A randomized comparative trial of relative motion splints versus metacarpophalangeal joint blocking splints in the management of trigger finger

Abstract

Evidence supports the use of hand-based metacarpophalangeal joint (MCPJ) blocking splints as an intervention for trigger finger (TF). In practice, finger-based relative motion (RM) splints are also implemented without evidence. This randomized comparative trial (RCT) aims to evaluate implementation of MCPJ blocking and RM splints for effectiveness, function, occupational performance, and wearability after six weeks of TF management. Priori analysis determined 36 individuals were needed for random assignment to the RM or MCPJ blocking splint groups. This trial was conducted at Hospital Sultan Haji Ahmad Shah, with participants required to attend three therapy sessions in Week-1, Week-3, and Week-6. Outcomes assessed included: Stages of Stenosing Tenosynovitis (SST), Visual Analog Pain Scale, number of triggering events in ten active fists (NTE), Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH), Canadian Occupational Performance Measure (COPM), comfort, and satisfaction. A mixed-effect ANOVA was used to examine the main effects and interaction effects between two groups. The final result involved 35 participants (RM Group=18 & MCPJ Blocking Group=17). There were significant differences in SST (p<0.001), NTE (p<0.001), pain during rest (p=0.046), pain during activities (p<0.001), DASH (p<0.001), COPM performance score (p<0.001), and COPM satisfaction score (p<0.001) after six weeks, signifying that both splints were effective in reducing TF’s severity, and improving hand function and occupational performance. Between groups, there were no differences detected. None of the splint group demonstrated a superior effect for these outcomes. Both groups reported a mean comfort and satisfaction score of about 7/10 when wearing the splint during rest, and a mean comfort and satisfaction score of roughly 4/10 when wearing the splint during activities. Given both RM splints and MCPJ blocking splints showed positive results within group, this study concluded that both splints are effective in managing TF. Also, given no differences were detected between both splints in terms of various effects, this study concluded that the RM splint is equivalent to the MCPJ blocking splint in TF management. This study had provided an evidence for the implementation of RM splints as an intervention for TF.