See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/51904470

Trigger Finger Treatment: A Comparison of 2 Splint Designs

Article  in  The Journal of hand surgery · December 2011

DOI: 10.1016/j.jhsa.2011.10.038 · Source: PubMed

CITATIONS READS
31 3,386

3 authors:

Kauser Tarbhai Susan Hannah

University Health Network University Health Network
1 PUBLICATION   31 CITATIONS    2 PUBLICATIONS   42 CITATIONS   

SEE PROFILE SEE PROFILE

Herb von Schroeder

University of Toronto
102 PUBLICATIONS   2,683 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Nitanol Scaffold Oxygen Differential Laminar Bioreactor View project

Grip strenth assessment View project

All content following this page was uploaded by Kauser Tarbhai on 23 April 2018.

The user has requested enhancement of the downloaded file.

 SCIENTIFIC ARTICLE

Trigger Finger Treatment: A Comparison of 2

Splint Designs
Kauser Tarbhai, BScOT, Susan Hannah, MEd, Herbert P. von Schroeder, MD

Purpose To compare the effectiveness of 2 splint designs in treating trigger finger.

Methods This prospective, randomized study of 30 subjects evaluated splinting efficacy for
trigger finger, comparing 2 splint designs: a custom metacarpophalangeal (MCP) joint
blocking splint and a distal interphalangeal (DIP) joint blocking splint. We evaluated range
of motion, grip strength, severity and frequency of triggering, functional impact, and
performance measure scores. Subjects recorded frequency of splint use, splint comfort, and
functional impact of the splint. We undertook statistical analysis of splint effectiveness
before and after treatment and of differences between the 2 splint groups. We evaluated
qualitative data to identify trends in subjective preference toward splint design.
Results Both groups showed quick and significant improvement of triggering; however,
the MCP joint blocking splint was successful in providing at least partial relief of
triggering and pain in 10 of 13 trigger finger subjects, whereas the DIP joint blocking
splint provided at least partial relief of triggering and pain in 7 of 15 subjects after 6
weeks of treatment. Data showed statistically significant improvement in both groups at
6 weeks, which was maintained in a minority of the cohort for 1 year. There was little
difference between the 2 splint groups for impact on function. Subjects who wore the
MCP joint blocking splint reported higher rates of comfort compared with those who
wore the DIP joint blocking splint.
Conclusions Subject comfort with the MCP joint blocking splint allowed for longer periods of
usage. Selection of a splint design depends on clinical presentation, vocation, and leisure
activities. Initiating conservative treatment with the MCP joint blocking splint has value for
patients with trigger finger and positive outcomes in 77% of subjects, whereas use of the DIP
joint splint was effective in about half of subjects. (J Hand Surg 2012;37A:243–249.
Copyright © 2012 by the American Society for Surgery of the Hand. All rights reserved.)
Type of study/level of evidence Therapeutic I.
Key words Randomized controlled trial, splint, trigger finger.

RIGGER FINGER IS a common hand condition

From the University of Toronto Hand Program, Toronto Western Hospital, Toronto, Ontario, Canada.
Received for publication January 17, 2011; accepted in revised form October 20, 2011.
Research funding was provided by the University Health Network Allied Health research fund.
No benefits in any form have been received or will be received related directly or indirectly to the
subject of this article.
Corresponding author: Herb von Schroeder, MD, 399 Bathurst Street, 2E, Toronto, ON M5T 2S8,
Canada; e-mail: herb.vonschroeder@uhn.ca.
0363-5023/12/37A02-0006$36.00/0
doi:10.1016/j.jhsa.2011.10.038
T characterized by pain, swelling, and clicking of
a digit during flexion or extension. In advanced
cases, the digit can lock into flexion or extension.1– 6
Trigger finger can be associated with osteoarthritis,
metabolic disorders such as diabetes or collagen dis-
eases, rheumatoid arthritis, and carpal tunnel syn-
drome.1–3,6 –11 It affects women more often than men,
especially in the later decades of life.3,6,10 The thumb
and long and ring fingers are more commonly affected
than the index and small fingers.2,3,6

©  ASSH 䉬 Published by Elsevier, Inc. All rights reserved. 䉬 243

244 TRIGGER FINGER

Trigger finger may occur as the result of a discrep-

ancy in flexor tendon volume and in the size of the A1
pulley lumen.1–3,6 – 8 The exact etiology for trigger fin-
ger is unknown, but various authors2,3,6 have presented
theories relating to inflammation of the tendon sheath,
fibrocartilaginous metaplasia of the A1 pulley,1 vascu-
lar or lymphatic imbalances, and altered distribution of
loading forces in the hand.
Treatment for trigger finger can be either medical or
surgical.3,12–16 Medical intervention includes use of
oral anti-inflammatory medication, injection with corti-
costeroids,3,6 –9,15,17–20 a combination of corticosteroid
injection with splinting,3,16 and splint alone.2,3,5,6,10,21
A variety of splint designs may be effective.2,3,6,10,21 In
1988, Evans et al2 demonstrated a 73% success rate
using a hand-based metacarpophalangeal (MCP) joint FIGURE 1: Metacarpophalangeal joint blocking splint to treat
blocking splint with proximal interphalangeal (PIP) a trigger finger. The splint allows flexion of the interphal-
angeal joints.
joints free in combination with a specific exercise pro-
gram to treat trigger finger problems. In 1998, Rogers et
al10 reported an 83% success rate with use of a distal
medical information as well as demographic data. We
interphalangeal (DIP) joint blocking splint. In the same
excluded subjects if they did not speak English, had a
year Lindlor–Tons and Ingell5 described an alternate
trigger thumb, or had involvement of more than 1 digit
MCP joint splint design that extended from the palm
in the same hand. A priori power analysis determined
across the MCP joint and included a ring around the
that 13 subjects would be required in each group. The
proximal phalanx. More recently, Colbourn et al6 used
study had research ethics board approval and met all
a single group pre- and post-designed study to evaluate
ethical guidelines.
the effectiveness of an MCP joint blocking splint with
A certified hand therapist saw subjects to assess pain,
the MCP joints positioned in 10° to 15° of flexion. They
frequency, and severity of triggering, the impact of
found that 93% of participants reported improvement in
triggering on function (Appendix 1; available at the
triggering as a result of using the splint.
Journal’s Web site at www.jhandsurg.org), the pres-
Although splinting to treat trigger finger has been
ence or absence of swelling at the A1 pulley level,
described as inexpensive and helpful in reducing symp-
range of motion of all finger joints of the hand, and
toms of triggering with minimal complications,2,5,6,10,16
bilateral grip strength, using a dynamometer as a gen-
a review of the literature showed little comprehensive
eral measure to compare it with the opposite side and
or objective data to clearly support the role of splinting,
look for changes with treatment. We assessed these
nor has there been an adequate comparison of different
parameters at each clinic visit at day 0 and weeks 1, 3,
splint designs.
6, 12, and at 1 year after initiation of splint treatment.
Our primary objective was to conduct a prospective
We used the Canadian Occupational Performance Mea-
randomized trial to determine whether 1 of 2 different
sure (COPM)22 to assess change in function over time.
splint designs (MCP joint blocking splint or DIP joint
The COPM is designed to measure patient-identified
blocking splint) was more effective in treating trigger
issues in self-care, productivity, and leisure.
finger. The secondary goal was to compare the 2 splint
A second certified hand therapist provided 1 of 2
designs from a qualitative perspective with respect to
types of splint based on a random draw. The 2 types
comfort, compliance, and usefulness during functional
were an MCP joint blocking splint (Fig. 1) that ex-
activities. tended from the palm across the MCP joint and in-
cluded a ring around the proximal phalanx or a DIP
MATERIALS AND METHODS joint blocking splint (Fig. 2). Splints for the MCP joint
We conducted the study at a university-affiliated teach- were custom-made from thermoplastic material and
ing hospital in a large urban setting. A hand surgeon were secured by the ring around the base of the in-
assessed subjects, all of whom had trigger finger but volved finger. For the DIP joint, 1 of 3 options was used
had never been treated, for triggering at the A1 pulley to achieve the best and most comfortable fit: a pre-
and obtained informed consent. We gathered associated formed Stax splint (North Coast Medical, Gilroy, CA)

JHS 䉬 Vol A, February 

 TRIGGER FINGER 245

FIGURE 2: Distal interphalangeal joint blocking splint to treat a trigger finger. The splint allows flexion of the proximal
interphalangeal and metacarpophalangeal joints. We used 2 types: A Stax or a similar custom thermoplastic design, and B an
aluminum splint. We chose the type for each subject based on best fit.

(Fig. 2A), a thermoplastic splint in the same shape as a
Stax but custom made for optimal sizing, or an alumi-
num splint with tape (Fig. 2B). The tape for the DIP
joint blocking splints did not cross the PIP joint. We
checked the fit of all splints at each follow-up visit and
adjusted them as needed to maximize comfort. Sub-
jects were instructed to wear the splint as much as
possible over a 24-hour period and to monitor the
amount of time the splint was not used as well as
the reasons for not wearing the splint. Subjects
were also asked to keep a diary to track the number
of hours of splint use, and to rate splint comfort
and the impact of the splint on function.
We analyzed descriptively demographic information
and data collected from the subjects’ diaries, including
information regarding splint comfort, percentage of
time that the splint was used per 24-hour period (25%,
50%, 75%, or 100%), and its impact on activities of
daily living. Subjects were asked to rate their ability to
function while wearing the splint as good, fair, or poor.
After 1 week, subjects were asked to rate the splint as
comfortable or uncomfortable. We collected subjective
comments regarding their general opinion of the splint.
We interviewed by phone those patients who did not
attend the scheduled assessment.
Assessment measures included pain, measured on a
10-cm-long visual analog scale and on 0- to 10-point
scales for severity of triggering, frequency of triggering,
and functional impact of triggering (Appendix 1; avail-
able at the Journal’s Web site at www.jhandsurg.org).
We compared changes at each follow-up period with
initial baseline values within each group to determine
change over the course of the study using Student’s
paired t-test with significance (␣) set at 0.05. We also
calculated net change of each of the measures at each
follow-up period to determine change over time. We
compared these between the groups (MCP joint vs DIP
joint splints) to assess for differences between the
groups over time using Student’s unpaired 2-tailed t-
test, with significance (␣) set at 0.05. There was no
statistical difference between groups within the first 6
weeks.
We categorized subjects who did not wear their
splint or who did not attend their follow-up appoint-
ment and could not be contacted by phone as dropouts
and did not include them in further analysis. We clas-
sified splint treatment as successful when subjects felt
that they had a satisfactory minimum of partial relief of
pain, triggering, and swelling.
At weeks 3 and 6, we asked subjects if they had
relief from pain, triggering, or swelling. If not, they
were given the option for alternate treatment such as
steroid injection or surgery. These patients were con-
sidered a failure of splint management and remained
under our care for alternate treatment but were not
included in the data analysis. Those who felt they were
benefiting from splinting continued to splint for up to 6
weeks. After 6 weeks, the frequency of splint use was
gradually decreased over time by the patient’s choos-
ing.
RESULTS
A total of 30 subjects who met the inclusion criteria
agreed to participate in this study; none refused. Two
subjects had bilateral involvement: one was in the MCP
joint group with both hands, and the other was in both
the MCP joint group for 1 hand and the DIP joint group
for the other hand, as determined by randomization. In
all, we treated 15 digits in the MCP group and 17 digits
in the DIP group. One subject with bilateral involve-
ment dropped out of the MCP joint group, which left 13
digits to be evaluated. Two subjects from the DIP joint
group dropped out, which left 15 digits in the DIP joint
group.
Both groups were similar in terms of age, hand
involvement, medical conditions, and length of

JHS 䉬 Vol A, February 

246 TRIGGER FINGER

TABLE 1. Demographic and Clinical Data: Comparison With Results

Demographics MCP Joint Splint Results DIP Joint Splint Results

Digits (no.) 13 10 S 15 7S
Age (y) 37–79 (mean 58) 36–79 (mean 68 y)
Duration of triggering (mo) 1–18 mo (mean 5.6 mo) 1–24 mo (mean 7 mo)
Gender Female 10 7S Female 7 2S
Dominance Dominant 8 5S Dominant 8 4S
Hand involvement Right 8 5S Right 8 4S
Digit involved D2 2 0 S D2 2 0 S
D3 2 2 S D3 7 2 S
D4 8 7 S D4 3 2 S
D5 1 1 S D5 3 3 S
Vocation Retired 3 2 S Retired 5 2 S
Administration work 3 3 S Administration work 1 0 S
Waiter 2 1 S Waiter 2 0 S
Homemaker 3 3 S Home maker 3 3 S
Auto assembly 1 1 S Electrician 1 1 S
Security personnel 1 0 S Construction work 1 1 S
Editorial assistant 1 0 S
Butcher 1 0 S
Associated medical conditions Diabetes 2 0 S Diabetes 4 2 S
Osteoarthritis 4 3 S Osteoarthritis 3 2 S
CTS 3 1 S CTS 1 0 S
Hypertension 1 1 S Hypertension 2 1 S
Other (cancer, AIDS) 4 3 S Other 4 2 S
None 2 2 S None 4 1 S
Type of swelling Diffuse 8 4S Diffuse 7 3S
Nodular 4 4S Nodular 3 1S
No swelling 1 0S No swelling 5 3S
Type of splint Ring MCP splint 13 10 S Stax splint 12 6S
Aluminum splint 3 1S
Stiffness 1 7

CTS, carpal tunnel syndrome; S, success.

For the MCP joint splint, n ⫽ 14 patients (1 bilateral), dropouts ⫽ 2. For the DIP joint splint, n ⫽ 17 patients, dropouts ⫽ 2.

triggering (Table 1). Although mild tightness was
noted in some PIP joints, this was not a functional
issue for those patients, and none had PIP joint
flexion contractures greater than 10°. The MCP
joint blocking splint resulted in a 77% success rate
(10 of 13 subjects), which was defined as complete
or partial relief of triggering, compared with a 47%
success rate for the DIP joint blocking splint (7 of
15 subjects) at 6 weeks. Table 2 summarizes the
results in terms of success (partial or complete
relief of symptoms) or failure at 6 weeks. There was
no relationship between splint failure and the
length of triggering, gender, or vocation. However,
the percentage of failure for patients with diabetes
was 4 of 6, and for patients with carpal tunnel
syndrome was 3 of 4 (Table 1).
Joint stiffness developed in both groups (1 of 13
in the MCP joint blocking group; 7 of 15 in the
DIP joint blocking group); however, stiffness re-
solved quickly once the splint was discontinued.
At 6 weeks, there was a slight decrease in grip
strength (4 of 13 in the MCP joint blocking group;
3 of 15 in the DIP joint blocking group) that also
resolved when the splint was discontinued. Al-
though this decrease was not statistically signifi-
cant, subjects mentioned the effect on grip and we
therefore considered it clinically relevant during
the treatment.
Neither group identified functional limitations when
assessed on day 0 before starting the splint, as deter-
mined by the COPM. Subjects in both groups reported
that the splints were awkward to use during functional

JHS 䉬 Vol A, February 

 TRIGGER FINGER 247

TABLE 2. Comparison and Results of MCP Versus DIP Splint Groups

MCP Joint Splint Results DIP Joint Splint Results

Success (combined) Complete relief of symptoms 4 Complete relief of symptoms 4

Partial relief of symptoms 6 Partial relief of symptoms 3
77% 47%
Failure (combined) No relief of symptoms 3 No relief of symptoms 8
23% 53%

For the MCP joint splint, n ⫽ 14 (1 bilateral), dropouts ⫽ 2, number of digits ⫽ 13. For the DIP joint splint, n ⫽ 17, dropouts ⫽ 2, number of
digits ⫽ 15.

TABLE 3. Summary of Diary Findings impact of the triggering on daily activities (Table 4).
Both groups showed immediate relief in all measures,
Qualitative
as documented after 1 week. Relief was maintained
Analysis MCP Joint Splint DIP Joint Splint
over the course of the study, and most measures met the
Splint use significance threshold. The initial scores for the severity
⬎18 h/d 10 (77%) 11 (73%) of the triggering were highest among the parameters
⬍12 h/d 3 (23%) 4 (27%) and also improved the most. There were no major
Splint comfort differences between the 2 types of splints based on the
Comfortable 10 (77%) 9 (60%) quantitative data.
Uncomfortable 3 (23%) 6 (40%)
Functioning with DISCUSSION
splint Statistical analysis of the quantitative data showed
Good 7 (54%) 7 (47%) quick reduction or relief of symptoms in both splint
Fair 5 (38%) 7 (47%) groups, which were maintained over 6 weeks and in
Poor 1 (7%) 1 (7%) some subjects for over 1 year. Overall, the 2 groups
Patient “Awkward to work” “Awkward to work” responded favorably to splinting, but the long-term data
comments “Takes too long to “Slips off easily” included only those that continued with the splint and
do things” “Causes stiffness in
were therefore self-selected.
“Edges digging” joints”
Descriptive analysis found that in both the splint
For the MCP joint splint, n ⫽ 14 (1 bilateral), dropouts ⫽ 2, number groups there was awkwardness with respect to the sub-
of digits ⫽ 13. For the DIP joint splint, n ⫽ 17, dropouts ⫽ 2, number
of ject’s use of the hand during daily activities. The MCP
digits ⫽ 15. joint blocking splint was reported to be slightly more
restrictive in function but was more comfortable than
the DIP joint blocking splint. This may be because the
activities (9 of 15 in the DIP joint blocking group; 9 of MCP joint blocking splint covered the tender A1 pulley
13 in the MCP joint blocking group). area and felt comfortable. The MCP joint blocking
Subjects who wore the MCP joint blocking splint splint group resulted in less stiffness (1 subject) than the
reported higher comfort ratings compared with those DIP joint blocking splint group (7 subjects). This may
who wore the DIP joint blocking splint (Table 3). There have also contributed to the higher dropout and failure
was little difference between groups regarding the per- rate in the DIP joint group. The other possible reason
centage of time wearing the splint and the impact on for a higher failure rate in the DIP joint group could be
function (Table 3). Descriptive analysis revealed that that the DIP joint splint was not custom made in the
subjects who continued to use either type of splint were case of the Stax splints, although best fit was obtained.
generally pleased that they had avoided injection or Grip measures decreased slightly with use of either
surgery. splint but recovered once the splint was removed. Al-
For quantitative analysis, the groups did not differ at though a subset of patients continued to wear and re-
day 0 with respect to measures for pain, severity of the ceive benefit from the splints, the dropout rate was
triggering, frequency of the triggering, and functional notable, particularly in the 6- to 12-week time frame.

JHS 䉬 Vol A, February 

248 TRIGGER FINGER

TABLE 4. Outcome Measurements for Trigger Finger Patients Wearing a Finger Splint Over Either the
MCP or the DIP Joint
MCP Joint Blocking
Splint DIP Joint Blocking Splint

Severity of Frequency Functional Severity of Frequency of Functional

Pain Trigger of Trigger Impact Pain Trigger Trigger Impact

Day 0 4.6 ⫾ 0.7 9.3 ⫾ 0.8 5.9 ⫾ 0.7 3.9 ⫾ 0.6 4.3 ⫾ 0.8 8.9 ⫾ 0.3 7.8 ⫾ 0.5 3.2 ⫾ 0.6
Wk 1 2.4 ⫾ 0.7 a
2.3 ⫾ 0.7 b
2.5 ⫾ 0.7 a
3.7 ⫾ 1.1 3.8 ⫾ 1.0 3.2 ⫾ 0.8 b
3.9 ⫾ 1.0 b
3.2 ⫾ 0.8
Wk 3 3.1 ⫾ 0.9a 4.1 ⫾ 1.2b 4.1 ⫾ 1.2 4.4 ⫾ 1.3 2.9 ⫾ 0.9a 3.5 ⫾ 1.0b 4.4 ⫾ 1.6b 3.2 ⫾ 1.0
Wk 6 3.0 ⫾ 0.9 4.3 ⫾ 1.4 b
3.4 ⫾ 1.2 a
2.7 ⫾ 0.9 2.6 ⫾ 0.9 a
4.7 ⫾ 1.6 b
5.2 ⫾ 1.7 a
3.3 ⫾ 1.1

Data represent a 0- to 10-point analog scale, shown as average values ⫾ standard error for measurements for pain, severity, frequency, and functional
impact of triggering on daily activities for patients who continued to use the splint.
Statistically significant difference from day 0: aP⬍.05 or bP⬍.01.

Splint compliance should be taken into account when
choosing this method of treatment.
Evans et al2 suggested use of a hand-based splint
design that blocked the MCP joint of the affected finger
and left the interphalangeal joints free (MCP joint
blocking splint design) in combination with a specific
exercise program to treat the triggering digit. They
demonstrated a success rate of 40 out of 55 subjects
with their protocol, defined as partial or complete im-
provement of symptoms, similar to our rate of 10 of 13
subjects showing at least partial relief of symptoms.
Evans et al believed that by altering the mechanics of
pressure at the A1 pulley that occurs with loading and
by minimizing the tendon excursion, local inflamma-
tion would be allowed to subside and reverse the pa-
thology of the tendon sheath. In a more recent study,
Colbourn et al6 found that 26 of 28 participants reported
improvement in triggering with use of the MCP joint
blocking splint in 10° to 15° of MCP flexion over a 6-
to 10-week period. This was higher than in our study, in
which the MCP joint blocking splint was in neutral
extension, and which took into account patient comfort,
compliance, and usefulness during functional activities.
Rogers et al10 reported an 83% success rate with use
of a DIP joint blocking splint to limit excursion of the
flexor digitorum profundus tendon and to allow digital
synovitis to resolve. They also demonstrated on a study
in cadavers that an aluminum splint at the DIP joint
prevented flexor digitorum profundus tendon excursion
to nearly the same extent as a Stax splint. Our results
were not nearly as positive, with a success rate of 47%
with the DIP joint blocking splint. The reasons are
speculative and may be subject related. Splint fit may be
a factor, although we ensured an optimal fit and
checked the fit with each follow-up visit. It could also
be that the Rogers et al patients worked in a meat plant
and had to wear a glove over the splint, which may have
improved compliance.
In general, selection of the splint design can depend
on clinical presentation, vocation, and leisure activities
of the subject. Given the increased comfort and de-
creased rate of failure, this study supports the use of the
MCP joint splint to treat a trigger finger. We currently
recommend starting with the MCP joint splint and
switching to the DIP joint splint only if the former is not
tolerated. Close monitoring of PIP joint stiffness is
required with use of the DIP joint blocking splint.
REFERENCES
1. Sampson SP, Badalamente MA, Hurst LC, Seidman J. Pathology of
human A1 pulley in trigger finger. J Hand Surg 1991;16A:714 –721.
2. Evans RB, Hunter JM, Burkhalter W. Conservative management of
the trigger finger: a new approach. J Hand Ther 1988;1:59 – 68.
3. Ryzewicz M, Wolf JM. Trigger digits: principles, management, and
complications. J Hand Surg 2006;31A:135–146.
4. Creighton JJ Jr, Idler RS, Strickland JW. Trigger finger and thumb.
Indiana Med 1990;83:260 –262.
5. Lindlor-Tons S, Ingell K. An alternative splint design for trigger
finger. J Hand Ther 1998;11:206 –208.
6. Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of splint-
ing for the treatment of trigger finger. J Hand Ther 2008;21:336 –
343.
7. Freiberg A, Mulholland RS, Levine R. Nonoperative treatment of
trigger fingers and thumbs. J Hand Surg 1989;14A:553–558.
8. Griggs SM, Weiss AP, Lane LB, Schwenker C, Akelman E, Sachar
K. Treatment of trigger finger in patients with diabetes mellitus.
J Hand Surg 1995;20A:787–789.
9. Newport ML, Lane LB, Stuchin SA. Treatment of trigger finger by
steroid injection. J Hand Surg 1990;15A:748 –750.
10. Rogers JA, McCarthy JA, Tiedman JJ. Functional distal interpha-
langeal joint splinting for trigger finger in laborers: a review and
cadaver investigation. Orthopaedics 1998;21:305–310.
11. Murphy D, Failla JM, Konuich MP. Steroid versus placebo injection
for trigger finger. J Hand Surg 1995;20A:628 – 631.
12. Benson LS, Ptaszek AJ. Injection versus surgery in the treatment of
trigger finger. J Hand Surg 1997;22A:138 –144.

JHS 䉬 Vol A, February 

 TRIGGER FINGER 249

13. Tanaka J, Muraji M, Negoro H, Yamashita H, Nakano T, Nakano K.
Subcutaneous release of trigger thumb and fingers in 210 fingers.
J Hand Surg 1990;15B:463– 465.
14. Turowski GA, Zdankiewicz PD, Thompson JG. The results of sur-
gical treatment of trigger finger. J Hand Surg 1997;22A:145–149.
15. Patel MR, Moradia VJ. Percutaneous release of trigger digit with and
without cortisone injection. J Hand Surg 1997;22A:150 –155.
16. Patel MR, Bassini L. Trigger fingers and thumb: when to splint,
inject, or operate. J Hand Surg 1992;17A:110 –113.
17. Faunø P, Anderson HJ, Simonsen O. A long-term follow-up of the
effect of repeated corticosteroid injections for stenosing tenovagini-
tis. J Hand Surg 1989;14B:242–243.
18. Marks MR, Gunther SF. Efficacy of cortisone injection in treatment
of trigger fingers and thumbs. J Hand Surg 1989;14A:722–727.
19. Anderson B, Kaye S. Treatment of flexor tenosynovitis of the
hand (“trigger finger”) with corticosteroids. A prospective study
of the response to local injection. Arch Intern Med 1991;
151:153–156.
20. Rhoades CE, Gelberman RH, Manjarris JF. Stenosing tenosyno-
vitis of the fingers and thumb. Results of a prospective trial of
steroid injection and splinting. Clin Orthop Relat Res 1984;190;
236 –238.
21. Nemoto K, Nemoto T, Terada N, Amako M, Kawaguchi M. Splint
therapy for trigger thumb and finger in children. J Hand Surg
1996;21B:416 – 418.
22. Carswell A, McColl MA, Law M, Baptiste S, Polatajko H, Pollock N.
The Canadian Occupational Performance Measure: a research & clinical
literature review. Can J Occup Ther 2004;71:210 –222.

JHS 䉬 Vol A, February 

249.e1 TRIGGER FINGER

APPENDIX 1. Trigger Finger Assessment

(Scoring Performed at Each Visit)
Severity of triggering 10
Lock, must manually pull out finger 8
Lock, can extend finger actively
Click with intense pain 5
Click with discomfort, no pain 3
Click with no discomfort or pain 1
No click, no discomfort 0
Frequency of triggering
All of the time 10
Several times per day 8
Once daily 6
Several times per week 4
About once per week 2
Not every week 1
Never 0
Functional impact of triggering
Disability (unable to perform any task with hand) 10
Severe (unable to perform 75% of tasks) 8
Moderate (unable to perform 50% of tasks) 6
Minimal (able to perform, but with discomfort) 3
None 0

JHS 䉬 Vol A, February 

View publication stats