Function and Scar in Trigger Finger Release

A Comparative Study of Hand Function and Scar-Related Health-Related Quality of Life in Trigger Finger Release

Trigger finger is a common upper limb impairment associated with a significant decrease in quality of life, hand dexterity and strength as well as increased pain while complying daily activities of living. Trigger finger can be managed through the surgical release of the ligaments in the affected finger. The open surgical release of trigger finger can be accomplished through multiple incision types. As such, each incision may present different risks of harming or disturbing the underlying anatomy in the hand. This study aims to assess the variation in three incisional techniques (oblique, transverse and vertical) to determine which incision is preferential to improve scar aesthetics, increase hand function and minimize complications. Patients will be observed following surgery and information about hand function and quality of life will be obtained through the administration of questionnaires. Data will be collected at four time-points, one prior to and three following surgery.

Study Overview

• Status: Completed
• Conditions: Trigger Finger
• Intervention / Treatment: Procedure: Trigger Finger Release through Transverse Incision; Procedure: Trigger Finger Release through Oblique Incision; Procedure: Trigger Finger Release through Vertical Incision

Detailed Description

A study describing the superior incision technique is still needed to assess post-open release outcomes of the surgical site such as aesthetics and hand function. This study contributes to literature by providing further clarification into which technique of open trigger finger release is preferential to optimize scar aesthetics, increase function and, minimize complications using patient reported outcome measures such as the MHQ and SCAR-Q. The primary objective of this study is to assess patient Health-Related Quality of Life related to hand function via three incisional techniques using the generic hand instrument, (MHQ). This will be measured at 1 week prior, 1 day prior, and 1, 3, and 6 months post operation. The secondary objective will be to evaluate the Health-Related Quality of Life related to scar appearance post trigger finger release of three (transverse, oblique and vertical) incisional techniques of trigger finger release using the SCAR-Q (a condition-specific scales) at 1, 3 and 6 months post operation.

This study will be employed as a three-arm prospective cohort study. Local surgeons practicing at St. Joseph's Healthcare who utilize different incisional techniques for trigger finger release will compare each of their techniques. As each group sees trigger finger at a roughly equal rate, it is expected that the target of 30 patients in each group will be met in a similar timeline. Data will be recorded by a research team member that is not the operating physician via a paper-based system specific to this study.

At consultation patients will be approached for consent within a private consultation room within the surgical clinic. One week prior to surgery patients will complete questionnaires at the principle investigator's office (completed by the RA) in a private room. Post operation, patients will return to the principle investigator's office at 1, 3, 6 and 12 months post operation to complete the same questionnaires and to document any complications they have experienced.

• Study Type: Observational
• Enrollment (Actual): 75

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada, L8N 4A6
      • St. Joseph's Healthcare

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Individuals receiving trigger finger release surgery from surgeons who are co-investigators in this study.

Description

Inclusion Criteria:

• 18 years of age or older
• Trigger finger release of the 2nd, 3rd, 4th, or 5th finger
• Diagnosed stenosing tenosynovitis or trigger finger prior to release
• Able to understand and communicate English

Exclusion Criteria:

1. Previous attempted surgical treatment
2. Patients undergoing any concomitant procedure on the same hand (e.g. carpal tunnel release)
3. Patients who are unable to provide informed consent.
4. Patients who do not have a fixed address

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Transverse incision; At the level of the A1 pulley, a transverse incision will be made and the flexor pulley will be exposed with blunt dissection. The pulley will be transected and the wound will subsequently be closed with 4.0 Monocryl after ensuring complete release	Procedure: Trigger Finger Release through Transverse Incision; At the level of the A1 pulley, a transverse incision will be made and the flexor pulley will be exposed with blunt dissection. The pulley will be transected and the wound will subsequently be closed with 4.0 Monocryl after ensuring complete release.
Oblique incision; At the level of the A1 pulley, a oblique incision will be made and the flexor pulley will be exposed with blunt dissection. The pulley will be transected and the wound will subsequently be closed with 4.0 Monocryl after ensuring complete release.	Procedure: Trigger Finger Release through Oblique Incision; At the level of the A1 pulley, a oblique incision will be made and the flexor pulley will be exposed with blunt dissection. The pulley will be transected and the wound will subsequently be closed with 4.0 Monocryl after ensuring complete release.
Vertical incision; At the level of the A1 pulley, a vertical incision will be made and the flexor pulley will be exposed with blunt dissection. The pulley will be transected and the wound will subsequently be closed with 4.0 Monocryl after ensuring complete release.	Procedure: Trigger Finger Release through Vertical Incision; At the level of the A1 pulley, a vertical incision will be made and the flexor pulley will be exposed with blunt dissection. The pulley will be transected and the wound will subsequently be closed with 4.0 Monocryl after ensuring complete release.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Health-Related Quality of Life related to hand function	Outcome measured through the Michigan Hand Questionnaire (MHQ). The MHQ has a total score of 100; the lowest possible score is 0. A score of 100 on the MHQ indicates the best possible ability.	1 week prior, 1 day prior, and 1, 3 and 12 months post operation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Health-Related Quality of Life related to scar appearance	Scar appearance, symptoms and the psychosocial impact of the scar will be measured using the SCAR-Q. This questionnaire has a minimum score of 0 and a maximum score of 100 with higher scores indicating a better outcome.	1 week prior, 1 day prior, and 1, 3 and 12 months post operation

Collaborators and Investigators

• Sponsor: McMaster University
• Investigators: Principal Investigator: Achilles Thoma, MD, McMaster University

Study record dates

Study Major Dates

• Study Start (Actual): June 10, 2019
• Primary Completion (Actual): June 18, 2024
• Study Completion (Actual): June 18, 2024

Study Registration Dates

• First Submitted: July 13, 2022
• First Submitted That Met QC Criteria: July 25, 2022
• First Posted (Actual): July 28, 2022

Study Record Updates

• Last Update Posted (Actual): June 24, 2024
• Last Update Submitted That Met QC Criteria: June 21, 2024
• Last Verified: June 1, 2024

More Information

Terms related to this study

• Keywords: Function; Scar; Health-Related Quality of Life
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Muscular Diseases; Tendinopathy; Tendon Entrapment; Trigger Finger Disorder
• Other Study ID Numbers: 7242

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: we do not plan on sharing data with other researchers

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No