A Randomized Controlled Trial Comparing Fascial Manipulation with Traditional Physiotherapy for the Treatment of Trigger Fingers

Ori Firsteter 1 Arnon Ravid 1 Yaakov Pizem 1 Jacques Peylan 2 Galit Nahum 1 Sorin Daniel Iordache 3
1"Migdal Hamea" Physiotherapy Department, Clalit Health Services, Tel Aviv, Israel
2Beilinson Hospital, Pethach Tikva, Israel
3Hand Surgery Unit, Galilee Medical Center, Israel

Introduction: Traditional physiotherapy modalities such as physical agents in conjunction with manipulations, and gliding exercises are commonly used for the treatment of trigger fingers. Fascial manipulation is a manual therapy method which uses techniques of deep kneading of muscular fascia at specific points, termed centers of coordination (cc) and centers of fusion. The purpose of this study was to investigate the efficiency of the technique and to compare it with traditional physiotherapy.

Methods: Eligible patients with trigger finger were randomized in one of two treatment groups, either fascial manipulation (Group A) or traditional physiotherapy (Group B). The initial assessment included the Quinell staging, the measurement of the grip and pinch power, a Quick DASH questionnaire and a VAS chart. The assessment was repeated at 6 weeks by an assessor, blinded to the protocol. A mail survey was conducted six month from the end of the treatment.

Results: Thirty four patients were allocated to either Group A (19 patients) and Group B (15 patients). Analyzing both groups, the grip strength increased from 20±9 Kg to 23±11 kg (p<0.02) and the pinch from 2.5±1.2 Kg to 2.8±1.5 Kg (p<0.05). The DASH and VAS scores at baseline, end of treatment, and 6 month were 27±16, 19±13, 15±23 (p<0.01) and 5.3±1.9, 3.7±2.2, 3.7±2.2 (p<0.01), respectively. At 6 months, 18 (53%) patients had no or minimal symptoms, 6 (17%) had symptoms not requiring an intervention and 9 (26%) underwent an additional treatment. There were no significant differences in outcome between the two treatment groups.

Conclusions: Physiotherapy is an efficient treatment for trigger finger. Seventy five percent of the patients did not require an additional treatment for a 6 month period. Fascial manipulation was found to be as effective as traditional physiotherapy.