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Managing PIP Joint Contractures
207 Plays3 days ago
Hand Therapy Academy welcomes Allison to the show! Miranda and Allison dive into their favorite strategies for managing PIP joint contractures. They break down both tried-and-true methods and creative approaches that therapists can bring into practice.
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Transcript
Introduction to Hand Therapy Academy
00:00:04
Miranda Materi
Hi, I'm Miranda.
00:00:05
Allison Johnson
And I'm Allison, and we are Hand Therapy Academy.
Favorite PIP Extension Options
00:00:10
Miranda Materi
All right, we are here today at the clinic and we have Allison in and she is going to um talk about some of her favorite PIP extension options or splinting options and what you do for STIP PIP, specifically in the direction of extension.
00:00:26
Allison Johnson
Yeah.
Challenges and Solutions for PIP Joint Issues
00:00:27
Allison Johnson
Um, so i think the PIP joint can be pesky, especially when there's, um, like a flexion contracture. um and sometimes like I struggle deciding what split might be the best to use for a certain person.
00:00:43
Allison Johnson
but I, I think I often use multiple splits. Like I have patients do multiple things.
Custom Nighttime Extension Splints
00:00:49
Allison Johnson
Is that something you do or do you just stick to one type
00:00:53
Miranda Materi
No, I typically try different. I see which one's going to probably give the best result. i don't I don't know.
00:00:58
Allison Johnson
yeah yeah me too
00:00:59
Miranda Materi
I have my favorites, of course, and often it is a couple of things. Like often it's a nighttime extension splint that I custom make, and it's usually probably including the MCP joint.
00:01:10
Allison Johnson
yeah just to give it more reference
00:01:10
Miranda Materi
i can Yeah, I get more leverage, and then usually it's wearing something during the day like an L&B.
00:01:17
Allison Johnson
Yeah, I
Long Wear and Resistive Stretching Splints
00:01:18
Allison Johnson
agree. I think I always, always a nighttime one for me because that's six to eight hours of time that they don't need to be using their hand that they could be getting that, that push on the joint.
00:01:29
Allison Johnson
Um, and then I like and B's too. I also sometimes like, um, reverse knuckle benders. Have you used those before? Like the reverse knuckle?
00:01:38
Miranda Materi
you know I I haven't but I I do notice that you like you order them so I'm like oh they must work well and I don't know why I've never they've never been my go-to and I don't know why I don't know if it's like they're a little intimidating with all the rubber band I don't know
00:01:39
Allison Johnson
Okay.
00:01:53
Allison Johnson
they're definitely more cumbersome than something like an lmb because i do like lmbs too especially if someone can spend more time wearing it i think the reason sometimes i go with a reverse knuckle bender is because you can add resistance to it with how many rubber bands you put on um and so especially if someone is like i just don't have the time to wear you know, my LMB for like as long as I want them to.
00:02:16
Miranda Materi
ah
00:02:16
Allison Johnson
might do a reverse knuckle bender just because they can make it a little more resistive for the shorter amount of time they're able to wear it.
Balancing Wear Duration and Patient Tolerance
00:02:24
Allison Johnson
But it's definitely a lot more like cumbersome and big and they could job their eye out with like the little hook with the rubber bands going.
00:02:32
Miranda Materi
Do you feel like you, so you do feel like you get a better, a better stretch with the reverse knucklebender than you do the LMB?
00:02:38
Allison Johnson
Um, Yes, I think because you can make it more aggressive. Like I know you can kind of adjust the LMBs, but you can you can get more of a stretch on the reverse knuckle benders, I think.
00:02:48
Miranda Materi
Yeah, that's true. ah You can't, there's only so far that you can bend the springs and then they spring back on the l and b
00:02:54
Allison Johnson
For the LMB, yeah. But I do really like the LMBs when someone can be, you know, wearing it as long as they can tolerate because I think that's better more time in it than an aggressive stretch.
00:03:03
Miranda Materi
How long do you usually have them wear the L&B for?
00:03:07
Allison Johnson
Um, I
Serial Casting for Stiff Joints
00:03:08
Allison Johnson
tell them to like work up to an hour and if they have the time for it even longer, what about you? Okay.
00:03:14
Miranda Materi
um yeah Usually do like 30 minutes, like three times a day.
00:03:18
Allison Johnson
okay I'm asking too much.
00:03:18
Miranda Materi
But no, I don't know. I think like everybody's so different. Right. And then how much do they gain? And maybe they need more time. You know, I never thought to do an hour. I don't know why, but
00:03:31
Allison Johnson
I think a lot of people can't tolerate an hour at first and that's a good time commitment.
00:03:34
Miranda Materi
yeah. Yeah. I think my favorite, favorite PIP extension is a serial cast though.
00:03:42
Allison Johnson
Oh, I forget about serial casting. Yes.
00:03:46
Miranda Materi
So if it's a really stiff joint, then i know, like I've just had like really good results with serial casting. I feel like they have to be in a long time. And there's something about like the plaster that's kind of cooling. And usually when you take, you take it off their joint inflammation is down and it just looks good. And you know, you might gain like five to 10 degrees each week. and
00:04:08
Allison Johnson
Yeah, that's great. So when you're doing the serial casting, are you doing it weekly? Are they coming in once a week?
00:04:13
Miranda Materi
Yeah. Once a week, typically.
00:04:15
Allison Johnson
Okay, that's great. I forget i forget about serial casting. That is a great one. do
00:04:20
Miranda Materi
And it's cheap.
00:04:23
Allison Johnson
So cheap, easy to do.
00:04:24
Miranda Materi
Easy to do.
00:04:26
Allison Johnson
do you feel do is it hard to get people to buy into having a cast on their finger, do you think?
00:04:32
Miranda Materi
Um, I've never had some, I mean, I guess I shouldn't say never, not that I recall. Like, I think usually people are like, yeah, let's get it done. And I presented as like, this is something I've had like a lot of good success with. And, and I tell them we can make it removable or we can make it
Patient Compliance and Treatment Spectrum
00:04:48
Miranda Materi
permanent. And it just depends on you know, the scenario, the case scenario. Like, so sometimes the first time we do it, I'll be like, oh, we'll make it removable so you can take it, slide it on and off.
00:04:56
Miranda Materi
And that way you can still do exercises. Just put it back on when you're done and wear all the time. Um, so, and I think to make it removable, you know, usually you put a little lotion on the finger or maybe have them dip their finger in paraffin.
00:05:02
Allison Johnson
That's a great.
00:05:10
Allison Johnson
Yeah. Okay. That's good. I've never made a removable one.
00:05:12
Miranda Materi
I think, I think the downside is that it's messy, right?
00:05:13
Allison Johnson
I don't think.
00:05:17
Miranda Materi
You're casting, it's getting everywhere,
00:05:19
Allison Johnson
Mm-hmm. What kind of fun?
00:05:21
Miranda Materi
but kind of fun. Yeah. I think it's fun to, to mix it up and usually patients, especially I feel like younger patients, um, that have a little bit more pliability and their joints respond really well to serial casting.
00:05:33
Allison Johnson
Yeah, I need to remember about serial casting. I haven't done that in a while, but that is a great one. And I think it's probably good, too, for patients that aren't really going to be compliant with splint wear because a non-removable one, they can't take it off.
00:05:42
Miranda Materi
Yes.
00:05:45
Allison Johnson
Yeah.
00:05:46
Miranda Materi
Yeah. So usually like I'll present the options, like this is our, our least aggressive option, you know, and maybe that's just a nighttime split and then the most aggressive being serial casting. And then there's a few things in between, right? Like the joint jack,
00:05:58
Miranda Materi
um an RMO, like a relative motion split, I think works really well.
00:06:01
Allison Johnson
Yeah.
00:06:02
Miranda Materi
I forget about those. I think the RMO is hard for people to buy into though, because they don't really understand it.
00:06:09
Allison Johnson
Yeah.
00:06:10
Miranda Materi
Yeah. They don't get, but so explaining it to the patients and then telling them just wear it all the time and I want to see how much you improve, you know, in a few days and see you again. So I always present it like as a spectrum and then kind of see where they're at and what they want
Effectiveness of Joint Jacks and Finger Press Method
00:06:24
Miranda Materi
to try. And then also how hard is the joint? Does it have a hard end feel? Is it soft end feel? How long we've been dealing with it for?
00:06:31
Allison Johnson
Yeah, that's a, yeah, those are all really great points.
00:06:35
Miranda Materi
What about, um, have you used any joint jacks?
00:06:35
Allison Johnson
for
00:06:39
Allison Johnson
I haven't in a while because I also kind of forgot about joint jacks, but I used to they, those are pretty good, i think, but I think you have to have at least, like you can't have a contracture worse than 30 degrees for those, right?
00:06:53
Miranda Materi
Yeah, I was going to 20. It's 20 to 30, but...
00:06:54
Allison Johnson
um be Okay. um But yeah, I feel like those have pretty good success if people wear them.
00:07:01
Miranda Materi
Yeah, I think so too. I think they're pretty aggressive.
00:07:04
Allison Johnson
They're pretty aggressive.
00:07:04
Miranda Materi
and And those are intimidating put there's like a screw and you're twisting it.
00:07:07
Allison Johnson
Yeah.
00:07:08
Miranda Materi
and
00:07:10
Allison Johnson
There is a...
00:07:10
Miranda Materi
And then...
00:07:11
Allison Johnson
Oh, you go.
00:07:11
Miranda Materi
Can you about the new one that's on the market?
00:07:14
Allison Johnson
Finger press? Is that the one you've seen?
00:07:15
Miranda Materi
Yeah.
00:07:17
Allison Johnson
I haven't tried it yet with anybody.
00:07:19
Miranda Materi
Yeah, think...
00:07:19
Allison Johnson
I have one. So I want to try it. Have you tried
00:07:23
Miranda Materi
And so for, I haven't tried it, but for our audience, can you, they might already know, but can you explain what the finger press is?
00:07:30
Allison Johnson
Yes. Let me think. So it's, um, I think how they made it, it's a 3d printed like plastic material and it comes in different sizes and like different lengths. Um, so you put it on and there's like kind of like the slide thing and that's how you straighten the finger. You like slide it forward or like distally and it straightens the PIP joint.
00:07:52
Miranda Materi
Right. And is it, do you attach it to a splint, right? Or no, it's its own thing.
00:07:56
Allison Johnson
It's its own thing.
00:07:57
Miranda Materi
Okay. So you don't need, it's its own splint.
00:08:00
Allison Johnson
It's its own split. Yeah. here
00:08:02
Miranda Materi
and That's an option.
00:08:03
Allison Johnson
So yeah, that's also an option that I do want to try.
00:08:03
Miranda Materi
Well,
00:08:07
Allison Johnson
ah just haven't yet, but yeah.
00:08:10
Miranda Materi
Yeah, it would be interesting if there was like something that really looked at all these different um things side by side and then compared how much pressure actually put on the joint, right?
00:08:16
Allison Johnson
Types this one.
00:08:21
Miranda Materi
So you could kind of have
00:08:22
Allison Johnson
Yeah.
Research on Splint Pressure Comparison
00:08:23
Miranda Materi
this gauge.
00:08:23
Miranda Materi
I mean, I think we kind of subjectively assess it like the joint jack's aggressive, the L&B is not as much, you know, but it'd be nice to have like a side by side comparison of all of them.
00:08:31
Allison Johnson
Right.
00:08:34
Allison Johnson
That would be a really cool study. Sounds like another great capstone project.
00:08:41
Miranda Materi
I know. And someone, and we need someone with like an engineering background.
00:08:41
Allison Johnson
I'm going to say engineering. Yeah, because I don't know how to get that information. But yeah.
00:08:47
Miranda Materi
Yeah, would be interesting though. I guess, that you know, what it could be is just like measuring the patient's joint and then have them wear it and then see how much has improved from that wearing time.
00:08:57
Allison Johnson
Like regionally. Yeah, that'd be really cool.
00:09:02
Miranda Materi
It'd have to be, it you'd have to have a lot of patients. So.
00:09:04
Allison Johnson
Yeah, with similar injuries.
Invitation for Listener Feedback
00:09:06
Miranda Materi
no Okay, well, if you have any suggestions or information or want to share your favorite PIP extension, orthosis, or dynamic splint, let us know. You can reach out to us, info at hamtherapyacademy or at hamtherapyacademy.