gms | German Medical Science

Clinical issue/s: It's difficult to decide which approach to use to treat the PIP stiffness. We must evaluate the joint, end-feel, healing phase, edema and adherences. The soft end-feel, early stiffness state, has a good response to passive mobilization. In the hard end-feel, chronic stiffness, the cross-linked collagen fibers are harder and less responsive to passive mobilization. We have to choose between active, passive, dynamic, static, serial kind of tissue stress, to induce a ROM change.

Clinical reasoning: Passive mobilization on an early stiffness joint, let us gain ROM and the patient move more easily the PIP, increasing AROM causing plastic tissue change. During passive mobilization on a chronicle stiffness, we gain ROM after a long joint stress, but fibers won't changes in a long period. The response will be elastic and the patient often come back with no measurable improvement. In order to obtain a plastic response it's necessary to produce a more prolonged application to tissues.

Innovative, analytical or new approach: During the evaluation a lot of factors are considered: time from the trauma, A-PROM, stiffness, edema, adherences, healing, plastic or elastic response of PIP. This brings to new concept as Casting Motion to Mobilize Stiffness, or, more recently, Active Redirection. Blocking normal joints lets stiff joints receive the muscle power needed to move them actively, causing a plastic change. It's also improved the brain relearned movement pattern, discouraging old imbalances patterns, (GradedMotorImagery). PROM is no more necessary to let stiff joints mobilize, when AROM is repeated during all day.

Contribution to advancing HT practice: During the evaluation it's important to state which tissue healing moment the patient come to us and to guide the hand in A-PROM. Later it's important to isolate the active movement of the stiff PIP joint, blocking the others, to gain active motion and a durable tissue modification. In literature there are few cases treated with these methods. It would be interesting to deepen the effectiveness of the treatment.