Case report illustrating use of serial elastic tension digital neoprene orthoses (ETDNO) protocol in the treatment of proximal interphalangeal joint flexion contracture

Vicenç Punsola-Izard; Karen S Schultz; Elena Ozaes-Lara; Judit Mendieta-Zamora; Aroa Casado; Manuel Llusà-Perez

doi:10.1016/j.jht.2022.06.003

Case report illustrating use of serial elastic tension digital neoprene orthoses (ETDNO) protocol in the treatment of proximal interphalangeal joint flexion contracture

J Hand Ther. 2023 Jul-Sep;36(3):684-692. doi: 10.1016/j.jht.2022.06.003. Epub 2022 Jul 29.

Authors

Vicenç Punsola-Izard¹, Karen S Schultz², Elena Ozaes-Lara³, Judit Mendieta-Zamora⁴, Aroa Casado⁵, Manuel Llusà-Perez⁶

Affiliations

¹ Hand Therapy Barcelona, Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain. Electronic address: v.punsola@handtherapybcn.com.
² Senior Consulting Therapist: Karen Schultz Hand and Upper Limb Strategies (KSHULS); Senior Occupational Therapist/Hand and Upper limb service of the University of Colorado.
³ Hand Therapy Barcelona, Barcelona, Spain.
⁴ Hand Therapy Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain.
⁵ Hand Therapy Barcelona, Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain.
⁶ Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain.

PMID: 35909069
DOI: 10.1016/j.jht.2022.06.003

Abstract

Introduction: This case report details the application of a treatment regimen using a serial elastic tension digital neoprene orthosis (ETDNO) protocol for a patient with an eight-month-old finger crush injury who experienced recurrence of a 45º proximal interphalangeal joint (PIPJ) flexion contracture two months after arthrolysis.

Purpose of the study: To illustrate how the application strategy of ETDNO can increase the daily total end range time (TERT) and modify finger stiffness.

Results: The patient reached full extension following 15 weeks of ETDNO treatment. The six-month follow-up evaluation revealed that the PIPJ was stable with full flexion and extension. The joint did not require continued orthosis use.

Discussion: The literature describes orthosis application as the treatment of choice for PIPJ flexion contracture, but no study has described an ideal program for use nor the full and stable resolution of the flexion contracture. The current literature describes a maximum daily total end range time (TERT) of 12 hours a per day. The serial ETDNO protocol that this study described increased the daily TERT to nearly 24 hour per day and demonstrated an excellent result in the treatment of PIPJ flexion contracture CONCLUSION: This outcome suggests that clinicians will want to consider this new orthosis design and management protocol as a novel option for the treatment of PIPJ flexion contracture. We need future research to better define the optimum number of hours of daily TERT for the effective treatment of PIPJ flexion contracture. In addition, we will also benefit from the exploration of the optimum orthosis design to enable the highest amount of TERT.

Keywords: Conservative treatment; Flexion contracture; Interphalangeal joint; Orthosis.