Highlights
- •New protocol as a novel option for the treatment of proximal interphalangeal joint flexion contracture.
- •First orthosis 24 hour per day application in treatment of proximal interphalangeal joint flexion contracture.
- •New orthosis design, more comfortable for the patient, allows prolonged clinical use.
Abstract
Introduction
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.
Purpose of the Study
To illustrate how the application strategy of ETDNO can increase the daily total end
range time (TERT) and modify finger stiffness.
Results
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.
Discussion
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
Conclusion
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
Keywords
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References
- Some biochemical and biophysical aspects of joint stiffness.Ann Surg. 1966; 164: 1-12https://doi.org/10.1097/00000658-196607000-00001
- Mechanical factors in joint stiffness and tissue growth.J Hand Ther. 1995; 8: 91-96https://doi.org/10.1016/s0894-1130(12)80305-x
- The stiff finger.Hand Clin. 2010; 26: 191-204https://doi.org/10.1016/j.hcl.2010.02.001
- The anatomy of the interphalangeal joints.in: Bowers WH The Interphalangeal Joints. Churchill Livingstone, Edinburgh, London, Melbourne and New York1987: 2-13
- Splinting in the management of proximal interphalangeal joint flexion contracture.J Hand Ther. 1996; 9: 378-386https://doi.org/10.1016/s0894-1130(96)80045-7
- Management of posttraumatic proximal interphalangeal joint contracture.J Hand Surg Am. 2013; 38: 1651-1658
- Proximal interphalangeal joint injuries and their initial treatment.J Trauma. 1975; 15: 380-385https://doi.org/10.1097/00005373-197505000-00002
- The stiff proximal interphalangeal joint.Hand. 1977; 9: 102-108https://doi.org/10.1016/s0072-968x(77)80002-8
- Physiology and therapeutic value of passive joint motion.Clin Orthop Relat Res. 1984; 185: 113-125
- The role of static and dynamic splints physiotherapy techniques and time in straightening contracted interphalangeal joints.Lepr India. 1969; 4: 323-328
- The use of splints in the treatment of joint stiffness: biologic rationale and an algorithm for making clinical decisions.Phys Ther. 1994; 74: 1101-1107https://doi.org/10.1093/ptj/74.12.1101
- A proposed decision hierarchy for splinting the stiff joint, with an emphasis on force application parameters.J Hand Ther. 2002; 15: 158-162https://doi.org/10.1053/hanthe.2002.v15.015015
- Force magnitude of commercial spring-coil and spring-wire splints designed to extend the proximal interphalangeal joint.J Hand Ther. 1988; 1: 86-90https://doi.org/10.1016/S0894-1130(88)80053-X
- Splinting proximal interphalangeal joint flexion contractures: a new design.Am J Occup Ther. 1986; 40: 408-413https://doi.org/10.5014/ajot.40.6.408
- Effect of total end range time on improving passive range of motion.J Hand Ther. 1994; 7: 150-157https://doi.org/10.1016/s0894-1130(12)80056-1
- Biomechanics of soft-tissue growth and remodeling with plaster casting.J Hand Ther. 1995; 8: 131-137https://doi.org/10.1016/s0894-1130(12)80310-3
- Static progressive splinting.J Hand Ther. 2002; 15: 163-178https://doi.org/10.1053/hanthe.2002.v15.015016
- Low-load, prolonged stretch in the treatment of knee flexion contractures in nursing home residents.Phys Ther. 1995; 75: 886-897https://doi.org/10.1093/ptj/75.10.886
- Optimal daily total end range time for contracture: resolution in hand splinting.J Hand Ther. 2003; 16: 207-218https://doi.org/10.1016/s0894-1130(03)00036-x
- Randomized controlled trial of daily total end range time (TERT) for Capener splinting of the stiff proximal interphalangeal joint.Am J Occup Ther. 2012; 66: 243-248https://doi.org/10.5014/ajot.2012.002816
- Le collage en tension dans les orthèses dynamiques en matériau néoprène [Tension force in dynamic splints made of neoprene].Chir Main. 2001; 20: 231-235https://doi.org/10.1016/s1297-3203(01)00039-7
- A preliminary investigation of the neoprene tube finger extension splint.J Hand Ther. 1997; 10: 213-221
- A novel splint for proximal interphalangeal joint contractures: a case report.Arch Phys Med and Rehab. 2012; 93: 1856-1859
Article info
Publication history
Published online: July 28, 2022
Accepted:
June 8,
2022
Received in revised form:
March 19,
2022
Received:
August 9,
2021
Publication stage
In Press Corrected ProofFootnotes
Competing or conflict of interest statement: There is no conflicts of interest.
Identification
Copyright
© 2022 Published by Elsevier Inc.