Finger Orthoses

Question 1

Ox Management of the Fingers

Answer 1

must be low profile enough to enable normal function of adjacent joints/fingers

Question 2

Mallet Finger

Presentation

Answer 2

Flexion of DIP

Question 3

Mallet Finger

Causes

Answer 3

• axial load to extended DIP
• Flexion force to the finger tip
• laceration of the extensor tendon
• avulsion of the tendon

Question 4

Mallet Finger

Function

Answer 4

• inability to extend DIP (extensor lag)
• passive extension is possible
• contracture can develop over time if the DIP cannot be passivley extended

Question 5

Mallet Finger

Treatment Goals

Answer 5

• prevent DIP flexion with stack splint
• maintain DIP extensio nor hyperextension

Question 6

Mallet Finger

Treatment Protocol

Answer 6

• maintained extension for 6 weeks (no flexion at all)
• after 6 weeks weaned off orthosis
• may still wear at night

Question 7

Mallet Finger

Complications

Answer 7

• extensor lag: refer to physician
• <10 deg is considered acceptable

Question 8

Boutonniere Deformity

Presentation

Answer 8

PIP Flexion and DIP hyperextension

Question 9

Boutonniere Deformity

Causes

Answer 9

• disruption of the central slip attachment
• axial loading, lacerations, burns, RA

Question 10

Boutonniere Deformity

Mechanism of injury in RA

Answer 10

• synovitis: inflammation and thickening of the synovium
• surrounding structures may be compromised

Question 11

Boutonniere Deformity

Treatment Goals

Answer 11

• maintain PIP extension
• free motion at MCP and DIP

Question 12

Boutonniere Deformity

Treatment Protocol

Answer 12

6-8 wks

Question 13

Boutonniere Deformity

Complications

Answer 13

PIP flexion contracture may require serial casting

Question 14

Swan Neck Deformity

Presentation

Answer 14

• PIP Hyperextension and DIP flexion
• PROM may be possible or may be contracted

Question 15

Swan Neck Deformity

Causes

Answer 15

• lateral bands of extensor mechanism shift dorsally
• RA or trauma

Question 16

Swan Neck Deformity

Treatment Goals

Answer 16

• prevent PIP hyperextension
• facilitate DIP extension and promote PIP flexion

Question 17

Swan Neck Deformity

Treatment protocols

Answer 17

dorsal orthosis with PIP 20 deg flexion

Question 18

Swan Neck Deformity

Complications

Answer 18

if extensor lag is present, the orthosis can be extended distally and maintain DIP in neutral

Question 19

Grade I sprain

Answer 19

• maintain full extension (less place for edema to develop)
• if painful, slight flexion
• start AROM as pain decreases
• heals 2-3 wks

ligament intact but may have minimal fiber damage

Question 20

Grade II Sprain

Answer 20

• immobilize joint 2-4 wks
• avoid ML stress

AROM stable but instability during PROM
Collateral ligament disrupted

Question 20

Grade III Sprain

Answer 20

Surgery

complete tear