Orthoses to Treat PIP Joint Contractures

Proximal interphalangeal (PIP) joint flexion contractures, or loss of extension at the middle joint of the finger, can occur after injury, disease and surgery and can interfere with the functional use of the hand. Loss of extension at the PIP joint can cause difficulty reaching into your pocket or may interfere with opening your hand to grab a glass of water.

Anatomy of the PIP Joint

In several ways, the anatomy of the PIP joint creates an inclination for flexion contractures. Most notably, the tendons that flex the joint are much stronger than the extensor mechanism that extends the joint. In addition, the volar plate (piece of soft tissue at the volar aspect of the joint) and collateral ligaments (lateral support structures of the joint) may contribute to loss of extension through shortening and scarring.

Research and understanding of soft tissue tells us that the sooner a contracture is treated the better, as longstanding contractures begin to develop shortening of the skin, muscles, tendons and ligaments, which will need to elongate in order for a contracture to resolve.

View Video - 3pp Step Up Splint for Treatment of PIP Joint Contractures

Orthoses to Treat PIP Joint Contractures

Most often orthoses are used with PIP joint contractures to assist with increasing passive range of motion (PROM) at the joint. Research suggests that longer use of an orthosis in both total duration and daily duration means greater and faster contracture resolution.

The modified Weeks Test is meant to help us choose the best orthosis to treat a PIP flexion contracture. To complete the test, measure PROM of the PIP joint prior to any treatment. Then measure the motion again after a thermal modality (i.e. moist heat or paraffin), exercise, and prolonged stretching of the joint.

The following table gives information on how to use the results of the modified Weeks Test:

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