Treat the brain and not just the finger
It is well documented that when a finger is injured and not used functionally for a period of time, the motor representation of the finger on the brain is diminished. Trauma to a joint results in a normal tissue response of increased oedema, inflammation, collagen cross linking and poor movement between tissue planes. As the joint is unable to move, an abnormal pattern of movement develops, which results in re-patterning of the motor cortex.
When presented with a finger that has poor active flexion or extension, the natural response is to provide a splint to straighten the finger and to perform passive mobilisation exercises in order to reduce joint stiffness. This treatment approach may be effective, but improvements in active and passive range of motion are often short lived, with the need for frequent hand therapy sessions over a long period of time.
Judy Colditz, OT/L, CHT, FAOTA describes a method called Active Re-Direction whereby all forms of passive splinting and exercise are replaced with volitional active movement of the stiff joint. This is achieved through the use of a splint which blocks MP joint hyperextension and permits full active flexion and extension of the PIP joint repeatedly throughout the day. This concept simultaneously reduces oedema, accomplishes differential glide of tissue planes and ensures remapping of the motor cortex. The result is the achievement of full active flexion and extension of the stiff joint and improved use of the finger when performing functional tasks.
Active re-direction was recently applied to two of my patients with success:
Nicky presented with poor active range of motion of the right little finger as a result of an old injury. The PIPJ was not stiff, but re-patterning of the motor cortex was preventing adequate control of the finger during finger flexion and extension. The Active Re-Direction Splint assisted with regaining a normal pattern of movement and cortical re-mapping.
Active Finger Extension Before Treatment Active Re-direction Splint Active Finger Extension After Treatment
Casey presented with a stiff PIPJ following a knife laceration to the joint. She was unable to flex or extend the PIPJ more than is presented in the first picture. An Active Re-Direction Splint was provided and Casey was able to regain full active flexiona nd extension of the PIP and DIP joints of the index finger.
Active Finger Extension Before Treatment Active Finger Extension After Treatment Active Finger Flexion After Treatment
It is recommended that an active regime is used as opposed to a passive regime in order to ensure both cortical and mechanical stress is applied for optimum results.
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