Research Article|Articles in Press

Exercise relative motion orthoses: Use of the pencil test and variations of its use for assessing and managing different finger conditions

Published:March 11, 2023DOI:


      • Exercise relative motion orthoses are frequently used by clinicians.
      • The relative motion (RM) pencil test is used prior to fabricating an exercise RM orthosis.
      • Measurement of the metacarpophalangeal differential is described.
      • Various clinical conditions are linked with the best suited exercise relative motion orthosis.
      • An algorithm is provided for decisions related to evaluation, exercise and RM orthosis design.


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        • Hirth MJ
        • Howell JW
        • O'Brien L.
        Relative motion orthoses in the management of various hand conditions: a scoping review.
        J Hand Ther. 2016; 29: 405-432
        • DeMott L
        • Mock M
        • Flinn S.
        Effects of relative motion orthoses and re-direction exercises for extensor lag following proximal phalanx fractures; a case series report.
        in: Poster presentation at: American Society of Hand Therapists (ASHT) Conference. October 8th-11th. Denver, CO, 2015
      1. McMahon R. Relative motion orthosis in proximal phalanx ORIF. Poster presentation at: Australian Hand Therapy Association (AHTA) Conference. October 18th-20th, 2019, Brisbane Australia.

        • Hirth MJ
        • Howell JW
        • O'Brien L
        Two case reports-Use of relative motion orthoses to manage extensor tendon zones III-IV and sagittal band injury in adjacent fingers.
        J Hand Ther. 2017; 30: 546-557
        • Wajon S
        • Howell JW.
        Prescription of exercise relative motion orthoses to improve limited proximal interphalangeal joint movement: a prospective, multi-center, consecutive case series.
        J Hand Ther. 2021; (Online January 14)
        • Merritt WH
        • Howell JW
        • Tune R
        • et al.
        Achieving immediate active motion by using relative motion splinting after long extensor repair and sagittal band ruptures with tendon subluxation.
        Oper Tech Plast Reconstr Surg. 2000; 7 (1053/oa.2000.5972): 31-37
        • Howell JW
        • Merritt WH
        • Robinson SJ.
        Immediate controlled active motion following zones 4-7 extensor tendon repair.
        J Hand Ther. 2005; 18: 182-190
        • Merritt WH.
        Relative motion splint: active motion after extensor tendon injury and repair.
        J Hand Surg. 2014; 39: 1187-1194
        • Henry SL
        • Howell JW.
        Use of a relative motion flexion orthosis for postoperative management of zone I/II flexor digitorum profundus repair: a retrospective consecutive case series.
        J Hand Ther. 2020; 33: 296-304
        • Newington L
        • Ross R
        • Howell JW.
        Relative motion flexion splinting for rehabilitation of flexor tendon repairs: a systematic review.
        Hand Ther Online. 2022;
        • Merritt WH
        • Howell JW.
        Relative motion orthoses: The concepts and application to hand therapy management of finger extensor tendon zone III and VII repairs, acute and chronic boutonniere deformity, and sagittal band injury.
        in: Skirven TM Osterman AL Fedorczyk J Amadio PC Felder S Shin EK Rehabilitation of the Hand and Upper Extremity. 7th Edition. Elsevier, Philadelphia PA2020: 1496-1510
        • Hirth MJ
        • Howell JW
        • Brown T
        • O'Brien L
        Relative motion extension management of zone V-VI extensor tendon repairs: does international practice align with the current evidence?.
        J Hand Ther. 2020; 34: 76-89
        • Collocott SJF
        • Kelly E
        • Foster M
        • et al.
        A randomized clinical trial comparing early active motion programs: earlier hand function, TAM, orthotic satisfaction with a relative motion extension program for zone V and VI extensor tendon repairs.
        J Hand Ther. 2020; 33: 13-24
        • Lalonde DH
        • Flewelling LA.
        Solving hand/finger pain problems with the pencil test and relative motion splinting.
        Plast Reconstruct Surg Global Open. 2017; 5
      2. Feehan L, Ewald SG. Relative motion orthoses: A six-question decision making tool for thinking beyond thermoplastics. (Article currently in review for Relative Motion 2023 special issue)

        • Merritt WH
        • Jarrell K.
        A paradigm shift in managing acute and chronic boutonniere deformity: anatomic rationale and early clinical results for the relative motion concept permitting immediate active motion and hand use.
        Ann Plastic Surg. 2020; 84: S141-S150
        • Merritt WH
        • Wong AL
        • Lalonde DH
        Recent developments are changing extensor tendon management.
        Plast Reconstr Surg 2020. 2020; 145: 617e-628e