Authors (including presenting author) :
Poon CY (1), Chan WY (1), Chan NY (1), Lam PL (2)
Affiliation :
(1) Department of Physiotherapy, David Trench Rehabilitation Centre, Queen Mary Hospital, (2) Department of Physiotherapy, Queen Mary Hospital
Introduction :
Trigger finger (TF) is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon. It is usually associated with dysfunction and pain. The main hypothesis is stenosing tenosynovitis at the level of the first annular (A1) pulley. Non-invasive management is often considered before corticosteroid injection or surgery.
Objectives :
To assess the efficacy of structured physiotherapy program on patient with TF
Methodology :
Patients with a diagnosis of TF received physiotherapy weekly in a ‘Click Free Program’, which run over 5-6 weeks. Around 8 to 12 patients were provided with customized exercise program, education video, education pamphlet and interventions such as ultrasound and shockwave therapy in each session. They were assessed before and after the program for Numeric Pain Rating Scare (NPRS), hand muscle strength using power and pinch grip, functional disability level using Quick Disability of the Arm, Shoulder and Hand (Quick DASH) score and subjective improvement using Numeric Global Rate of Change Scale (NGRCS).
Result & Outcome :
From November 2015 to November 2018, 325 patients were reviewed and 272 of them (83.7%) completed the program. 86 (26%) of them were male with mean age 65.3±10.6, and 239 (74%) of them were female with mean age 61.7±9.9. An average of 5.1±2.6 sessions was attended. NGCRS was 5.3±2.6 and the mean Quick DASH score was significantly decreased from 33.3±20.0 (pre-treatment) to 26.4±18.4 (post-treatment) (p<0.001, 95% CI 5.1 to 8.7). The subjective pain level experienced by patient (NPRS) was significantly reduced from 5.8±2.4 to 3.1±2.1(p<0.001, 95%CI 1.9 to 2.5). Muscle strength also showed significant improvement: power grip increased from 15.6±7.3 kgf to 17.8±7.2 kgf (p<0.001, 95%CI -2.7 to -1.6) and pinch grip increased from 2.0±1.5 kgf to 2.5±1.5 kgf (p<0.001, 95%CI -0.6 to -0.4). It was found that a structured group exercise program on top of conventional physiotherapy treatment could enhance improvement of symptoms and upper limb functional outcomes. We also believed that peer support would play an important role. Patients who attended the program shared their own experiences and walk along with each other on the rehabilitation pathway. Therefore, Click Free Program was shown to be efficax for treating patient with TF.
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