Relative motion orthoses in the management of various hand conditions: A scoping review

J Hand Ther. 2016 Oct-Dec;29(4):405-432. doi: 10.1016/j.jht.2016.07.001. Epub 2016 Oct 25.


Study design: Scoping review.

Introduction: The relative motion (RM) concept and immediate controlled active motion (ICAM) program, originally applied after zones IV-VII extensor tendon repairs, have been modified and extended to a variety of hand conditions, such as sagittal band injury, boutonniere deformity, and extensor lag.

Purpose of the study: To scope the published and unpublished literature to review ICAM modifications, hand conditions for which the RM concept is used, and describe the preferred degree of relative metacarpophalangeal joint extension/flexion reported and spectrum of orthosis design.

Methods: Electronic and manual searches of scientific and gray literature and expert consultation were conducted. Documents with quantitative data were assessed with Oxford Levels of Evidence and the Structured Effectiveness Quality Evaluation Scale.

Results: Fifteen references met the inclusion criteria; 1 was level III evidence, and others were level IV evidence. RM-ICAM modifications, preferred degree of relative extension/flexion, orthotic design, management of other hand conditions and knowledge gaps were identified.

Conclusion: RM orthoses may improve outcomes in a variety of hand conditions; however, high-quality studies that contribute to the evidence base for its use are needed.

Level of evidence: Not applicable.

Keywords: Boutonniere; Extensor tendon; ICAM; Merritt splint; Relative motion; Sagittal band.

Publication types

  • Review

MeSH terms

  • Disability Evaluation
  • Equipment Design
  • Equipment Safety
  • Female
  • Hand Deformities, Acquired / diagnosis
  • Hand Deformities, Acquired / rehabilitation*
  • Hand Injuries / diagnosis
  • Hand Injuries / rehabilitation*
  • Hand Strength / physiology
  • Humans
  • Male
  • Orthotic Devices / statistics & numerical data*
  • Prognosis
  • Range of Motion, Articular / physiology*
  • Tendon Injuries / diagnosis
  • Tendon Injuries / rehabilitation*
  • Treatment Outcome