The Effects of a Structured Hand Exercise Program on Trigger Finger: A Randomized Controlled Trial

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• Trigger Finger Disorder 94

Keywords

• Trigger finger
• tenosynovitis
• physiotherapy
• conservative treatment
• Exercise

Study arms

• Experimental
  Exercise

  Behavioral: Exercise

• No intervention
  Control

  Participants will receive no intervention.

Interventions

• BehavioralExercise

  Participants will receive a 6-week structured hand exercise program. Participants will attend a face-to-face exercise session to learn all hand exercises. The exercise program will include: (1) Finger flexor stretching, (2) Tendon gliding exercise and (3) Isometric finger flexor exercise. A weekly tele follow-up will be done to participants in the experimental group

Primary outcomes

1. Numeric Pain Rating Scale (NPRS) during triggering or movement

   NPRS consists of 11-point numeric scale from '0' (no pain) to '10' (worst pain imaginable). Participants rate the pain level based on their own pain intensity from 0-10

   Time frame: Baseline, 6 weeks after baseline, 10 weeks after baseline

Secondary outcomes

1. Trigger finger stage in the Green Classification

   Green's classification for trigger finger: Grade 1 (A history of catching with local pain). Grade 2 (Demonstrable catching with normal active extension). Grade 3 (Demonstrable locking requiring passive extension). Grade 4 (Fixed flexion deformity)

   Time frame: Baseline, 6 weeks after baseline, 10 weeks after baseline

2. Frequency of triggering

   The frequency of triggering will be represented by the number of triggering events in ten active fists, from 0 to 10. Two questions will be asked: (1) What is the average number of triggering in ten active fists in the past one week? (2) What is the average number of painful triggering in ten active fists in the past one week?

   Time frame: Baseline, 6 weeks after baseline, 10 weeks after baseline

3. Functional score by Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (Hong Kong version)

   Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) is a shorten version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). QuickDASH consisted of 11 items to measure physical function and symptoms in patients with upper limb disorders. DASH and QuickDASH were translated into Hong Kong version. Participants must complete at least 10 of the 11 items for a score to be calculated and the scores range from 0 (no disability) to 100 (most severe disability).

   Time frame: Baseline, 6 weeks after baseline, 10 weeks after baseline

4. Grip strength of the affected hand

   Grip strength will be assessed using the American Society of Hand Therapists (ASHT) protocol. Participants will be seated in a chair without arm rests, with hips and knees in 90 degrees. Shoulder holds in adduction and neutral rotation. Elbow holds in 90 degrees flexion with forearm in neutral rotation. Participants grip the dynamometer in 15-30 degrees wrist extension and 0-15 degrees of ulnar deviation. Participants will be asked to grip the dynamometer as hard as they can for 3 trials. The mean of the 3 trials will be recorded as the grip strength in kg.

   Time frame: Baseline, 6 weeks after baseline, 10 weeks after baseline

5. Structural changes using musculoskeletal ultrasound (A1 pulley thickness, flexor tendon thicknesses, A1 pulley lumen size)

   Musculoskeletal ultrasound with a linear transducer (12MHz probe) will be used to evaluate the structural outcome measures.

   Time frame: Baseline, 6 weeks after baseline, 10 weeks after baseline

Individual participant data

Plan to share: Yes — The study data can be provided via contacting the Principal Investigator

Supporting information: Study protocol, Sap, Icf, Csr