BRIEF REPORT Randomized Controlled Trial of Daily Total End Range Time (TERT) for Capener Splinting of the Stiff Proximal Interphalangeal Joint

Susan Peters is Hand Therapist, Hand and Upper Limb Rehabilitation Unit, EKCO Occupational Services, Brisbane, Queensland, Australia. Joint stiffness and joint contracture are secondary complications of traumatic hand injury resulting in loss of active range of motion (AROM) and passive range of motion (PROM; American Society for Surgery of the Hand, 2006; Colditz, 2004; Creighton & Steichen, 1994; E-Hand. Com, 2009;Michlovitz, Harris,&Watkins, 2004; Page & Stern, 1998). This loss of joint motion impairs hand function and results in difficulty participating in normal activities of daily living (ADLs) such as dressing, eating, and work-related tasks (Schneider et al., 2008). Consequently, occupational therapists are frequently challenged with the task of improving range of motion (ROM) to facilitate restoration of function after hand trauma (Michlovitz et al., 2004). Proximal interphalangeal (PIP) joint extension deficits are a common pattern of deformity resulting from hand injury (Creighton & Steichen, 1994; Page & Stern, 1998; Prosser, 1996). The anatomy of the PIP joint and its tendency to sit in flexion in the presence of edema postinjury create a predisposition toward loss of extension PROM. After trauma, changes occur within the collagen matrix of the soft tissues encapsulating the PIP joint that result in shortening and disorganization of fibers and contracture formation (Brand, 1995; Brand & Hollister, 1999). Dynamic Capener splints are a common treatment used for improving PIP joint extension (Capener, 1967; Fess & McCollum, 1988; Li-Tsang, Hung, & Mak, 2002; Prosser, 1996;Wilton, 1997b). A dynamic extension-mobilizing force is applied via the splint through spring coils that sit on either side of the PIP joint. The splint is designed to encourage PIP extension while allowing the distal interphalangeal joint to move freely (Figure 1). Growth and reoganization of contracted soft tissues are promoted as a result of extended periods of splint use (Brand, 1995; Fess & McCollum, 1998; Flowers &