The Stiff Finger

This case report details the application of a treatment regimen using a serial elastic tension digital neoprene orthosis (ETDNO) protocol for a patient with an eight-month-old finger crush injury who experienced recurrence of a 45º proximal interphalangeal joint (PIPJ) flexion contracture two months after arthrolysis.

To illustrate how the application strategy of ETDNO can increase the daily total end range time (TERT) and modify finger stiffness.

The patient reached full extension following 15 weeks of ETDNO treatment. The six-month follow-up evaluation revealed that the PIPJ was stable with full flexion and extension. The joint did not require continued orthosis use.

The literature describes orthosis application as the treatment of choice for PIPJ flexion contracture, but no study has described an ideal program for use nor the full and stable resolution of the flexion contracture. The current literature describes a maximum daily total end range time (TERT) of 12 hours a per day. The serial ETDNO protocol that this study described increased the daily TERT to nearly 24 hour per day and demonstrated an excellent result in the treatment of PIPJ flexion contracture

This outcome suggests that clinicians will want to consider this new orthosis design and management protocol as a novel option for the treatment of PIPJ flexion contracture. We need future research to better define the optimum number of hours of daily TERT for the effective treatment of PIPJ flexion contracture. In addition, we will also benefit from the exploration of the optimum orthosis design to enable the highest amount of TERT

We investigated closed passive manipulation as an alternative to surgery for certain proximal interphalangeal (PIP) joint extension contractures.

We retrospectively reviewed all patients with PIP joint extension contractures treated with passive manipulation at our institution between 2015 and 2019. The included patients were a minimum of 12 weeks from their initial injury/surgery (median 179 days; interquartile range: 130–228 days), had plateaued with therapy, and underwent a 1-time passive manipulation. All included fingers had congruent PIP joints and no indwelling hardware that could have had direct adhesions. Most (80%) patients had a direct injury to the finger ray(s) that led to the contractures. Most (75%) patients had the manipulation performed under local anesthesia in the office. Available measures of passive range of motion (PROM) and active range of motion (AROM) immediately, within 6 weeks, between 6 and 12 weeks, and at >12 weeks after the manipulation were recorded.

Twenty-eight patients and 46 digits met the criteria. The median PIP joint PROM improved from 50° to 90° immediately following the manipulation. The median PROM values within 6 weeks, between 6 and 12 weeks, and at >12 weeks following manipulation were 80°, 85°, and 85°, respectively. The median AROM immediately after the manipulation improved from 40° to 90°, and the median AROM values within 6 weeks, between 6 and 12 weeks, and at >12 weeks were 70°, 50°, and 60°, respectively. None of the patients experienced worsening of PIP joint range of motion. One patient who had 4 fingers manipulated had a 45° distal interphalangeal joint extension lag for one of the fingers after the manipulation. Eight fingers underwent later flexor tenolysis or reconstruction to improve AROM after the gains in PROM via manipulation were maintained.

Passive manipulation is an alternative to surgical release for select PIP joint extension contractures.

Therapeutic IV.

Les lésions capsuloligamentaires des doigts longs et du pouce sont très fréquentes, notamment en pratique sportive. Leur traitement est souvent considéré comme simple. Cependant, lorsqu’il est différé ou mal effectué, des raideurs articulaires difficiles à corriger apparaissent. La prise en charge doit éviter les immobilisations prolongées ou en position non physiologiques. La mobilisation précoce est recommandée. Pour ne pas compromettre la meilleure récupération fonctionnelle, il faut éviter la perte de l’extension au niveau des IPP et la perte de la flexion au niveau des MP. Au niveau du pouce, il importe de bien évaluer les lésions du ligament collatéral ulnaire. La rééducation doit permettre la récupération de la stabilité articulaire et des amplitudes de mouvement. Il faut prévenir le patient que la récupération des raideurs installées est longue, difficile et contraignante par le port de différentes orthèses. Le risque de séquelles fonctionnelles avec limitation des amplitudes articulaires et de séquelle esthétique avec persistance d’une grosse articulation en particulier au niveau des IPP existe.

Joint injuries of the fingers and the thumb are one of the most common injuries of the hand especially in sport practice. They are often overlooked by patients or even doctors. Thus, improper treatment occurs regularly. Necessary treatment and rehabilitation techniques may be delayed and lead to permanent deformities of the digit. Prolonged immobilization and bad position of the joint can cause stiffness and may subsequently result in irreversible loss of motion in the digit. Timely and accurate diagnosis and appropriate treatment is critical for all joint injuries. Stiffness complications can be more easily prevented than treated. Early motion is recommended. We have to avoid loss of extension for the PIP joint and loss of flexion for the MP joint. At the thumb it is important to properly assess the lesions of the ulnar collateral ligament. Rehabilitation must allow the recovery of joint stability and range of motion. It is necessary to warm the patient that the recovery of the stiffness installed is long, difficult and constraining with wearing of different splints. The risk of functional sequelae with limitation of the range of motion and aesthetic sequelae with persistence of a large joint, in particular at PIP joint, exists.