EFFECTIVENESS OF ORTHOSIS ALONE, INJECTION ALONE, OR BOTH FOR TRIGGER FINGER: A THREE-ARM PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Trigger finger is a common condition that affects approximately 3% of adults. Conservative management options include orthoses and injections. The goal of this study was to evaluate the efficacy of splinting versus cortisone injection versus combined treatment for non-surgical management of trigger finger. Patients with Green severity grade 1-3 trigger finger in one or two digits who had never received treatment were randomized to a custom-fit night time extension orthosis, cortisone injection, or combined treatment. Patients were randomized immediately prior to treatment and stratified by Green severity score and history of diabetes. Patient reported outcome measures (perceived recovery, pain, function, and patient-reported wrist and hand evaluation score) and presence/amount of triggering with 10 repeated grip were collected at 6-week, 3-, 6-, and 12-month intervals. After the 6-week follow up patients were allowed to cross over into other treatment group offered surgical management as deemed indicated by the treating surgeons. Side effects, complications, and additional interventions were also monitored. Between 2017-2021, 108 patients representing 127 trigger fingers were recruited by two surgeons with an average follow-up of 29 months. Four patients were lost to follow up, leaving 122 trigger fingers included in the study. At 6 weeks, there were no significant difference in incidence of triggering, symptom relief and PRWHE score in the Green grade 1 and 2 severity trigger fingers. However, patients with grade 3 trigger fingers had significantly lower rates of symptom relief and higher PRWHE scores than the orthosis alone group. Furthermore, conservative management success rate was significantly higher in grade 1 and 2 at 77.6% compared to grade 3 at 60.9%. Overall, across our study there was no significant difference in release rate between treatment arms. Orthoses alone are effective in about half (52.5%) of patients with for trigger finger. While overall success rate with conservative treatment was high (68.9%), there was lower success for patients with grade 3 trigger finger (60.8%). Our study shows no added benefit to adding a orthosis to cortisone injection for all severity groups. Based on our findings, our group recommends primary care referral to hand therapy for a trial of orthosis use. Initiation of orthosis, especially with lower grade trigger finger may be beneficial, while patients await specialist consultation.