Minimal clinically important difference of the Michigan Hand Outcomes Questionnaire score and the pain visual analogue scale in conservative treatment of trigger finger

Abstract

We investigated the minimal clinically important difference (MCID) of the Michigan Hand Outcomes Questionnaire (MHQ) and the pain visual analogue scale (VAS-pain) after conservative treatment of trigger finger. This secondary analysis of a randomized controlled trial compared pain reduction, symptoms and functional improvement at 12 weeks. Patients included were at least 18 years old and able to complete MHQ and VAS-pain at enrolment and 12 weeks after treatment. The MCIDs of MHQ and VAS-pain were evaluated using a distribution-based, anchor-based and receiver operating characteristic (ROC) curve-based approach. Of the 117 patients, the MCIDs of MHQ and VAS-pain using a distribution-based approach were 5.3 and 0.6, respectively; applying ROC method were 23.5 and 2.5, respectively; and using anchor questions were 15 and 2, respectively. These MCID values by anchor-based method with a minimal difference of 15 for MHQ and 2 for VAS-pain are recommended as primary evidence to determine clinically significant improvement after conservative treatment of trigger finger. Level of evidence: I

The management of trigger fingers: commentary and personal opinion

“…In these three articles, Jeon et al (2023) use 20 mg triamcinolone, Atthakomol et al (2023) 10 mg triamcinolone with 1% lidocaine and Bitar et al (2023) 20 mg of methylprednisolone (mixed with lidocaine).…”

“…I use 20 mg of triamcinolone, as I prefer a nonsoluble steroid and that is also the preferred option in our department. For the injection itself, Atthakomol et al (2023) and Bitar et al (2023) both use a 25G needle and a 2.5/3 ml syringe; 25 and 27G needles were used by Ring et al (2008). I use a smaller 30G needle in order to try to reduce the pain of the injection.…”

“…Trigger fingers are a common condition, so much so that it would be unusual in a general hand surgery clinic to not have someone present with symptoms of triggering. Three recent articles in the Journal look at the management of trigger fingers (Atthakomol et al, 2023;Bitar et al, 2023;Jeon et al, 2023). The aim of this article is to provide commentaries on these articles and my own opinion on the management of this painful but common condition.…”