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00:00:01
Stiff Finger Hacks
1.3k Plays2 years ago
Josh and Miranda cover some of their favorite interventions for managing a stiff finger.
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Transcript
Introduction and Challenge of PIP Joint Stiffness
00:00:06
Speaker
Hi, I'm Josh McDonald. And I'm Miranda Materi and we are Hand Therapy Academy. We're going to talk a little bit about PIP joint stiffness because man, is that a stubborn thing to try to treat?
Sharing Tips for PIP Joint Stiffness
00:00:16
Speaker
And so we're going to talk about how maybe we address it and some hacks that maybe we've come across. Certainly just trying to share the information and maybe pick something up off of this that maybe helps you with the patient you've got. All right. So the dreaded PIP joint, right? These can be stubborn. They can be tough.
00:00:33
Speaker
And I think you and I both learned a lot of tips from our patients as well as other practitioners that we're always happy to share. So what is, say you have a stiff PIP joint and I think it's usually a little harder to get extension. So let's
Importance of Consistent Exercise Routines
00:00:46
Speaker
go after that first. What are you doing to get extension back?
00:00:50
Speaker
One of my, it's not a fancy tip. It's not a trick. It's not some hack or something. It is the consistency of doing home program stuff. I like joint blocking. I'll tell patients joint blocking and I'll obviously show them it's either joint blocking for flexion or reverse joint blocking for extension where they're blocking that MCP inflection.
00:01:08
Speaker
and actively extending it and holding it for three seconds and then relaxing and holding for three seconds relaxing. I'll say that needs to be your new nervous tick. That needs to be something that every stoplight you're doing a couple of times every time you're lying at the grocery store when you're watching TV every commercial break like
00:01:24
Speaker
there needs to be no more than 30 minutes removed from you doing a couple of reps of that to try to get that joint rock free if it's a capsular tightness or maybe some central slip activation or just getting them consistent and following through with that and not like, yeah, I think I did that once yesterday, but this needs to be you doing all the time. And I think you saying just to reiterate that their MCP flexed and extending their PIP
00:01:50
Speaker
That is hard to show people. Do you have any tips? I show them in the clinic, and sometimes if they don't get it, I'm showing them with a Popsicle stick or a relative motion splint. What do you show them so they grasp the concept of keeping their MCP flexed?
00:02:06
Speaker
Yeah, yeah, I'll show them with my hand and then I'll do hand over hand on them and then I'll put their hand on them and show them what that looks like. And some patients do better with it up in space. Some patients do better with their pinky on the table and rested on their lap or the arm rest of the car or whatever. Sometimes I'll either have them take a video of it or I'll pull the front desk lady over and say, when you use your phone, you can take a video of this so you can remember how to do it at home and just try to get as many versions of that in as
Using Splints for PIP Stiffness
00:02:35
Speaker
possible.
00:02:35
Speaker
We'll talk about relative motion. That's another super successful way to work on PIP stiffness. But yeah, lots and lots of repetition in the clinic. Because oftentimes they'll just try to extend at the MCP, right? So when they're sitting at the MCP, it doesn't isolate the central slip as much. And I feel, you know, it doesn't work quite as well. Yeah, yeah. So the reverse joint blocking is a little tricky. But if they get it, it's something that can be very effective moving forwards. Okay. How about you? What's your kind of go to?
00:03:02
Speaker
Usually for any PAP joint stiffness because of the frequency that they have to do it at right like you're telling them you need to do this all the time. My go to is usually always the RMO because if they're bending their hand and they have that splint in the relative position.
00:03:17
Speaker
then they're gonna be successful, right? So if we're working on extension, say it's extension of the long finger, then that long finger needs to be held in relative flexion compared to the other joints. And then they're doing essentially reverse joint locking when they're opening and closing their hands throughout the day. So I really like that. I think sometimes getting patients to buy in and getting a comfortable one is key, right? So you have to really explain why this works and then making sure that you're making a good RMO because if it's not a good RMO, they're gonna hate wearing it.
00:03:46
Speaker
Yeah. No one's going to wear an uncomfortable splint, especially in those web spaces that can get really like uncomfortable pinching, rubbing. So yeah, it's gotta be a comfortable version of the, of an RMO. Yeah. And then talking about with flexion, I like it too, you know, so then you just put that joint in relative, um, extension compared to the other joints to work on more flexion of the PIP joint. Yeah. Yeah.
00:04:07
Speaker
If I've got a patient who's establishing a little bit of a flexion contracture of that PIP, I will sometimes, for the right patients, I'll use an LMB for them. And I'll send them home with it, give them instructions three times a day for 30 minutes as our target. If they're busy at work, I'll say, wear it on your way to work, wear it on your way home from work, and then maybe at lunchtime or something, throw it in your lunchbox if you need to. But I feel like that can help to
00:04:30
Speaker
provide that dynamic extension load to folder plate some of that joint capsule structures just to get them loosened up a little bit in the structures that are just hard to hit. But that can be an intense thing and so not everyone's quite ready for that if they're still very painful. Yeah. And so why don't so if people don't know what an LMB is why don't can you explain that to them?
00:04:50
Speaker
Yeah, it's we typically buy ours. You can make them, but it's a whole process to make them and they're not super expensive to just buy a pack of the small, medium, largest. It's usually two foam pads that on three foam pads. It's never two. It's three foam pads that go on.
00:05:08
Speaker
Volar surfaces of the finger and then a central one that goes on the dorsal and just proximal to that apex of the PIP joint and spring-loaded. So I got a wire on either side that spring loads and pulls that finger into extension. I can flex it to loosen the tension or flex it to increase the tension depending on how much I want for that patient and they slide it on and it provides a dynamic extension load to that PIP joint.
00:05:33
Speaker
So that is the LMB.
Serial Casting vs. Joint Jacks
00:05:36
Speaker
What about joint jacks? Are you using joint jacks at all? I'm not. It's been a long time since I had a doctor ask for them. I've got like two or three in case someone does ask for them. But if you don't know what that is, it's this it's kind of a metal stay that goes on the roller side of the finger.
00:05:52
Speaker
And then there's a strap that goes over PIP and you've got a thumb screwed that you twist and it just looks medieval. Um, enough of the stuff we give patients is a little intense and they talk about the torture devices we give them. This one literally looks like a torture device. So I feel like it's a little bit more intense than most of my patients are up for. Um, I dunno, do you use them?
00:06:13
Speaker
I don't, I would sometimes I'll get an order for them so I'll give it to the patient. But my favorite probably for a PIP flexion contracture beyond a relative motion splint is serial casting. So I love serial casting to get them an extension. I feel like you can do it gentle, you can do it over time. And there's something about the plaster that really decreases their edema. So I would much rather use a removable serial cast than a joint jack.
00:06:39
Speaker
Do you feel that when you do serial casting, you lose any, that's okay. If you do serial casting, do you feel like you lose any flexion while they're casted into extension? Well, so that's the thing. If I am worried about that, I'll make the cast removable. So I'll put like a couple, I'll have a different paraffin before I put the cast on so they can slide it on and off and do flexion exercises. Um, but if I'm not worried about that, like if it's a younger person, I'll just go directly to a serial cast and change it out once a week. Do you worry about that?
00:07:08
Speaker
I won't use serial casting on a patient if their PIP is stuck in a position because I wanna work on both directions at the same time. But I feel like if I can work, if it's, they've got some flexion but just can't extend all the way, like maybe it's a central slip that's become a flexion contracture, that kind of thing, then I'll use it. But I'm hesitant when I'm worried that, you know, we're working on both directions. And if I lock you into one, am I gonna lose the other? I can work on it on the recasting sessions.
00:07:38
Speaker
but then we're not necessarily getting a lot of that movement in between the sessions. Yeah. And I think it just depends on how far out they are, right? Like if, if they're really far out of that contracture, then you're going to oftentimes have to get your extension anyways, before you work on flexion. So I don't, it depends on the patient. I've had a patient, a young girl, she was probably like 13 that had his own two flexor tendon injury. And she was so afraid to move. She didn't move it the whole,
00:08:02
Speaker
And we saw her late, so we were getting her like 14 weeks out and we started serial casting with her and within, you know, I would say a month, we had almost gotten her to full extension.
00:08:12
Speaker
Granted, she was like a young kid, so. Yeah, yeah, yeah.
Ensuring Patient Compliance
00:08:15
Speaker
And a lot of these things we're talking about are devices, equipment, things to provide. But a lot of it is about them doing stuff both in the clinic and at home and saying, like, here's the stuff that you need to move. And stiffness gets better with movement. So whether it's done with a relative motion orthosis on or home program training, sometimes I'll make like an exercise splint.
00:08:36
Speaker
that's a little like a, like sugar tong style, DIP immobilizer and say, I want you to squeeze on things and pull into things. So I'm really blocking that DIP joint. So, so much more of that load of FTP and FDS is directed at the PIP. I'll do the same thing opposite of working on DIP. I'll make an a PIP mobilizer, but trying to get that load, get the patient moving as much as we can because movement begets more movement and kind of works past that stiffness.
00:09:02
Speaker
Yeah, I think that's a good point. If the patients aren't doing what you're asking them to do, there's no point in throwing more at them, right? Like you really need to see, are they being consistent with what I gave them last session before we try something more aggressive? Because if they're not doing it, then you need to go back and revisit why they're not doing it. Like, why are you having difficulties with this? And what can we do to help, you know, make this more achievable?
00:09:23
Speaker
And sometimes it's not that it's not important to them. They either don't understand or they just have a grasp like this needs to be pervasive in your world in order to get past the problem. And not just I did it a couple of times. Like if this is a big deal, we need to keep consistent with it. And so helping them find success. Right. Yeah, definitely.
Closing Remarks and Contact Information
00:09:42
Speaker
All right. I think that covers all things PIP joint stiffness. If you have any questions, you can email us info at handtherapyacademy.com or you can find us at handtherapyacademy on Instagram.
00:10:21
Speaker
Thank you.