If you have questions about a medical condition or this instruction, always ask your healthcare professional. Regaining full finger flexion is the intuitive goal of all patients with finger stiffness. This can make it easier to move and stretch. In this article, two hand surgeons offer a review of the best treatment for this condition. slide 4 of 9, PIP extension (with MP extension), E. Gregory Thompson MD - Internal Medicine. With your good hand, grasp your affected finger. Here we take a look at why stiff fingers may occur, and what you can do to help relieve stiffness, including splinting and specific exercises. A recent systematic review published in the Journal of Hand Therapy has examined the effectiveness of different orthoses for regaining full proximal interphalangeal (PIP) joint extension. The faster the joint begins to move the less likely there will be a problem with stiffness later on. Your doctor or physical therapist can recommend exercises for you, which might include range-of-motion exercises, strengthening exercises, aerobic exercise and other activities. The PIP can get stuck in a flexed position called a flexion contracture. Go to https://www.healthwise.net/patientEd. Use the thumb and fingers of your good hand to grasp below the middle joint of your affected finger. Curl your fingers so that the top two joints in them are bent, and your fingers wrap down. Disclaimer: BraceLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact. Ease off the exercises if you start to have pain. (1,2) See Figure 3. What appears at first to be a simple sprain of the PIP joint may result in a painful and stiff finger, making it difficult to use the hand for gripping activities. Your fingers will look like a hook. You will be told when to start these exercises and which ones will work best for you. Slowly bend your fingers around the imaginary ball, and squeeze the "ball" for about 6 seconds. At first, the treatments will involve controlling pain and swelling, especially if you had to have surgery. Fold a small towel in half, and lay it flat on a table. Hold your hand upward. For many, MP hyperextension is required for adequate elongation of the interosseous muscle/s. Slowly straighten your fingers to push the towel back so it is flat on the table again. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. (4). Range-of-motion exercises (also called stretching or flexibility exercises) help maintain normal joint function by increasing and preserving joint mobility and flexibility. It is also one of the most unforgiving joints when injured as stiffness and pain are a common result following any type of damage to this joint. Tendon Gliding and Blocking Exercises . The hook fist (MP joints extended, PIP and DIP joints flexed) … After a few weeks of being in the splint, it should be healed enough to begin strengthening exercises to help add stability around the joint. Painful DIP conditions can be helped with exercise. To block the MCP joint, gently stabilize your knuckle with the other hand as you practice bending and straightening your finger. This joint is called the proximal interphalangeal joint or PIP. The passive hook only elongates the interosseous muscles. Followin… Which Hook Exercise Most Effectively Decreases Finger Stiffness? MP joint extension with concurrent proximal interphalangeal (PIP) joint flexion is the position of elongation for the interosseous muscles. The PIP joint is very sensitive to injury and becomes stiff very rapidly when immobilized for even short periods of time. Learn about how to treat and rehab this type of injury. Place your good hand on a table, palm up. Unwind your fingers slightly so that your fingertips can touch the base of your palm. Blocking the MP joint in maximum extension (hyperextension) with active IP joint flexion assures maximum elongation of both the interosseous and the lumbrical muscles. For example, the tissue layers in the dorsal apparatus of the normal finger glide laterally and distally during finger flexion and extension1while the PIP joint capsular structures also move relative to one another (Figure 1). The most common after-effect of PIP dislocation is joint stiffness. The PIP is the middle joint nearest the knuckle joint, and PIP blocking prevents stiffness and increases strength and range of motion. Stiffness related to joint stiffness is more challenging to treat operatively, but some improvement can be achieved. In the presence of joint stiffness and/or interosseous muscle tightness, the MP joint cannot actively maintain full extension as the individual attempts concurrent active IP joint flexion. The extensor digitorum communis (EDC) has reasonable strength to maintain the MP joint at zero degrees, but it does not have enough power to hold the MP joint hyperextended in the presence of passive restraints of IP joint stiffness or interosseous muscle tightness. The DIP joint is excluded because the interosseous muscles primarily insert into the more proximal transverse and oblique fibers of the dorsal apparatus, concentrating their power more toward PIP joint extension. Slowly bend your affected finger. If passive flexion of the IP joints is extremely limited, wait until reasonable IP joint motion is regained before including MP joint extension/hyperextension. Your fingers and thumb will be pointing straight up. 1. https://bracelab.com/clinicians-classroom/interosseous-muscle-tightness-testing/, 2. https://bracelab.com/clinicians-classroom/lumbrical-muscle-tightness/, 3. https://bracelab.com/clinicians-classroom/touch-the-dots/, 4. Finger stiffness limiting interphalangeal (IP) joint flexion drives motion to the metacarpophalangeal (MP) joint, hyperflexing it (or hyperextending it in case of a … Lift and then lower your affected finger off the table. This will help differentiate between A1 and A3 pulley site involvement. The IP joint is the end joint of the thumb. Care instructions adapted under license by your healthcare professional. Note the effect on pain and triggering (5). If passive motion is limited, many endeavor to regain passive joint flexion and then work actively on composite finger flexion, often squeezing exercise putty at end range. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. It looks like your browser does not have JavaScript enabled. What is accomplished with the passive hook exercise (passively flexing the IP joints while passively extending the MP joint)? 65, Which Hook Exercise Most Effectively Decreases Finger Stiffness?, November 2020. Since the line of pull of the interosseous muscles is volar to the MCP joint and dorsal to the IP joints, interosseous muscle tightness is determined by defining the amount of passive proximal interphalangeal (PIP) joint flexion when the MCP joint is flexed and then determining if this amount of PIP joint flexion is less when the MCP joint is simultaneously brought into passive hyperextension. A common active hook exercise is holding a pencil with the IP joints flexed while actively extending the MP joints. Slowly bend your affected finger only at the joint closest to your fingernail. PIP Stiffness 11th Southampton Hand Course for Therapists and Surgeons September 2016 Summary!Causes!Management Causes of PIP stiffness!Injured posture " PIP flexed " MP extended!Joint pathology " Intra-articular injury" • Palmar plate injury " Joint pain " Arthritis!Tendon Pathology " Extensor tendon adhesion • Fracture • Surgery Why do we get stiff fingers? You must have JavaScript enabled in your browser to utilize the functionality of this website. Blocking exercises allow the index finger to improve flexion one joint at a time. This allows the good finger to brace to the injured finger while at the same time using the good fi… A blocking splint/orthosis is more effective than manual blocking exercises because the positioning can be more precise and the desired exercise can be repeated over a longer period of time. Isolated PIP flexion. SMT, Cert. What appears at first to be a simple sprain of the PIP joint may result in a painful and stiff finger, making it difficult to use the hand for gripping activities. When the ligaments have been sprained or partially torn, treatment may simply consist of a short period of splinting and early exercise. If instructing a patient in the active hook exercise, use the “Touch the Dots” (3) approach to assure maximum engagement of the EDC in tandem with active IP joint flexion. Debridement means cleaning out of the area in this case of abnormal bone and inflammatory tissue. A slow, firm sustained stretch at end range is most effective. One such injury is a sprain of the proximal interphalangeal joint, or PIP joint, of the finger. Subscribe to our e-newsletter by entering your Name and Email then clicking 'subscribe'. What appears at first to be a simple sprain of the PIP joint may result in a painful and stiff finger, making it difficult to use the hand for gripping activities. Your wrist should be relaxed, following the line of your fingers and thumb. Tai chi is another gentle exercise that keeps your joints more flexible. Put your hand with the affected finger on top of your good hand. Enter J321 in the search box to learn more about "Finger Sprain: Rehab Exercises". The passive hook should be used to elongate the interosseous muscles and should exclude the DIP joint. Osteoarthritis in the hands occurs most in the “Proximal Inter Phalangeal” (PIP) joint of the fingers. What appears at first to be a simple sprain of the PIP joint may result in a painful and stiff finger, making it difficult to use the hand for gripping activities. Bend and then straighten the last two joints of your affected finger. Your affected finger will be free to move. One such injury is a sprain of the proximal interphalangeal joint, or PIP joint, of the finger. It is an unforgiving joint when injured, and often becomes extremely stiff. Fists: Form a fist with your fingers and then unfurl your fingers. With your palm facing down, grab the towel and squeeze it for about 6 seconds. But what is the difference between the three types of hook exercises: passive, active, and blocked active? Put your hand with the affected finger on top of your good hand with your fingers wrapped around the thumb of your good hand like you are making a fist. To guide choice of orthosis, hold the MCP joint in extension and instruct patient to actively flex the IP joint. Blocking the MP joint in extension transmits the flexor tendon glide to the distal IP joints, mobilizing them into flexion. Your fingers and thumb will be pointing straight up. This allows mobility in bending and straightening but stability in sideways and twisting movements. Blocked MP joint motion with active IP joint flexion reestablishes the normal pattern of finger flexion in the motor cortex by assuring the patient initiates finger flexion with the extrinsic flexors. Jerry Ditz, DPT, Dip. Repeat the series of motions 8 to 12 times. The digit widget attaches to a rubber band, which is attached to a removable Velcro glove that is worn on the hand. Figure 3: Activities for improving wrist joint position sense. These exercises relieve stiffness and increase your ability to move your joints through their full range of motion. This joint is one of the most unforgiving joints in the body to injury. There are two ways joints become stiff. Please correct the marked field(s) below. Your fingertips should touch or be near the base of your fingers. Finger volar plate injury exercises and advice, February 2019 3 Finger volar plate injury exercises and advice If your fingers are still stiff after 6 weeks, then progress to the following exercises: Bend each of your fingers in turn towards your palm and hold for 3 seconds. What most people don’t realize is that the bones of the fingers heal extremely quickly, and if this joint suffers a significant fracture, they injury can become essentially irreparable within only 3 weeks. To regain PIP joint extension, the best way is probably by using a ‘digit widget’. At the middle joint of a finger (the proximal interphalangeal or PIP joint) All forms of hand arthritis can cause stiffness, swelling, pain, and deformity. The distal interphalangeal joint, or DIP for short, bends the last knuckle in your fingers and toes. Hand and finger exercises to perform to DECREASE STIFFNESS - Duration: 9:16. Try a gentle stretching routine each morning to ease joint stiffness and get your body ready for the day. This joint is one of the most unforgiving joints in the body to injury. This involves a minor outpatient surgery. PIP Stiffness 11th Southampton Hand Course for Therapists and Surgeons September 2016 Summary!Causes!Management Causes of PIP stiffness!Injured posture " PIP flexed " MP extended!Joint pathology " Intra-articular injury" • Palmar plate injury " Joint pain " Arthritis!Tendon Pathology " Extensor tendon adhesion • Fracture • Surgery The IP joints is therefore very stable but this makes it more prone to stiffness and other problems. Hold your hand upward. Block the MCP and PIP joints by holding your knuckle and first joint of your finger straight, and just bending the tip of your finger. Wrist and finger fractures, dislocations, ligament tears, synovitis, oedema and other soft tissue injuries can cause stiffness and loss of motion at the PIP joint, especially loss of joint extension. Dorsal capsulotomy with partial or full release of contracted collateral ligaments often can improve MP extension contractures, whereas PIP joint contractures are much more difficult to … Your therapist will be able to assess your finger and tailor a splinting/exercise program to suit your needs. Hold for about 6 seconds. https://bracelab.com/clinicians-classroom/interosseous-muscle-tightness-testing/, https://bracelab.com/clinicians-classroom/lumbrical-muscle-tightness/, https://bracelab.com/clinicians-classroom/touch-the-dots/, Clinical Pearl No. Place the hand with the affected finger flat on a table, palm up. ©2006-2020 Healthwise, Incorporated. If the PIP joint is not seated correctly as it heals, this may cause disfigurements, misalignments, chronic stiffness, and eventual decay of the soft tissues within the PIP joint. One such injury is a sprain of the proximal interphalangeal joint, or PIP joint, of the finger. Why is the blocked active hook the exercise of choice? We refer to this as the PIP joint. First, the healing process following trauma develops new collagen which is relatively disorganized and thus resistant to movement. The full fist (MP, PIP, and DIP joints flexed) elicits maximum flexor digitorum profundus (FDP) glide. Constraints other than joint tightness may provide resistance to full finger flexion. Here are some examples of exercises for you to try. A physical therapist (PT) can help you learn specific exercises to treat and prevent joint stiffness. same exercise for the PIP joint uses 3 points of pressure (see picture). A stiff proximal interphalangeal joint (PIP joint) can occur from a dislocation or strain to one of the ligaments surrounding the joint. Move back to your starting position, with your fingers wrapped around your good thumb. Because the origin of the lumbrical muscle is on the moving flexor digitorum profundus (FDP), elongation of the lumbrical muscle only occurs with the active hook exercise. 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