that compared to not wearing an orthotic device, orthotic usage improved SST scores (p<0.05).
Clinical Bottom Line: After reviewing the evidence, there is some limited support to suggest that trigger finger can be treated effectively with an orthotic device although no strong conclusions can be drawn. The Strength of Taxonomy (SORT) score of this systematic review is a B-level recommendation due to it being based on inconsistent or limited quality patient-orientated evidence.
Implications: Orthotic devices may be an effective intervention for the treatment of trigger finger and should be considered when treating this condition before progressing to more invasive measures. This appraisal's findings have shown positive effects of orthotic use, although more exploration into the effectiveness of orthotic variations is needed along with comparison to other invasive procedures.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Brandon Donahue
Second Advisor/Mentor
Nora Kraemer
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Orthotic Devices for the Conservative Treatment of Trigger Finger: A Critical Appraisal
Orthotic Devices for the Conservative Treatment of Trigger Finger: A Critical Appraisal
Kennedy Bican, ATS
Department of Health, Exercise, and Rehabilitative Sciences, Winona State University.
Clinical Question: In middle aged individuals with trigger finger, what is the treatment effect related to using an orthotic device versus no device on pain and triggering events?
Clinical Scenario: Currently, there is a limited number of published articles that examine how to best manage trigger finger. Furthermore, the existing evidence doesn’t provide conclusive support for one treatment strategy over another. The purpose of this critical appraisal is to explore whether trigger finger is best treated with orthotic devices, or if alternative options such as surgery or steroidal injection provide better outcomes.
Search Strategy: Seven articles were included in the appraisal from a comprehensive literature search of the PubMed, CINAHL, Cochrane, and ProQuest databases. Key search terms included: trigger finger, orthotic, device, conservative, treatment, and non-surgical. Studies were included if they were either a randomized control trial or cohort study, utilized participants aged 18 years and older diagnosed with trigger finger, and evaluated either pain levels or the number of triggering events experienced.
Evidence Quality Assessment: The quality of the seven articles was assessed using the PEDRO scale, with scores ranging from 2/10 to 7/10. The Oxford Level of Evidence of this appraisal was Level 2b, meaning the appraisal was compromised of cohort studies and lower quality randomized control trials.
Results and Summary of Search: The main outcomes analyzed in this appraisal included the Visual Analogue Pain Scores (VAS), Stage of Stenosing Tenosynovitis (SST), and number of triggering events. Limitations identified in the appraised literature included patient non-adherence to orthotic splinting, orthotic type variation, and attrition. Four studies evaluating triggering events all found that compared to not wearing an orthotic, orthotic usage decreased the number of triggering events for participants (p<0.05). Pain as measured by VAS scores was reduced by orthotic usage in all three studies (p<0.05). One study found that splinting alone, corticosteroid injection, and splinting (with injection) were equally effective in reducing pain and improving hand function. Two studies evaluating SST both found that compared to not wearing an orthotic device, orthotic usage improved SST scores (p<0.05).
Clinical Bottom Line: After reviewing the evidence, there is some limited support to suggest that trigger finger can be treated effectively with an orthotic device although no strong conclusions can be drawn. The Strength of Taxonomy (SORT) score of this systematic review is a B-level recommendation due to it being based on inconsistent or limited quality patient-orientated evidence.
Implications: Orthotic devices may be an effective intervention for the treatment of trigger finger and should be considered when treating this condition before progressing to more invasive measures. This appraisal's findings have shown positive effects of orthotic use, although more exploration into the effectiveness of orthotic variations is needed along with comparison to other invasive procedures.
