Orthoses to Restore Proximal Interphalangeal (PIP) Joint Motion

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.

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

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.

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.

• 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.

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.

Although clinicians routinely fabricate orthoses to assist with passive joint flexion, more studies are required to assess their effectiveness in improving PIP joint flexion.

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.