Evidence-based management of adult trigger digits.

The aim of this systematic review was to develop an evidence-based guideline to assist clinicians in the treatment of adult trigger digits. There is moderate evidence to suggest that local corticosteroid injection is a safe and effective short-term treatment and it may, therefore, be recommended as an initial treatment for this condition. However, when compared with surgery, there is strong evidence that corticosteroid injection is associated with increased rates of ongoing or recurrent symptoms at 6 months after intervention. There is strong evidence suggesting that trigger digit can be managed safely by surgical release. There is weak evidence to support the use of splinting or other non-operative modalities. Hence a single corticosteroid injection may be offered as the first line in treatment of adult trigger digits, but percutaneous release is a safe alternative. Surgery should be the next line if the injection fails, symptoms recur or the patient chooses. LEVEL OF EVIDENCE: I.

Gore-tex bags versus traditional hand bandaging: a comparison of range of motion, sensation and function in healthy subjects.

INTRODUCTION: Little evidence exists evaluating the possible effect of dressings on the recovery of function, sensation and joint motion following a hand burn. Hand burns are traditionally covered by a layer of non-adherent dressing followed by gauze and bandages. However, there is no evidence for the efficacy of this type of coverage relative to a functional recovery. The Gore-tex bag has a small body of research supporting its ability to provide a superior healing atmosphere, however there is no literature directly comparing it with the traditional dressing. METHOD: A randomised cross-over design was implemented to compare Gore-tex bags and traditional dressings in 30 healthy volunteers. Seven outcome measures of function, sensation, joint range of movement and subject perceptions were recorded before dressing, during both Gore-tex and traditional dressing interventions and between dressings. RESULTS: Statistically significant differences were found between the traditional dressings and Gore-tex bags. The Gore-tex bag dressings proved better for digit range of motion, 1st CMC joint motion and sensation. The traditional dressings were significantly better when perceived comfort was tested and there was no significant difference between the traditional dressing and Gore-tex bag regarding function and perceived function. CONCLUSION: The results of this study suggest that traditional dressings may detrimentally affect movement and reduce sensation but not necessarily affect function or comfort. Further investigation in a patient cohort with burnt hands is recommended.