Physical Rehabilitation Medicine/Stiff fingers in the morning after fracture
QUESTION: 15 November 2014, played Volleyball, Little Finger fracture at PIP Joint, injured volar plate pulling off some bone.
Hand Therapy to correct bend in finger and return some range of motion. I'm now left with a bump on top of the PIP joint.
Each morning my Little Finger and 4th Finger are stiff. I start to use them and the stiffness goes away.
Will I always have this stiffness ?
ANSWER: You likely have a PIP joint contracture with a flexion contracture. Meaning the PIP joint won't straighten all the way. I'd recommend seeing a certified hand therapist and have them do serial casting to the PIP joint with lots of stretching to the oblique retinacular ligament stretches. Following the serial casting you will need some type of dynamic extension splint to make sure the contracture doesn't worsen.
Tricky to treat these at times.
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QUESTION: Hand therapy commenced in March, this year.
At that stage the degree of bend was 55 degrees. I had a splint on each night to keep the finger straight, and a daytime one (a stretch material) so I could use the finger during the day.
Hand therapy finished in June and the degree of bending is now 24 degrees.
The hand therapist said overtime the bump on the PIP joint would reduce due to some bone remodelling.
I was hoping not to have the stiffness in the fingers.
Can you make any further comment.
Can you explain serial casting and oblique retinacular ligament stretches.
ANSWER: The bump won't reduce due to bone remodeling. Not sure where they are getting that. Bones heal at 6-8 weeks and they are then "what they are". You need to see a board certified hand surgeon (www.assh.org) and they will likely refer you to a board certified hand therapist (www.asht.org).
At this point you should have full flexion of the PIP joint (meaning you can make a fist) and extension should be, ideally, 20 degrees or less. Zero being perfectly straight.
Serial casting involves using plaster of Paris to straighten the finger. It is an advanced skill and not one that most therapists are able to effectively master. Make sure you ask if the therapist you see is able to do this.
Oblique retinacular ligament stretches involve holding the PIP joint as straight as possible while bending the DIP joint. This should be done 3 times per day for around 8-10 minutes.
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QUESTION: The Hand therapist made the night time splint. She measured my finger and then used a heating device to come up with a hard material that I put on top of the finger. It was secured underneath the finger with little Velcro ties.
The Oblique retinacular ligament stretches, I was told to firmly hold the injured finger at the middle so that only the DIP joint could bend. Repeated this 10 times for five sessions each day.
I did read that fingers re-model and you should wait before you put any rings back on your finger.
I just wish to remind you that the incident happened 12 months ago, November 15. I saw a doctor 3 weeks later. He said the injury was healing up nicely but keep the joint moving. I didn't worry about the finger much until it started to bend in January.
First available appointment with the Hand Therapist wasn't until March.
At that stage the damage was possibly done.
Whether or not the Hand therapist achieved a desired outcome, do you foresee that I will continue to have stiff fingers in the morning ?
Just realized I had not responded to your last email. If you want the finger straight then a splint on top of the finger does not have enough force to bring the finger into extension and is useless after the volar plate fracture heals at 8 weeks or so.
That's correct about the ligament stretches, hold the PIP joint and bend the DIP joint.
Finger swelling WILL go down. You'll see changes in your finger for up to a year. So yes, it will "remodel".
The later you address an injury the more it will take to correct. The hand therapist's desired outcome is YOUR outcome. If you aren't happy with it then it's not a successful outcome. Your fingers will in fact be stiff for awhile but this should resolve with time.