Traditional Physiotherapy vs. Fascial Manipulation for the Treatment of Trigger Finger: A Randomized Pilot Study.

BACKGROUND: Physiotherapy can help treat of trigger fingers (TF). OBJECTIVES: To compare efficacy of fascial manipulation (FM) and traditional physiotherapy (TP) techniques in treatment of TF. METHODS: Nineteen patients were randomized in the FM group and 15 in the TP group. All patients underwent eight physiotherapy sessions. The Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and visual analogue scale (VAS) scores, staging of stenosing tenosynovitis (SST) classification, triggering frequency, grip and pinch strength were recorded before and after treatment. We surveyed participants at 6 months for recurrence, further treatment, and the VAS and QuickDASH scores. The primary outcome measure was reduction in QuickDASH and VAS scores. RESULTS: Both FM and TF improved the QuickDASH and VAS scores at 6 months follow-up, without a significant difference. The QuickDASH score in the FM group improved from 28.4 ± 17.1 to 12.7 ± 16.3; TF scores improved from 27 ± 16.7 to 18.8 ± 29.4 (P = 0.001). The VAS score improved from 5.7 ± 2.1 to 1.2 ± 2.1 and from 4.8 ± 1.8 to 2 ± 2.6 for both groups, respectively (P < 0.001). SST and grip strength also improved following treatment, regardless of modality. At 6 months, four patients (22%) with an SST score of 1, three (30%) with a score of 2, and two (40%) with a score of 3A underwent additional treatment. CONCLUSIONS: Both FM and TP techniques are effective for the treatment of TF and should be considered for patients who present with SST scores of 1 or 2.

Spatial summation of pressure pain: effect of body region.

The characteristics of spatial summation of pressure pain are not clear. Pressure pain threshold (PPT) and perceived pressure pain intensity were measured in the hand, painfree back and myofascial trigger points (MTPs) in the back, using three different stimulus areas (0.5, 1 and 2 cm(2)). PPT decreased and perceived pain increased significantly with an increase in stimulation area in all the regions (e.g. PPT in the back, from 406+/-168 to 205+/-102kPa, P<0.0001). The magnitude of spatial summation of pressure pain was not significantly different between the regions. However, PPT in the back was significantly higher compared to the hand and MTPs (e.g. for 2 cm(2): mean of 205+/-102 vs 175+/-75 and 159+/-72kPa, P<0.01, respectively). Irrespective of body region, the quality of pain evoked with the large areas (1 and 2 cm(2)) was of pressure whereas in the small area (0.5 cm(2)) it was perceived as a prick. In conclusion, both PPT and perceived pressure pain intensity are subject to a considerable spatial summation in all the regions tested. The quality of pressure-evoked pain is probably determined by this spatial summation. Body region significantly affects the PPT level for a fixed stimulation area but not the magnitude of its spatial summation for areas up to 2 cm(2), which are probably within the receptive field of single spinal nociceptive neurons.