Effectiveness of Non-surgical Interventions for the Trigger Finger: a Randomized Clinical Trial

NCT ID: NCT02972879

Last Updated: 2017-07-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

132 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-03-01

Study Completion Date

2020-07-31

Brief Summary

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The aim of this study is to assess the effectiveness of therapeutic modalities (paraffin, ultrasound and orthotics) versus corticosteroid injection for trigger finger.

Detailed Description

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There are several forms of nonsurgical treatment for trigger finger, the most used are:

* Oral nonsteroidal and steroidal antiinflammatory's drugs use to resolve the inflammatory process
* Corticosteroids local injection: that proposes to control the inflammation, these injections have shown good effectiveness for trigger finger treatment.
* Orthotic: with the aim of to immobilize the affected joint until the resolution of the inflammatory process.
* Electrotherapeutic modalities:
* Paraffin that increases cellular metabolism and promotes peripheral vasodilatation, favoring the transduction tissue fluid, lymph flow, hyperemia and consequent absorption of exsudato.
* LASER -Lower Level Laser Therapy (LLLT): the absorption of light through the skin's photoreceptors stimulates mitochondrial chain reactions, promoting adenosine triphosphate (ATP) synthesis, acting on gene expression, which raises the level of growth factors and Tissue repair

Although the non-surgical treatment is often used there is no evidence in the literature of which is the most effective conservative treatment for trigger finger. Thus, it is necessary use appropriate methodology to define the benefits and harms of each treatment modality and assess the effectiveness of these nonsurgical treatments, and may define which one has a higher resolution and lower rates of trigger finger recurrences in short, medium and long term.

Conditions

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Trigger Finger

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Therapeutic Modalities

* Group 1: Metal orthotic, keeping 0º of the extension of the proximal interphalangeal joint, during all day, for 5 weeks, stopping the use only for bathing
* Group 2: 10 LLLT sessions applications on the A1 pulley and lump formed on the flexor tendon of the the affected finger; Two sessions per week, five weeks of treatment.
* Group 3: Paraffin bath 2 times a week for 20 minutes (total of 10 sessions).

Group Type ACTIVE_COMPARATOR

Therapeutic modalities: Orthotic (Group 1)

Intervention Type PROCEDURE

participants will be instructed to remove the orthosis only two hours in the morning, two hours in the afternoon and two hours at night to avoid joint stiffness

Therapeutic modalities: LLLT (Group 2)

Intervention Type PROCEDURE

The LLLT parameters are:

* LASER 904nm
* P: 1.5W/cm²
* 30mV/cm²
* Area 2 cm²
* 1 Joule por ponto ( in the A1 pulley)

Therapeutic modalities: Paraffin (Group 3)

Intervention Type PROCEDURE

Paraffin will be heated and maintained at 50 ° C. Participants will immerse their affected hand 10 times in heated paraffin, then they will roll up their affected hand in a towel that they will bring, after 20 minutes timed by a trained professional, the subjects will remove the towel and "paraffin glove":

Corticosteroid injection

Group 4: Corticosteroid injection in the A1 pulley, 1 application.

Group Type ACTIVE_COMPARATOR

Corticosteroid injection (Group 4)

Intervention Type PROCEDURE

The injection solution is composed of 1 ml of betamethasone and 1 ml of 2% lidocaine.This group may repeat the procedure in two weeks if they report that there was no improvement of the triggering or pain.

Interventions

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Therapeutic modalities: Orthotic (Group 1)

participants will be instructed to remove the orthosis only two hours in the morning, two hours in the afternoon and two hours at night to avoid joint stiffness

Intervention Type PROCEDURE

Therapeutic modalities: LLLT (Group 2)

The LLLT parameters are:

* LASER 904nm
* P: 1.5W/cm²
* 30mV/cm²
* Area 2 cm²
* 1 Joule por ponto ( in the A1 pulley)

Intervention Type PROCEDURE

Therapeutic modalities: Paraffin (Group 3)

Paraffin will be heated and maintained at 50 ° C. Participants will immerse their affected hand 10 times in heated paraffin, then they will roll up their affected hand in a towel that they will bring, after 20 minutes timed by a trained professional, the subjects will remove the towel and "paraffin glove":

Intervention Type PROCEDURE

Corticosteroid injection (Group 4)

The injection solution is composed of 1 ml of betamethasone and 1 ml of 2% lidocaine.This group may repeat the procedure in two weeks if they report that there was no improvement of the triggering or pain.

Intervention Type PROCEDURE

Other Intervention Names

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Metal orthotic Ibramed's LASERPULSED 904nm Bath Paraffin Carci´s Bethametasone

Eligibility Criteria

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Inclusion Criteria

* 2-3 grade of trigger finger (Quinnell´s classification)
* Signing the Terms of Consent.

Exclusion Criteria

* Presence of finger trigger in children
* Presence of traumatic finger trigger
* Secondary causes (patients with tumor of the tendon sheath,

synovitis tuberculosis, etc ...)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Federal University of São Paulo

OTHER

Sponsor Role collaborator

Beatriz Sernajoto Cristiani Pedro

OTHER

Sponsor Role lead

Responsible Party

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Beatriz Sernajoto Cristiani Pedro

BSCPedro

Responsibility Role SPONSOR_INVESTIGATOR

Central Contacts

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Beatriz S C Pedro

Role: CONTACT

05511998035668

References

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Reference Type BACKGROUND
PMID: 3918652 (View on PubMed)

Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of splinting for the treatment of trigger finger. J Hand Ther. 2008 Oct-Dec;21(4):336-43. doi: 10.1197/j.jht.2008.05.001. Epub 2008 Aug 22.

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PMID: 19006759 (View on PubMed)

Chen PT, Lin CJ, Jou IM, Chieh HF, Su FC, Kuo LC. One digit interruption: the altered force patterns during functionally cylindrical grasping tasks in patients with trigger digits. PLoS One. 2013 Dec 31;8(12):e83632. doi: 10.1371/journal.pone.0083632. eCollection 2013.

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PMID: 22189188 (View on PubMed)

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Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005617. doi: 10.1002/14651858.CD005617.pub2.

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Salim N, Abdullah S, Sapuan J, Haflah NH. Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers. J Hand Surg Eur Vol. 2012 Jan;37(1):27-34. doi: 10.1177/1753193411415343. Epub 2011 Aug 4.

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Valdes K. A retrospective review to determine the long-term efficacy of orthotic devices for trigger finger. J Hand Ther. 2012 Jan-Mar;25(1):89-95; quiz 96. doi: 10.1016/j.jht.2011.09.005.

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Reference Type BACKGROUND
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Related Links

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http://www.walt.nu/dosage-recommendations.html

World Association of Laser Therapy. Recommended antiinflammatory dosage for low level laser therapy. 2005. (accessed june 20, 2017).

Other Identifiers

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BSCPedro

Identifier Type: -

Identifier Source: org_study_id

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