Report on Hands from Doctors Demystify, February 2012

CONTENTS
DD Courses, of course
Which splint works best for trigger finger?
Arm Candy for your Fashionista atients
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Doctors Demystify /racing ;nno(ation
Doctors Demystify "humb /asal 8oint Arthritis ss
$O%RN&( &RT"C(E RE)"E*
*+at sp,int -or.s best for tri//er fin/er0
#ummary* "he authors performed a prospecti(e randomi<ed trial comparing two splint
designs for treatment of trigger finger- Fifteen patients recei(ed a D; fle4ion blocking
splint, and '7 patients recei(ed an , fle4ion blocking splint, which consisted of a
thermoplastic palm paddle with e4tension onto and around the pro4imal phalan4 of the
affected finger- /efore and immediately after splint fitting and ', 7, =, '%, and >% weeks
later, patients were assessed with grip strength and completion of an outcomes measure-
atients rated their splints as comfortable or uncomfortable, rated their ability to function
while wearing the splint as good, fair, or poor, indicated the fraction of a %$9hour day that
they wore the splint, and rated their pain on a (isual analog scale-
"he groups were well matched for age, hand in(ol(ement, and duration of triggering-
At = weeks, the , fle4ion blocking splint reduced or relie(ed triggering in 33? of
patients compared to $3? with the D; fle4ion blocking splint- /oth groups with roughly
e@ual fre@uency noted that the splints made functional acti(ities awkward- Comfort was
better with the , blocking splint although patients found it more restricti(e- "he drop9
out rate between = and '% weeks was considerable, but some patients continued the
splinting for up to a year and noted sustained impro(ement-
atients recei(ing relief were generally pleased to ha(e a(oided inAection or surgery-
8 Band #urg %&'% FebC73A*%$79%$: Abstract
Comment* ; like this study- Although their numbers are small, the authors pro(ided a
prospecti(e, randomi<ed, @uantified study on a ubi@uitous condition- "heir bracing
treatments do not seem applicable to trigger thumbs- As a surgeon, my first line of
treatment for trigger finger is a cortisone inAection, which typically relie(es triggering and
tenderness within a week and permanently relie(es triggering in appro4imately >&? of
inAected fingers- A second inAection months later in those patients with recurrences
permanently relie(es symptoms in appro4imately another $&?- ;n my practice, the '&?
of triggers that are resistant to % inAections get relief with trigger finger release- For
patients who are ad(erse to inAection or ad(erse to surgery, ; will recommend that they try
a custom thermoplastic , fle4ion block splint-
Challenge* e4ecute a prospecti(e randomi<ed trial designed along the lines of this study
comparing , fle4ion block splinting with cortisone inAection-
itch* !earn details about all sorts of snapping fingers from a surgeonDs point of (iew at
Doctors Demystify the Finger 8oints on an upcoming #aturday in a city near you-
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/est wishes,
1oy A- ,eals, ,D
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