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Trigger Finger
758 Plays4 months ago
Miranda and Josh talk about conservative management of trigger finger
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Transcript
Introduction to Hand Therapy Academy
00:00:05
joshmacd
Hi, I'm Josh McDonald.
00:00:06
mmateri
And I'm Randa Materia, and we are Hand Therapy Academy.
00:00:10
joshmacd
So we're trying to sprinkle in a little bit of this in a couple of different
Exploring ASHT Publications
00:00:13
joshmacd
podcasts. We want to talk a little bit today about another one of the articles or ASHT posters that we've put out, um just kind of help kind of share more knowledge about stuff.
Capstone Project Insights
00:00:22
joshmacd
Miranda did one not too long ago about trigger finger treatments. Miranda, you want to tell us a little bit about it?
00:00:27
mmateri
Yeah, so I think also I should start with the very first background of how this all started. I was doing my capstone at Mayo Clinic, and this was a very long time ago, and we were doing, or basically the standard of care was for the patient to get ah an injection in the A1 pulley for trigger finger, and then they would get sent to hand therapy immediately for immobilizing the PIP joint.
Effectiveness of Combined Treatments
00:00:54
mmateri
So it started out that way. ah And part of my capstone was doing a systematic literature review and going through all the literature and finding out what out there shows that splinting and injection together are better than injection alone or splinting alone. So that's where this all started at. And that was a long time ago. And during that time, the first part of the project was to look at, does it matter what joint you immobilize?
00:01:23
mmateri
and ah for a trigger finger. And we found that it didn't really matter as long as um you prevented the triggering. So you could immobilize the DIP as long as they didn't trigger it when they went into a fisted position.
Award-Winning Research Showcase
00:01:39
mmateri
Or you could do the PIP or the MCP. It really didn't matter. do You just want to prevent that um triggering for from occurring wherever it occurred at. um So ah from that lit review, we decided that it didn't really matter ah where it was done at.
00:01:57
mmateri
And then a few years, and that actually was my first poster at ASHT with Mayo Clinic. And that was an exciting one because that one won best poster. But I think that was mostly because of the work that they were already doing at Mayo Clinic.
00:02:08
joshmacd
Nice!
00:02:12
mmateri
I just happened, my timing was good. Right. And I was the one with the most time to put it together. So that was kind of a cool project. And then later on ah we ended up doing the clinical guidelines for trigger finger at the Mayo Clinic. So we acquired more literature and we ended up redoing the literature and submitting um another poster. And basically the outcomes show that it is slightly better if you add a splint wall after an injection. So I think the ah studies where injection or splinting alone was around 50 to 60% effective.
00:02:50
mmateri
if it was in the early stages of triggering. And then in the next stage was we compared injection alone, and that was pretty effective, but with injection splinting together, it was like 5%, I can't remember all the data, but it was like 5% to 7% more.
Patient-Centric Treatment Choices
00:03:08
mmateri
ah So it was basically just showing that splinting is a little better than injection alone with treating trigger finger. And the first part was like, it doesn't matter where you immobilize them at.
00:03:18
joshmacd
Okay, okay, lots of good information there and very applicable to what we're doing and what we're teaching patients and how we're picking to do things. um Do you have a preference on which joint you like to immobilize?
00:03:30
mmateri
Um, honestly, I'll give, I show the patients and I let them decide. And sometimes I say, just take both and change them out based on the functional tasks. So the last person I had was, he was a wound care physician. Um, and both would do the job, but there were certain tasks he couldn't do with the DIP immobilized. And there were certain tasks he couldn't do with the PIP. So he would switch them out based on whatever job he was doing.
00:03:54
joshmacd
Interesting, okay, but in both cases, like an off-the-shelf overlay.
00:03:58
mmateri
Um, yeah, I did end up giving him and I think for the, um, for the DIP, I ended up making him something a little bit different because it was slightly, he had shorter fingers and it was slightly too long.
00:04:09
joshmacd
Okay.
00:04:10
mmateri
So I just gave him like a little, like my own version of a d a novel late that he would put on the same prints.
00:04:16
joshmacd
Okay, okay, cool.
00:04:17
mmateri
It was basically the same principle. And if an oval eight would have worked, I would have done that.
00:04:21
joshmacd
Okay. um Do you like to immobilize the MCP with that pa paddle in the palm? I've heard it called a light bulb splint because it looks like an upside down light bulb. do you Do you use that very often?
00:04:32
mmateri
Yeah, I did sometimes. It's definitely not my go-to. My favorite is probably the PIP. But if I have a patient that there's some circumstance where you know their PIP is getting stiff or something like that, I might do that. How about you?
00:04:45
joshmacd
i I rarely immobilize the MCP. The DIP, I feel like I have a hard time knit not just falling off all the time. So 90% of the time I'm PIP.
00:04:53
mmateri
Yeah.
00:04:56
joshmacd
My next is probably MCP and that's usually for patients who have like a Bouchard's nodule or maybe it's not even Bouchard's nodule, they just have very bony joints and getting that oval eight to fit right over a bony joint. Because once it slides over the joint, it's loose on their finger. but it has to be a bigger size to get over that. So then I'll do that paddle light bulb splint thing, because that just has to go around P1 with a Velcro in the back. But if like that polymer piece is a little uncomfortable, you're trying to cut around the phenar crease and all that. So it gets a little bit more involved.
00:05:27
mmateri
But the thing that I like about the MCP or the, yeah, the MCP one is that it does avoid them putting pressure over their A1 pulley. So I think it's good for that aspect.
Challenges in Thumb Treatments
00:05:38
mmateri
Like if they're doing a lot of driving or something and they have pressure in their palm, or if they have some activity that's putting a lot of pressure over it, then I do like that as an option, or I will tell them to get a padded glove, or I've even sewn them like the neoprene option of that.
00:05:52
joshmacd
Yeah, yeah. there's a I think you can get an Amazon trigger finger splint or something like that.
00:05:56
mmateri
Oh, the trigger geographic figure solution.
00:05:56
joshmacd
Yeah, yeah. Yes, that's what it is.
00:05:58
mmateri
Yeah, I basically sell a version of that and I've even done where I've made a pocket and put the thermoplastic inside of it.
00:05:58
joshmacd
Yeah, yeah.
00:06:04
joshmacd
Oh, okay. I like that. um Yeah. And I feel like that, like you said, if they have pain with pressure directly to that A1 pulley, or ah like when they're putting their hand on a steering wheel, or if just, sometimes that oval eight cuts into the web spaces on either side, and it just doesn't sit right on their hand. So you can custom make one out of an Orphacast or something like that, or just go with a thermoplastic paddle there. And if they're happy with that, go for it.
00:06:28
mmateri
Yeah. And i I do want to say for all of the studies, it wasn't about, none of them included the thumb.
00:06:35
joshmacd
Yeah, whole different bag when you're talking about the thumb.
00:06:37
mmateri
Yeah. So like that has the thumb we know is like the conservative options aren't as successful as the the other digits.
00:06:45
joshmacd
Yeah.
00:06:45
mmateri
When I say conservative, I mean injection and splinting.
00:06:48
joshmacd
Yeah. And I'll have patients that come in for the conservative management of the thumb, sometimes from a surgeon because they don't want injections. They don't want surgery. They're like, I'm going to try the conservative. And I've had a patient who just wanted to keep trying, want to keep trying. And I say, I'll give it six weeks. And if we aren't noticeably better, maybe not a hundred percent, but noticeably better with triggering a pain in that thumb, this isn't the answer. um If the thumb is just so stubborn.
00:07:12
mmateri
Yeah. I know. And then I think, you know, and then you're like educating the patient, there's different stages of triggering. You know, we, if the stages are improving, I'll go over all that. But are a lot of times those patients that want conservative with them, it's not as successful. Do you ever have luck with it?
00:07:25
joshmacd
I have had one patient just recently that another one of our therapists was treating and she very much went. It took a long time, but she was going. She was like, I refuse to do injections and I'm not going to do surgery. I want to do this. And gosh, I feel like it was three months and we just kept checking and she kept progressing backwards through the stages of trigger finger, but it was a slow, arduous walk. And now she says it doesn't trigger on me ever and I have no pain to it. So yeah, yeah, it's,
00:07:49
mmateri
That's amazing. I like those, those stories are good stories.
00:07:52
joshmacd
Yeah, yeah, it's a good story. it feel It felt in the middle of it like, man, are we just banging our head against the wall? But she kept talking about small incremental changes. So that's that's what counts.
00:08:00
mmateri
I know, and it does show you that, you know, there are exceptions to the rule, right? Not everything is an absolute.
00:08:05
joshmacd
yeah
00:08:06
mmateri
We go off of our experiences and, and the of course we go off the research and, but there are those outliers that get better when we think, you know, maybe they won't or vice versa.
Therapy vs. Surgery Perspectives
00:08:15
mmateri
You think they're going to get better and they don't.
00:08:16
joshmacd
Yeah, yeah. It's interesting to hear you say that the conservative splinting only was 50 to 60% successful. I feel like clinically I see it much more successful than that, um but that maybe the sample size that comes into the clinic is already in better position than the people who get to the doctor first and just go to surgery. You know, like maybe the sample size is different. I don't know, but I feel like I see better than 50, 60% success rate.
00:08:40
mmateri
Yeah, I, and you know, like these numbers are from a while. So I'm like recalling off the top of my head. but they're They're close guys. They're close.
00:08:49
joshmacd
Yeah. Yeah. We're going to quote you on that for sure.
00:08:50
mmateri
by Yeah. Yeah. Don't get me on it. It might be off by like 5% or something.
00:08:53
joshmacd
Yeah. Yeah. But still, I would have thought it'd be somewhere in the 80% because I feel like we have pretty good success with the overlay splinting or, you know, customer, whatever.
00:09:02
mmateri
Yeah.
00:09:02
joshmacd
Yeah. Yeah.
00:09:03
mmateri
But how many times do you have that? Like I had a patient last week and then they were like, you know, the, the doctor wants to do surgery. Um, but I refuse and I'm trying to, and they said therapy won't work. So a lot of times the patients, the doctors are telling him therapy won't work either.
00:09:19
joshmacd
Yeah.
00:09:19
mmateri
And those are the ones I really love when they get better. Cause you're like, cause therapy does work.
00:09:24
joshmacd
Yes, and and I've talked to patients before, and and we use the analogy, when you're a hammer, everything looks like a nail.
00:09:24
mmateri
Yeah.
00:09:30
joshmacd
When you're a therapist, all of our problems can be fixed with therapy when you're a surgeon, just up to surgery. That's what you're here for. We can fix your carpal tunnel with surgery, we can fix your trigger finger with surgery, just do the surgery.
00:09:39
mmateri
yeah
00:09:40
joshmacd
Therapy's not that effective anyway. Well, you ask me and I'll say, why are you gonna cut yourself open? Let's try the conservative for six weeks and see what we get, yeah.
00:09:47
mmateri
Yeah, but I do and to be fair to surgeons too, i I know that they're pretty careful too. They're not just having people go to surgery to go to surgery.
00:09:55
joshmacd
Yeah, yeah, yeah, yeah.
00:09:55
mmateri
And you know that too.
Engagement and Contact Information
00:09:59
joshmacd
Yeah, well, it's just interesting to hear some different perspectives on what is a normal pretty ah common diagnosis that we see, but also something that Miranda got a chance to do some poster presentations at ASHT a little while ago. So very cool, thank you for sharing Miranda.
00:10:12
mmateri
You're welcome.
00:10:13
joshmacd
And if we if you have any questions, please feel free to reach out to us in our email info at Hand Therapy Academy or on any of our social media platforms with the Handel Hand Therapy Academy.