
Orthoses to Restore Proximal Interphalangeal (PIP) Joint Motion
Overview of the Review
This systematic review examined the current evidence supporting orthotic interventions for restoring PIP joint extension and flexion following hand injuries or conditions. The review analyzed a total of 12 randomized controlled trials.
Study Inclusion and Exclusion Criteria
The studies included adult patients with a hand injury or condition (either surgically or conservatively managed) that resulted in limited active or passive PIP joint motion. Certain clinical conditions, such as unstable fractures, dislocations, neurologic conditions, and arthritic conditions, were excluded due to the differing pathophysiology of these contractures.
Comparison of Interventions
The studies compared orthotic interventions to hand therapy alone, no intervention, or alternative therapies. The primary outcomes measured included finger goniometer readings of active or passive movement, either isolated to the PIP joint or related to total finger motion. Secondary outcomes included:
- Pain (visual analog scale or verbal numeric scale)
- Patient adherence (self-reported wear time)
- Patient-reported outcome measures (e.g., DASH questionnaire, Patient-Rated Wrist and Hand Evaluation)
- Adverse events
Limitations and Bias in the Studies
There was inherent bias in the clinical trials, as blinding the treating therapists was not possible. Most studies also could not blind participants for the same reason.
Conditions Studied
Eleven of the twelve studies focused on patients diagnosed with Dupuytren’s disease or those with fixed deformities of the PIP joint following trauma or surgery.
Key Findings
- A small number of studies provided moderate certainty evidence that orthoses were not effective in restoring PIP joint extension or flexion, nor in improving patient satisfaction following surgery for Dupuytren’s disease.
- In contrast, a few studies indicated with very low certainty that orthotic intervention restored PIP joint extension to a clinically meaningful extent for patients with a fixed flexion deformity.
Clinical Implications
Based on these findings, the authors suggest that postoperative hand therapy for Dupuytren’s disease patients should primarily focus on non-orthotic-based care, including:
- Education
- Scar management
- Exercises
However, orthotic intervention appeared to be more effective than hand therapy alone for improving PIP joint extension in patients with fixed flexion deformities following traumatic finger injury or surgery. Notably, no studies evaluated orthotic interventions for improving PIP joint flexion.
Need for Further Research
Although clinicians routinely fabricate orthoses to assist with passive joint flexion, more studies are required to assess their effectiveness in improving PIP joint flexion.
Learn More with Orfit Academy
We offer several courses on the Orfit Academy focused on orthotic interventions for the stiff PIP joint. Visit www.orfit.com/academy to learn how to fabricate a variety of orthoses designed to enhance motion at the challenging PIP joint. We feature:
- The Isoforce Outrigger Orthosis for dynamic and static progressive PIP joint extension
- A variety of orthoses to increase passive PIP joint flexion
Reference
Yates, S. E., Glinsky, J. V., Hirth, M. J., & Fuller, J. T. (2024). Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis. Journal of Hand Therapy.
Written by Debby Schwartz, OTD, OTR/L, CHT
Physical Rehabilitation Product and Educational Specialist at Orfit Industries America.
Debby is a certified hand therapist with over 36 years of clinical experience. She completed her Doctorate of Occupational Therapy at Rocky Mountain University of Health Professions in 2010. She has worked at Orfit Industries America as Product and Educational Specialist since 2007.
Debby is also an adjunct professor at the Occupational Therapy Department of Touro University, School of Health Sciences, and at the Occupational Therapy Department at Yeshiva University, Katz School of Science and Health in NYC. She has written many book chapters in the field of hand therapy and multiple articles for hand therapy journals, including the ASHT Times and the Journal of Hand Therapy. She has published a new textbook on orthotic fabrication together with Dr. Katherine Schofield, entitled “Orthotic Design and Fabrication for the Upper Extremity: A Practical Guide”.


