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Review
. 2014 Jul;41(3):501-12.
doi: 10.1016/j.cps.2014.03.011.

Management of the stiff finger: evidence and outcomes

Guang Yang  1 , Evan P McGlinn  2 , Kevin C Chung  3
Affiliations
Review

Management of the stiff finger: evidence and outcomes

Guang Yang et al. Clin Plast Surg. 2014 Jul.

Abstract

The term "stiff finger" refers to a reduction in the range of motion in the finger. Prevention of stiff fingers by judicious mobilization of the joints is prudent to avoid more complicated treatment after established stiffness occurs. Static progressive and dynamic splints are considered effective non-operative interventions to treat stiff fingers. Capsulotomy and collateral ligament release and other soft tissue release of the MCP and PIP joint are also discussed in this article. Future outcomes research is vital to assessing the effectiveness of these surgical procedures and guiding postoperative treatments.

Keywords: Capsulotomy; Contracture; Finger; Metacarpophalangeal joint; Proximal interphalangeal joint; Splint; Stiffness.

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Figures

Figure 1
Figure 1
Anatomy of the MCP joint. The collateral ligaments arise from the metacarpal head to the base of proximal phalanx. Proximal and volar to the collateral ligament is the ACL (accessory collateral ligament). The volar plate is directly palmar to the joint.
Figure 2
Figure 2
Anatomy of the PIP joint. The collateral ligaments and volar plate of the PIP joint are similar to the MCP joint. The extensor apparatus and flexor tendons embrace the joint.
Figure 3
Figure 3
Anatomy of volar plate of the PIP joint. The volar plate is composed of fibrous and membranous portion, and it is reinforced by two checkrein ligaments proximally.
Figure 4
Figure 4
Safe position of the hand. The wrist is in 30° of extension, the MCP joint is in 70° to 90° flexion position, and the PIP joint is in full extension.
Figure 5
Figure 5
The MCP extension contracture release. (A) Dorsal curvilinear incisions over the MCP joint were made. (B) We excised the dorsal capsule of the joint. (C) If joint passive flexion was not enough after the dorsal capsule excised, we divided the collateral ligament from the origin on the metacarpal head. (D) The MCP joint flexion can help to identify the tight collateral ligament.
Figure 6
Figure 6
The MCP joint extension contracture release in another patient. (A) We incised the portion of the sagittal band to expose the dorsal capsule. (B) The dorsal capsule was excised. (C) The MCP joint can be passive flexed to 90 degree after release.
Figure 7
Figure 7
The PIP joint flexion contracture release. (A) The PIP joint flexion contraction of the ring finger. (B) A mid-lateral incision was made on the ulnar border of the ring finger. (C) The A3 pulley was incised and we retracted the flexor tendon to explore the PIP joint. (D) An incision in periosteal attachments of the volar plate was performed. (E,F) The volar plate (arrow) was subperiosteally dissected to the joint space. (G) A passive extension of the finger was able to bring the finger in a full-extended posture.
Figure 7
Figure 7
The PIP joint flexion contracture release. (A) The PIP joint flexion contraction of the ring finger. (B) A mid-lateral incision was made on the ulnar border of the ring finger. (C) The A3 pulley was incised and we retracted the flexor tendon to explore the PIP joint. (D) An incision in periosteal attachments of the volar plate was performed. (E,F) The volar plate (arrow) was subperiosteally dissected to the joint space. (G) A passive extension of the finger was able to bring the finger in a full-extended posture.
Figure 8
Figure 8
The PIP joint extension contracture release. (A) A curvilinear incision was made over the dorsal PIP joint. (B, C) The lateral band was released and then the dorsal capsule was incised. (D) The PIP joint was able to flex to about 90 degree after release.
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