The ability to use the hand effectively for functional tasks is related to the available range of motion in the fingers. There is scarce literature on the specific motion needed for functional use of the digits, however one study suggests that at least 61 degrees is needed at the metacarpophalangeal (MCP) joint, at least 60 degrees at the proximal interphalangeal (PIP) joint, and at least 39 degrees at the distal interphalangeal (DIP) joint.
In treating hand injuries, therapists strive to provide interventions to regain lost motion. Understanding how to detect and diagnose the specifics behind the restriction is key to effective treatment. The following is a review of how to diagnose and treat some of the causes of limited range of motion in fingers following injury or prolonged immobilization.
||Example of Treatment
|Intrinsic Tightness||Tightness in the lumbricals and interossei, which perform MCP flexion and IP extension||PIP flexion is greater with the MCP in flexion than when the MCP joint is in extension||Stretch the intrinsics with active and passive IP flexion and MCP extension||Holding or block the MCP’s in extension while flexing the IP joints as fully as possible|
|Extrinsic Flexor Tendon Tightness||Tightness in the tendons that flex the fingers and cross the wrist||PIP extension is greater when the MCP flexed, than when it is in extension||Stretch the extrinsic flexors with digit and wrist extension.||Perform passive digit and wrist extension stretches with the elbow fully extended|
|Extrinsic Flexor Tendon Adhesion||Long flexor tendon scarring following a tendon repair or wound involving scarring near the tendon||The joint distal to the scar extends more with the proximal joint in flexion than in extension. Passive flexion is greater than active flexion.||Active tendon excursion exercises and tendon glide against resistance to assist with pull through scar||Perform table top putty scraping or pulling exercise.|
|Extrinsic Extensor Tendon Tightness||Tightness in the long tendons that extend the MCP’s and cross the wrist||PIP flexion is greater with the MCP joint in extension, than when the MCP is flexed||Stretch the extrinsic extensors with digit and wrist flexion||Perform passive digit and wrist flexion stretches with the elbow in full extension|
|Extrinsic Extensor Tendon Adhesion||Extensor tendon scarring following a tendon repair or wound involving scarring near the tendon||There is greater flexion of the joint distal to the scar with the proximal joint extended than when the joint is flexed. Passive extension is greater than active extension||Active tendon excursion exercises and tendon gliding against resistance to assist with pull through scar||Extension of the digits against 3pp putty or rubber band resistance|
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