Extracorporeal Shock Wave in the Treatment of Trigger Finger

NCT ID: NCT03928873

Last Updated: 2019-04-26

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

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-20

Study Completion Date

2019-11-22

Brief Summary

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Trigger finger (TF) is a condition that causes triggering, snapping, or locking on flexion of the involved finger, with a life- time risk between 2%-3% in the general population. A variety of treatments have been described, but the most effective treatment for this common disorder is still under debate. Recently, extracorporeal shock wave therapy(ESWT) has been advanced as a possible alternative to surgery for the treatment of musculoskeletal disorders in patients recalcitrant to traditional conservative treatment.

However, the effectiveness of ESWT on the treatment of TF is still in lack of evidence. The purpose of this study is to conduct a prospective randomized clinical trial to compare the efficacies of ESWT at two different energy flux density with placebo treatment for the management of TF. The investigators intended to enrolled 60 participants randomly allocated to three groups: low energy ESWT (1500 impulses and 0.006mJ/mm2, 3bar, once per week for 4 weeks), high energy ESWT (1500 impulses and 0.01mJ/mm2, 5.8bar, once per week for 4 weeks) or placebo treatment groups. The effectiveness of the treatment will be assessed using cure rates, a visual analogue scale, the frequency of triggering, the severity of triggering, the functional impact of triggering, and the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) at 1, 3, and 6 months after treatment. An intention-to-treat analysis will be used in this study. The investigators intend to determine the efficacy of ESWT in the treatment of TF and to find out the ideal energy set-up of ESWT for TF treatment.

Detailed Description

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Trigger finger (TF) (also known as stenosing tenovaginitis) is characteristic of triggering, snapping, or locking on flexion of the involved metacarpophalangeal joint of finger, with incidence of 2%-3% in the general population and approximately 10% in diabetic patients. A variety of treatments have been described, including activity restriction, stretching exercise, splitting, non-steroid anti-inflammatory drugs, steroid injection, percutaneous or open release. However, none of the above-mentioned treatments is absolutely better than the others. The most effective treatment for this common disorder is still under debate.

Recently, extracorporeal shock wave therapy (ESWT) is getting popular as an alternative to surgery for the treatment of musculoskeletal disorders in patients recalcitrant to traditional conservative treatment. ESWT has been reported to effectively treat orthopedic disorders, such as plantar fasciitis, lateral epicondylitis of the elbow, calcific tendinopathies of the shoulder, and the non-union of long bone fractures. Biologically, ESWT is believed to result in a mechanosensitive feedback between the acoustic impulse and the stimulated cells, involving specific transduction pathways and gene expression. Furthermore, previous studies have shown that increased angiogenetic growth factors with ESWT are causally related to enhanced neovascularization and blood supply in the tendinopathy area of the tendon. ESWT can also induce the repair of the inflamed tissues by tissue regeneration and stimulates nitric oxide synthase, leading to suppression of ongoing inflammation in the soft tissues. However, there are still few clinical evidence on ESWT in treatment of TF in the literature.

One randomized control study reported the efficacy of ESWT in treatment of TF in 2016, and claimed that ESWT was as effective as steroid injection in treatment of TF. However, this clinical study was limited to the lack of control group with placebo treatment, since steroid injection for TF is reported to be with short-term effect and only effective in 57% of patients. Further evidence on the efficacy of ESWT in treatment of TF is needed to be clarified. In addition, the ideal energy set-up and protocol for ESWT are still left to be proven.

Considering the noninvasive advantage and potentially biological effect on the thickening of the flexor tendon and its sheath, the investigators hypothesize ESWT is effective on relieving the symptoms of TF. The purpose of this study is to conduct a prospective randomized clinical trial to compare the efficacies of ESWT at two different energy flux density with placebo treatment for the management of TF. The investigators intended to determine the efficacy of ESWT in the treatment of TF and to find out the ideal energy set-up of ESWT for TF treatment.

Conditions

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Trigger Finger

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Our pilot experiment on safety and effectiveness of Extracorporeal shock wave therapy (ESWT), we choose the two energy doses of ESWT for experiment:

1. Low energy ESWT (1500 impulses and 0.006mJ/mm2, 3bar, once per week for 4 weeks)
2. High energy ESWT (1500 impulses and 0.01mJ/mm2, 5.8bar, once per week for 4 weeks) In order to realize the effectiveness of ESWT on trigger finger, we will enroll a placebo group in which all participants will receive ESWT probe treatment with only vibration without transferring energy once per week for 4 weeks.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
The patients will be randomized to each group. All participants are blinded to the treatment groups. All of the outcome will be followed by an assistant who is blinded to the allocation.

Study Groups

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Low energy ESWT

Low energy ESWT (using LITEMED"LM-ESWT-mini System with 1500 impulses and 0.006mJ/mm2, 3bar, once per week for 4 weeks)

Group Type EXPERIMENTAL

Low energy ESWT

Intervention Type DEVICE

1500 impulses and 0.006mJ/mm2, 3bar, once per week for 4 weeks

High energy ESWT

High energy ESWT (using LITEMED"LM-ESWT-mini System with 1500 impulses and 0.01mJ/mm2, 5.8bar, once per week for 4 weeks)

Group Type EXPERIMENTAL

High energy ESWT

Intervention Type DEVICE

1500 impulses and 0.01mJ/mm2, 5.8bar, once per week for 4 weeks

Sham treatment

All participants will receive sham treatment using ESWT Probe with only vibration without transferring energy once per week for 4 weeks.

Group Type SHAM_COMPARATOR

Sham ESWT

Intervention Type DEVICE

sham treatment using ESWT Probe with only vibration without transferring energy once per week for 4 weeks

Interventions

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Low energy ESWT

1500 impulses and 0.006mJ/mm2, 3bar, once per week for 4 weeks

Intervention Type DEVICE

High energy ESWT

1500 impulses and 0.01mJ/mm2, 5.8bar, once per week for 4 weeks

Intervention Type DEVICE

Sham ESWT

sham treatment using ESWT Probe with only vibration without transferring energy once per week for 4 weeks

Intervention Type DEVICE

Other Intervention Names

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"LITEMED"LM-ESWT-mini System "LITEMED"LM-ESWT-mini System "LITEMED"LM-ESWT-mini System

Eligibility Criteria

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Inclusion Criteria

1. Older than 20 years of age
2. Grade 2\~3 trigger finger based on the Quinnell classification

Exclusion Criteria

1. Previous treatment by physical therapy, local corticosteroid injection, or surgical release for trigger finger before the study
2. The presence of a musculoskeletal disease or previous nerve injuries at the upper extremities
3. Multiple trigger finger; local infection; malignancy; inflammatory arthritis; cardiac arrhythmia or cardiac pacemaker; and pregnancy.
Minimum Eligible Age

20 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Taipei Medical University WanFang Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Yu-Pin Chen, M.D.

Role: PRINCIPAL_INVESTIGATOR

Taipei Medical University WanFang Hospital

Locations

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Taipei Medical University WanFang Hospital

Taipei, , Taiwan

Site Status RECRUITING

Countries

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Taiwan

Central Contacts

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Yu-Pin Chen, M.D.

Role: CONTACT

+886-933296411

Facility Contacts

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Yu-pin Chen, MD

Role: primary

+886933296411

References

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Koh S, Nakamura S, Hattori T, Hirata H. Trigger digits in diabetes: their incidence and characteristics. J Hand Surg Eur Vol. 2010 May;35(4):302-5. doi: 10.1177/1753193409341103. Epub 2009 Aug 17.

Reference Type BACKGROUND
PMID: 19687073 (View on PubMed)

Strom L. Trigger finger in diabetes. J Med Soc N J. 1977 Nov;74(11):951-4. No abstract available.

Reference Type BACKGROUND
PMID: 269967 (View on PubMed)

Amirfeyz R, McNinch R, Watts A, Rodrigues J, Davis TRC, Glassey N, Bullock J. Evidence-based management of adult trigger digits. J Hand Surg Eur Vol. 2017 Jun;42(5):473-480. doi: 10.1177/1753193416682917. Epub 2016 Dec 21.

Reference Type BACKGROUND
PMID: 28488453 (View on PubMed)

Romeo P, Lavanga V, Pagani D, Sansone V. Extracorporeal shock wave therapy in musculoskeletal disorders: a review. Med Princ Pract. 2014;23(1):7-13. doi: 10.1159/000355472. Epub 2013 Nov 5.

Reference Type BACKGROUND
PMID: 24217134 (View on PubMed)

Yin M, Chen N, Huang Q, Marla AS, Ma J, Ye J, Mo W. New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis. Arch Phys Med Rehabil. 2017 Dec;98(12):2371-2377. doi: 10.1016/j.apmr.2017.05.016. Epub 2017 Jun 17.

Reference Type BACKGROUND
PMID: 28634056 (View on PubMed)

Yang TH, Huang YC, Lau YC, Wang LY. Efficacy of Radial Extracorporeal Shock Wave Therapy on Lateral Epicondylosis, and Changes in the Common Extensor Tendon Stiffness with Pretherapy and Posttherapy in Real-Time Sonoelastography: A Randomized Controlled Study. Am J Phys Med Rehabil. 2017 Feb;96(2):93-100. doi: 10.1097/PHM.0000000000000547.

Reference Type BACKGROUND
PMID: 27323324 (View on PubMed)

Arirachakaran A, Boonard M, Yamaphai S, Prommahachai A, Kesprayura S, Kongtharvonskul J. Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol. 2017 Apr;27(3):381-390. doi: 10.1007/s00590-016-1839-y. Epub 2016 Aug 23.

Reference Type BACKGROUND
PMID: 27554465 (View on PubMed)

Alkhawashki HM. Shock wave therapy of fracture nonunion. Injury. 2015 Nov;46(11):2248-52. doi: 10.1016/j.injury.2015.06.035. Epub 2015 Jul 3.

Reference Type BACKGROUND
PMID: 26323379 (View on PubMed)

Cacchio A, Giordano L, Colafarina O, Rompe JD, Tavernese E, Ioppolo F, Flamini S, Spacca G, Santilli V. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg Am. 2009 Nov;91(11):2589-97. doi: 10.2106/JBJS.H.00841.

Reference Type BACKGROUND
PMID: 19884432 (View on PubMed)

Hsu RW, Hsu WH, Tai CL, Lee KF. Effect of shock-wave therapy on patellar tendinopathy in a rabbit model. J Orthop Res. 2004 Jan;22(1):221-7. doi: 10.1016/S0736-0266(03)00138-4.

Reference Type BACKGROUND
PMID: 14656684 (View on PubMed)

Orhan Z, Ozturan K, Guven A, Cam K. The effect of extracorporeal shock waves on a rat model of injury to tendo Achillis. A histological and biomechanical study. J Bone Joint Surg Br. 2004 May;86(4):613-8.

Reference Type BACKGROUND
PMID: 15174564 (View on PubMed)

Seok H, Kim SH. The effectiveness of extracorporeal shock wave therapy vs. local steroid injection for management of carpal tunnel syndrome: a randomized controlled trial. Am J Phys Med Rehabil. 2013 Apr;92(4):327-34. doi: 10.1097/PHM.0b013e31826edc7b.

Reference Type BACKGROUND
PMID: 23044704 (View on PubMed)

Yildirim P, Gultekin A, Yildirim A, Karahan AY, Tok F. Extracorporeal shock wave therapy versus corticosteroid injection in the treatment of trigger finger: a randomized controlled study. J Hand Surg Eur Vol. 2016 Nov;41(9):977-983. doi: 10.1177/1753193415622733. Epub 2016 Sep 28.

Reference Type BACKGROUND
PMID: 26763271 (View on PubMed)

Fleisch SB, Spindler KP, Lee DH. Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review. J Am Acad Orthop Surg. 2007 Mar;15(3):166-71. doi: 10.5435/00124635-200703000-00006.

Reference Type BACKGROUND
PMID: 17341673 (View on PubMed)

Chen YP, Lin CY, Kuo YJ, Lee OK. Extracorporeal Shockwave Therapy in the Treatment of Trigger Finger: A Randomized Controlled Study. Arch Phys Med Rehabil. 2021 Nov;102(11):2083-2090.e1. doi: 10.1016/j.apmr.2021.04.015. Epub 2021 May 21.

Reference Type DERIVED
PMID: 34029555 (View on PubMed)

Other Identifiers

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N201810059

Identifier Type: -

Identifier Source: org_study_id

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