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Background and study aims This study aims to establish an alternative treatment for patients with two particular forms of Tenosynovitis; Trigger Finger disease or De Quervains. These separate pathologies constitute the majority of referrals from our local GP practices to our Musculoskeletal Clinical Assessment, Triage and Therapy Service (MCATTS) at Guy's & St Thomas’ Hospitals. A tendon is a strong tissue that attaches a muscle to a bone. In these cases the tendons come from muscles in the forearm and attach to the bones of the thumb or fingers, by passing through the palm. The muscle pulling on these tendons bend the fingers towards the palm, or straighten the thumbs. Tendons are encased within a tunnel of tissue called a tendon sheath that covers and protects the tendons, whilst allowing them to slide in and out without any friction. When the sheath becomes inflamed this is termed tenosynovitis. In trigger finger disease the tendon cannot easily slide back in due to the swelling of the tendon or the sheath. The finger can become locked unless you straightened forcefully. In De Quevains disease, the tendons that straighten the thumb are involved due to a tenosynovitis. The typical symptom is pain over your wrist at the base of your thumb that is made worse by activity and eased by rest. Laser therapy has shown clinical success in a wide variety of musculoskeletal and wound healing scenarios. This study aims to quantify the effect of laser therapy on the treatment of trigger finger disease in diabetic and non-diabetic groups and De Quervains Tenosynovitis. The study shall quantify both the effectiveness of laser by reducing symptoms, finger-locking, and improving function. We also aim to establish the duration of treatment required for both in terms of hospital visits, and days from the initial consultation. Who can participate? Any patient 18 years of age or older with full mental capacity and no active cancer What does the study involve? There are 3 groups in this study: 1. Trigger finger in non-diabetics 2. Trigger finger in diabetics 3. Patients with De Quervains We will expect to recruit about 30 patients in each group and randomly assign half into receiving laser therapy (receiving 2 sessions a week for 6 weeks), and half to splinting (for 6 weeks). If patients have not improved in either group we will then proceed to our standard level of care. What are the possible benefits and risks of participating? Currently each trigger finger disease and De Quervains are managed by splinting, proceeding to steroid injections and then ultimately surgery. Steroid injections can be very painful, and can increase the risk of infection and tendon rupture. In diabetics it has also been shown to affect blood sugar levels for more than 5 days, which can be problematic in insulin controlled diabetics. Surgery carries further risks of pain, infection, bleeding and scarring. K-laser is a non-invasive alternative that avoids all of these potential risks. There has not been a single reported case of any form of complication associated with high intensity laser therapy. There are however many examples of where this novel treatment modality can enhance recovery of different forms of tendonitis and chronic inflammatory changes. The risk profile associated with this study is therefore negligible based on published evidence. Where is the study run from? The Hand therapy department, Third Floor, Lambeth Wing, St Thomas’ Hospital When is the study starting and how long is it expected to run for? The study is expected to run from June 2013-June 2014 Who is funding the study? Guy’s & St Thomas’ NHS Trust Who is the main contact? Mr Mohammed Tahir [email protected]

Inclusion criteria

• Trigger finger disease, De Quervains tenosynovitis

Links

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