gms | German Medical Science

Clinical issue/s: Stiffness of the finger joints can be caused by intrinsic or extrinsic tightness, or a combination of factors including edema, adaptive shortening and / or tightening of the joint capsule, ligaments, fascia, and muscle tendon unit. Static progressive orthoses are used to help clients regain PROM through the application of low load, prolonged stress. The goal is to achieve plastic deformation or permanent elongation of the soft tissues and encourage remodeling and realignment of collagen fibers that is compatible with full ROM.

Clinical reasoning: Plastic deformation of soft tissues can be achieved by creep loading or by stress relaxation loading. Creep based loading is achieved with a constant force and varying displacement provided by dynamic orthoses. Stress relaxation loading is achieved with incremental changes in force and a constant displacement provided by static progressive orthoses.

Both types of orthoses are designed to provide a low load, prolonged stretch to tight and shortened tissues. Evidence informed practice suggests that "low load prolonged stress" and "total end range time are the key factors towards gaining PROM in stiff joints.

Innovative, analytical or new approach: The fabrication steps of a Static Progressive IP Finger Flexion Orthosis using a simple circumferential hand based orthosis as the base, and an inexpensive garden glove with different tying mechanisms as the underlying outrigger is outlined.

The orthosis allows for a static progressive pull of individual digits towards passive flexion. A pulley is placed across the palmar aspect of the orthosis at the level of the distal palmar crease to ensure full PIP and DIP flexion.

Contribution to advancing HT practice: This orthotic design allows each finger to be pulled into end range flexion by a non- elastic pull. The Modified Weeks Test described by Flowers (2002) can be helpful in determining whether to use a static progressive or dynamic orthosis.