I am a hand therapist in a busy mid-town practice. We have a patient with a very stiff PIP after a hunting accident. Even our best therapist has been unable to come up with a splint that would work to restore motion to the PIP without affecting the joints on either side. Is there anything out there you know of that might help?
Your question is amazingly timely since there has been a recent study reporting on the use of a new splint that might be helpful. This is based on a single case report for use with a stiff, unmoving proximal interphalangeal (PIP) joint. But the results were dramatic and the reported benefits of the split far outweigh any disadvantages.
Here's a brief summary of the case. A 49-year-old man involved in an all-terrain-vehicle accident suffered multiple injuries to the head, face, and fingers (including finger fractures). He also fractured his femur (thigh bone). By the time his finger fractures were healed (seven weeks later), he was left with a stiff PIP joint of the middle and ring fingers of his dominant (right) hand.
The splint used was a flexible, roll-on splint made of silicone. It was easy to get on and off and fairly comfortable so the patient was compliant in wearing it six to 10 hours a day. It did cause some swelling and discomfort at night, so it was only worn during the daytime hours. However, because he could bend the other joints, hand function was not severely limited.
And best of all, in 12 weeks' time, the patient experienced significant improvements! He reported a decrease in pain and the therapists documented greatly improved motion, pinch and grip strength, and hand/upper extremity function.
A patent has been granted to the authors of this study (and makers of the splint). It comes in five sizes and has trim marks where the edges can be lopped off to fit the patient. A small opening in the tip of the splint makes it possible to visually inspect the patient's skin for adequate circulation (color and temperature). For more information, you can email the lead author at the University of Pittsburgh Centers for Rehab Services: Ronit Wollstein, MD at firstname.lastname@example.org.
Ronit Wollstein, MD, et al. A Novel Splint for Proximal Interphalangeal Joint Contractures: A Case Report. In Archives of Physical Medicine and Rehabilitation. October 2012. Vol. 93. No. 10. Pp. 1856-1859.
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