Written on behalf of the stiff finger

Effectiveness of a novel finger range-of-motion brace for extensor tendon injury: a report of 10 patients

BACKGROUND

Extensor tendon injuries require surgical repair, followed by rehabilitation to ensure optimal outcomes. Immobilization has been the cornerstone of postoperative management. However, immobilization after surgery frequently makes the finger stiffness, often resulting in reduced functionality and quality of life for patients. Recent studies indicate that early controlled motion can significantly improve outcomes, but safe early range of motion (ROM) exercise is a significant clinical challenge. This article aims to check the efficacy of the novel designed finger ROM brace for preventing finger stiffness for extensor tendon injuries with case series.

METHODS

A finger ROM brace was designed based on the natural finger movement. Like a real finger, there are two tiny hinge joints and three round-shape body components. The design aimed to be ergonomic dynamic splint assisting controlled motion to promote early motion, thus reducing tendon tension and preventing stiffness. Elastic resistant ROM exercise could be by inserting a silicone band into the groove on the components and free movement could be achieved by removing a silicone band.

RESULT

Between December 2022 and July 2023, 10 patients who underwent tenorrhaphy because of extensor tendon laceration were involved. Complete extensor tendon laceration was 3 patients, other seven patients had partial laceration of extensor tendons. Surgery was performed within 2 days of injury, and no infection was observed in all patients. After the extensor tendon was confirmed as healed state by ultrasound, the patients were permit the active exercise wearing finger ROM brace with a silicone band. Within 1-2 weeks after elastic resistant exercise, the patients could achieve free full ROM movement without any complication.

CONCLUSION

The novel finger ROM brace combines the advantages of dynamic splinting and under-actuated mechanisms to offer a comprehensive solution for preventing stiffness after extensor tendon suture. Future studies should focus on clinical trials to validate the efficacy and safety of this brace in a larger population.

Management of Index Finger Metacarpophalangeal Joint Arthritis

Metacarpophalangeal joint arthritis of the index finger is a debilitating disease often caused by osteoarthritis or inflammatory arthritides such as rheumatoid arthritis. Treatment options include nonsurgical management with nonsteroidal anti-inflammatory drugs, splinting, occupational therapy, corticosteroid injections, and disease-modifying antirheumatic drugs. Operative management options include arthrodesis and arthroplasty, which can be further broken down into silicone implants and 2 component resurfacing implants. The article summarizes the current literature for each of the treatment options for metacarpophalangeal joint arthritis of the index finger.

How controlled motion alters the biophysical properties of musculoskeletal tissue architecture

INTRODUCTION

Movement is fundamental to the normal behaviour of the hand, not only for day-to-day activity, but also for fundamental processes like development, tissue homeostasis and repair. Controlled motion is a concept that hand therapists apply to their patients daily for functional gains, yet the scientific understanding of how this works is poorly understood.

PURPOSE OF THE ARTICLE

To review the biology of the tissues in the hand that respond to movement and provide a basic science understanding of how it can be manipulated to facilitate better functionThe review outlines the concept of controlled motion and actions across the scales of tissue architecture, highlighting the the role of movement forces in tissue development, homeostasis and repair. The biophysical behaviour of mechanosensitve tissues of the hand such as skin, tendon, bone and cartilage are discussed.

CONCLUSION

Controlled motion during early healing is a form of controlled stress and can be harnessed to generate appropriate reparative tissues. Understanding the temporal and spatial biology of tissue repair allows therapists to tailor therapies that allow optimal recovery based around progressive biophysical stimuli by movement.

Complications of Proximal Interphalangeal Joint Injuries: Prevention and Treatment

Proximal interphalangeal joint injuries are one of the most common injuries of the hand. The severity of injury can vary from a minor sprain to a complex intra-articular fracture. Because of the complex anatomy of the joint, complications may occur even after an appropriate treatment. This article provides a comprehensive review on existing techniques to manage complications and imparts practical points to help prevent further complications after proximal interphalangeal joint injury.

Results of Operative Intervention for Finger Stiffness After Fractures of the Hand

Background: Posttraumatic finger stiffness can occur as a result of hand fractures. The purpose was to assess and quantify the improvement in range of motion (ROM) after surgical management of the stiff finger in patients who developed loss of motion following treatment for a metacarpal or phalangeal fracture. In addition, an aim was to identify possible risk factors for suboptimal improvement in ROM postoperatively. Methods: A retrospective review was performed on 18 patients who underwent surgery to improve finger stiffness following metacarpal or phalangeal fracture. Demographic data including age, initial diagnosis and treatment, health history, and worker's compensation status were collected. We determined the number of specific procedures performed at the time of surgery, the number of days between surgical release and initiation of therapy, and the total active motion (TAM) prior to surgical release and at the patient's last follow-up. Results: Mean TAM improved from 150° preoperatively (range 60°-241°) to 191° postoperatively (range 61°-271°). Most patients required multiple anatomic structures released concomitantly, with an average of 3.1. Patients who started physical therapy within 7 days of the release improved by 59°, whereas those who started physical therapy after 7 days (average 11.5 days) lost 19° of motion. Patients who had filed a worker's compensation claim improved an average of 9°, whereas nonworker's compensation patients improved an average of 58°. Degree of TAM improvement had a weak correlation with patient age or preoperative TAM. Conclusions: Surgical release for stiff fingers following hand fractures can offer modest improvements in ROM in some patients. Although the overall increase in motion as a result of these operations is generally limited, functional improvement can be obtained. Delay in initiating physical therapy is a risk factor for persistent or worsened stiffness. Patients involved in worker's compensation claims demonstrated significantly lower TAM improvement after surgical intervention.

Extension orthoses and the stiff proximal interphalangeal joint following hand trauma: A review of current clinical practice in the Australian context

Introduction

Extension orthoses are frequently prescribed by hand therapists to treat fixed flexion deformity of the proximal interphalangeal joint. A wide variety of proximal interphalangeal joint extension orthoses exist, but there is limited research evidence to guide implementation in clinical practice. Consequently, effective management of fixed flexion deformity of the PIP joint remains a challenge.

Method

An electronic survey was distributed to members of the Australian Hand Therapy Association. The survey included two case scenarios, (including a fixed flexion deformity of 30° and 55°) and participants were asked to identify their preferred orthosis for each case. Responses to closed questions were analyzed descriptively. Thematic analysis for open-ended questions was completed by two experienced hand therapists.

Results

One hundred ninety-five therapists completed the electronic survey. Handmade capener (21.7%), pre-fabricated capener (22.2%), and static finger troughs (21.1%) were the preferred orthoses for treatment of contractures of 30°. Serial casts (60.9%) were the preferred choice for a contracture of 55°. Key themes influencing choice of orthosis reflected an evidence-based practice approach to clinical reasoning that combined use of available evidence with therapists’ experience and the needs of the patient. Therapists’ interpretation and application of research differed according to their unique situation.

Conclusion

Orthotic prescription is a multifaceted process that combines therapists’ interpretation of evidence with their experience and the needs of the patient. Further research is needed to evaluate and clarify current theories that are used to guide intervention.

Management of the stiff finger: evidence and outcomes

The term "stiff finger" refers to a reduction in the range of motion in the finger. Prevention of stiff fingers by judicious mobilization of the joints is prudent to avoid more complicated treatment after established stiffness occurs. Static progressive and dynamic splints are considered effective non-operative interventions to treat stiff fingers. Capsulotomy and collateral ligament release and other soft tissue release of the MCP and PIP joint are also discussed in this article. Future outcomes research is vital to assessing the effectiveness of these surgical procedures and guiding postoperative treatments.

Closed Reduction of Hand Fractures

Stiffness is the most frequent consequence of open hand fracture treatment. Although initial injury severity and occurrence adjacent to the flexor tendon sheath are the most highly correlated determinants of hand fracture outcome, operative intervention accentuates the ultimate risk of stiffness. Closed treatment may minimize this risk. Articular fractures are at greater risk for stiffness than extra-articular fractures. Functional tolerance for small amounts of variation from perfect anatomic restoration gives us increased latitude for closed hand fracture management. Operative treatment may be justified for simple closed fractures when they are unstable, irreducible, or open, or when the surgeon believes that the risk-to-benefit ratio is favorable.

Immediate controlled active motion following zone 4-7 extensor tendon repair

This article describes a splint management program for zone 4-7 extensor tendon repairs that allows for immediate controlled active motion (ICAM) of the repair and greater arcs of motion for adjacent digits. The splint is designed to relieve tension on the tenorrhaphy by positioning the involved digit in slight metacarpophalangeal joint hyperextension relative to the uninvolved digits with a simple yoke splint designed to control the metacarpophalangeal joints and a second splint to control wrist position. Cadaver and intraoperative trials support this technique, and 140 patient cases managed over 20 years. The majority of patients achieved a rating of excellent for both digital extension and flexion as judged by Miller's criteria. There were very few extension lags and no tendon ruptures. Patients returned to work in the ICAM splint on average in 18 days. The average time to complete the program was seven weeks after repair, and required an average of eight therapy visits. The results of this study demonstrate that the ICAM splinting technique is safe, simple to manage, decreases the morbidity associated with immobilization, is cost effective, and has high patient compliance when compared to other early motion programs.

Plaster of Paris: the forgotten hand splinting material

This article examines the concept of tissue adaptation in response to the application of plaster of Paris splints and casts. A review of the history of plaster of Paris and its composition, its working properties, and precautions for its use introduces the reader to this oft-forgotten material. Four designs are described for plaster of Paris application-circumferential padded casts, digital unpadded casts, plaster slabs, and contour molds. The discussion of clinical application of plaster of Paris covers joint tightness, arthritis, contracted joints due to spasticity, muscle-tendon tightness, skin tightness, skin and joint tightness, and edema reduction. In addition, a new application called casting motion to mobilize stiffness (CMMS), developed by the author, is discussed. The use of plaster of Paris to improve postoperative flexor tendon glide is also discussed. This review article intends to stimulate the reader to use plaster of Paris splinting or casting more frequently to solve clinical problems.