Orthosis vs. exercise for the treatment of adult idiopathic trigger fingers: A randomized clinical trial.

Only 55 people were studied, and the trial was sized for a difference in the QuickDASH, not for the Green grade that the paper calls its primary outcome. Everyone had idiopathic trigger finger of grade 2 or 3, in one digit, with symptoms for less than six months. It tells you nothing about grade 4 locked fingers, thumbs, more than one digit, or people with diabetes, rheumatoid arthritis and similar conditions. The findings cannot be extended to orthoses that block the knuckle or the end joint instead of the PIP joint, because different designs may fit differently and change how much people wear them. Participants could tell whether they were wearing an orthosis. The authors themselves say the improvement seen in the hand therapy group (37.0% improved by at least one grade at six weeks) may reflect spontaneous recovery or adaptation rather than the treatment. Five of the six people lost to follow-up were in the hand therapy group, so the three-month comparison rests on smaller and uneven groups, and the results cannot be generalised to the locked digit. The authors note that a larger study would be needed before relationships between participant characteristics and outcome can be examined.

The author declared no financial support for the research, authorship or publication of the article, and no competing interests. The trial was approved by the Kuwait University Health Sciences Center ethics committee.

Do not read this as proof that a PIP-blocking orthosis is the best treatment for trigger finger. The trial compared it only with hand therapy, not with steroid injections or surgery, and 37.0% of the hand therapy group still improved by at least one grade. The authors say that improvement may reflect spontaneous recovery or adapting to the problem rather than the treatment.