Transcript
josh MacDonald: Hi, I'm Josh McDonald.
Miranda Materi: And I'm Randa Materi, and we are Ham Therapy Academy.
josh MacDonald: All right, we're gonna do our second of two. We're not gonna do a ton of them, but another journal article review for something we found had some good clinical implications. Miranda's gonna talk to us a little bit about trigger finger and maybe a different way to splint it, or maybe not.
Miranda Materi: Yeah, so I want to start by saying when I saw the title of this article, and I'm going to share the title, but I thought, why didn't I think of doing that for trigger finger? And it's basically, it was a randomized controlled study comparing a relative motion orthosis with our traditional MCP blocking orthosis. So it compared those two and was like, I wonder why I didn't think of using an RMO, because I feel like we've talked about this, too, where you're using a relative a relative motion splint for a lot of different things, or people are kind of throwing it at everything and seeing if it works. So the interesting thing about this study is it showed, well, it didn't really work that well. So that's, I guess, why I didn't think it as an idea. Yeah.
josh MacDonald: Maybe it's a good thing.
Miranda Materi: Yeah.
josh MacDonald: That's how research goes sometimes. Sometimes you have a really great idea and you find out, okay, it's not a good idea, but that's why we do research.
Miranda Materi: yeah because Yeah, because in theory I thought, well, great, because you stop a little bit of the gliding of that tendon, so maybe it'd be enough to stop the triggering. But in this study, it really didn't help. So in this study, they had 35 participants and they graded their triggering one through three, and they randomized these to either an MCP blocking orthosis or relative motionless orthosis. So we didn't compare them if you immobilize the PIP or the DIP. It was simply an RMO versus an MCP blocking. And then they looked at, did it improve the triggering? And no, it did not in the RMO group, or it did by like 24% compared to the blocking splint, which was around 60 some percent.
Miranda Materi: So you had 60% relief with the blocking and around 20 some percent with the relative motion. And then it looked at function and the blocking orthosis did better than the relative motion splint as well.
Miranda Materi: So kind of an interesting read.
josh MacDonald: Yeah, interesting that the relative motion orthosis had poor functional scores than the MCP blocking. Like the whole point of the RMO is to be more functional because it allows some joint movement but it's less functional in this study. So that was kind of interesting.
Miranda Materi: Yeah, that is interesting. And then thinking about like compare, like, have you ever worn an RMO orthosis?
josh MacDonald: I did when I first read an article about it for extensor tendon and heard um that the surgeon that kind of wrote it all talk about it in a lecture. i'm like, i think this would fall off at night.
josh MacDonald: Like, I don't see how this thing would stay on at night. So I made one and wore it a couple of nights in a row. Like it totally stayed on. Yep. It worked.
Miranda Materi: And was it comfortable?
josh MacDonald: um It was okay. It was all right. It wasn't fantastic, but it was better than the alternative conservative management extensor tendon splints of the time.
Miranda Materi: Yeah.
Miranda Materi: Yeah, definitely that. But I think like I was thinking if I would rather wear one, you know, which one it would it be?
josh MacDonald: Yeah.
Miranda Materi: And I don't, for some reason, I don't really think the RMOs are that comfortable. And most the time patients don't really love them. Like I have a patient that's wearing it for a sagittal band injury and it's helped her significantly, but it's still like, she's like, it's still not great to have to wear this, you know?
josh MacDonald: Yes. and And it depends on what the alternative is, right? If for an extensor tendon, if it's, you know, zone five on one, like a fight bite, and you have to wear this little thing instead of that giant post-operative dressing they come in with or the alternative splint, it's way better.
Miranda Materi: Yeah.
josh MacDonald: But yeah, you're right. If I can immobilize PAP or the MCP with that little MCP blocking kind of paddle, I've heard it called a light bulb splint because it looks like an upside down light bulb on your hand with a circle in your palm and around the the p one it's not that much better than those other alternatives we already have for trigger fingers.
Miranda Materi: Yeah. And I think about ease of making it like the light bulb splint, like you're calling it, or the blocking splint is much easier to make than a relative motion splint, right?
josh MacDonald: Yes.
Miranda Materi: You have to make sure, um, you know, you get that MCP and extension compared to other ones and it has to be comfortable.
josh MacDonald: Yeah.
Miranda Materi: And then you're really worrying about three fingers as opposed to one finger.
josh MacDonald: Yeah. Yeah.
Miranda Materi: Yeah.
josh MacDonald: Yeah, and it's interesting. We are, like you said, we're we're throwing ah RMOs at a lot of different problems um and it's worked for a bunch of them. I know there's some studies talking about using them for flexor tendons.
josh MacDonald: um I can't imagine the patient trust I would have to have to put a flexor tendon patient in an ah RMO. um even like I'm fine with a wrist-free dorsal blocking at times for the right patient caseload, but man, an RMO, I feel like you're your potential for...
josh MacDonald: deviation off of the plan of care is so high for that.
Miranda Materi: Yeah, it really is. um Unless it's, you know, if it's a flexor tendon that's further out where you're trying to get more gliding or you're using it more as a blocking splint, I can't imagine it being the first line of treatment.
Miranda Materi: But that's, I guess, why we do research, right? Like, what is the rupture rate with that?
josh MacDonald: Right.
Miranda Materi: We should find that article and read it and see.
josh MacDonald: Yeah. Yeah. And it's relative motion flexion of the injured digit, right? So you're holding it in flexion.
Miranda Materi: Uh-huh.
josh MacDonald: And for this, it was the first line of splinting um because it keeps it flexed. But I think about the wound issues on that hand, maybe it's for, and I didn't, I don't, I don't have the article details.
josh MacDonald: Maybe it was for something that was not a full, complete rupture of the tendon, you know, like a 60% laceration of the tendon, something like that.
Miranda Materi: yeah
josh MacDonald: Yeah. yeah i don't know. It's,
Miranda Materi: and then what strand of repair are we doing like a six and eight so i mean what strand of repair could tolerate that that that's interesting yeah
josh MacDonald: Yeah. Yeah.
josh MacDonald: yeah Yeah. Maybe next time. Maybe next time. um So yeah, it is interesting. um On a side note, we were talking ahead of time about treating trigger fingers. And I have currently now a patient on my caseload, and I have had several recently. They happen to be older patients because the office I'm in, who are who chose to do a conservative management of it because they didn't want the surgery or couldn't do the injections for whatever reason and they said i want to try the conservative and when they come in they'll say yeah it still triggers every once in a while i take it off and test it or when i'm doing things it still has triggering and i think
josh MacDonald: That's not the protocol. Like you got to go wear it all the time. And so I think sometimes the success rates, maybe not for research because you're monitoring them more closely, but the success rates are so highly dependent on patient compliance with that.
josh MacDonald: It's like it's almost like a mallet, but maybe not quite as diligent as a mallet, but like 99 percent of the time it's got to be on.
Miranda Materi: Yeah.
Miranda Materi: Yeah, you got to wear it. And I think that was the interesting about this article thing too, or I think it helps to for us to say, yeah, they wore this MCP blocking splint for six weeks, right? So that's typically what we say.
josh MacDonald: Yeah.
Miranda Materi: But this is another article proving that you need to wear it for six weeks for that success rate.
josh MacDonald: Yeah. Yeah. um As a point of reference, Miranda has done articles on, like written as an author, articles on trigger finger. And she was saying earlier that the success rate of splinting MCP versus PIP, in general, the success rate for splinting of trigger finger is roughly mid-60s percent success rate. so And that's what this found with the MCP blocking as well.
Miranda Materi: Yeah, so it's just nice to have another source that confirms that.
josh MacDonald: Yeah. Yeah. Another confirmation.
Miranda Materi: Yeah.
josh MacDonald: Yeah. All right. Well, hopefully this informs our practice a little bit. It's always good to do research, even if it doesn't turn out the way you expect it. But yeah, if you have any questions or any thoughts on trigger finger treatment, give us a call, give us an email, or you can reach out to us on our social media platforms at Hand Therapy Academy.
