Focusing on fingers with proximal interphalangeal joint flexion contractures, this study seeks to determine whether significant differences exist between the joint passive range of motion PROM improvement when receiving higher doses of daily total end range time (TERT) compared to those that receive lower doses. The study randomized a parallel group of fifty-seven fingers in fifty patients with concealed allocation and assessor blinding. Divided into two groups receiving different doses of daily total end range time with an elastic tension digital neoprene orthosis, they also participated in an identical exercise program. Patients reported orthosis wear time, and the researchers performed goniometric measurements at every session during the three-week period. The primary outcome related the time patients wore the orthosis to the degrees of improvement in PROM extension. Compared to group B (daily TERT of twelve hours), group A (TERT, twenty+ hours) showed a statistically significant greater improvement in PROM after three weeks of treatment. Group A improved by a mean of 29° compared to group B’s mean of 19° improvement. This study provides evidence that a higher dose of daily TERT can generate better results in the treatment of the proximal interphalangeal joint flexion contractures.

Proximal interphalangeal joint flexion contracture is a frequent condition in hand therapy. Clinicians most frequently apply orthosis management for conservative treatment. Orthoses should apply forces for long periods of time following the total end range time (TERT) concept. These forces necessarily transmit through the skin; however, skin has physiological limitations determined by blood flow. Using three fresh frozen human cadavers, this study quantified and compared forces, skin contact surfaces and pressure of two finger orthoses, an elastic tension digital neoprene orthosis (ETDNO) and an LMB 501 orthosis. The study also investigated the effects of a new method of orthosis construction (serial ETDNO orthoses) that customizes forces to a specific finger position. We evaluated forces and contact surfaces for multiple ETDNO models tailored to the cadaver fingers in multiple PIP flexion positions. The results showed that the LMB 501 orthosis applied pressures beyond the recommended limits if applied for more than eight hours a day. This fact was the cause of time limited LMB orthosis application. This results also show that, at 30° of PIPJ flexion, straight ETDNOs created a mean pressure approaching the end of the recommended pressure limits. If the therapist modified the ETDNO design, the skin pressure decreased and reduced the risk of skin damage. With the results of this study, we concluded that for PIPJ flexion contracture, the upper limit of force application is 200 g (1.96 N). Forces beyond this amount would likely cause skin irritation and possibly skin injuries. This would cause a reduction in the daily TERT and limit outcomes.

Background/Objectives: The treatment of proximal interphalangeal joint stiffness is challenging due to methodological inconsistencies in existing studies. While many studies report range of motion improvements, their limitations raise concerns about result reliability. This review examines whether studies follow standardized protocols or present inconsistencies that hinder evidence-based clinical recommendations. Methods: A systematic review was conducted following PRISMA 2020 guidelines. A literature search in PubMed, Cochrane, PEDro, and ScienceDirect included randomized controlled trials, observational studies, case reports, and systematic reviews. Study quality was assessed based on design, blinding, data collection, and reporting consistency, focusing on standardized range of motion measurements. Results: Most studies showed significant methodological deficiencies, including a lack of controls, inconsistent outcome measures, small samples, and failure to report essential data such as baseline and final range of motion values with standard deviations. These inconsistencies prevented determination of whether reported improvements were treatment-induced or influenced by external factors. Conclusions: Greater methodological rigor is needed in research on the proximal interphalangeal joint. Without standardized protocols, rigorous data collection, and proper controls, treatment effectiveness cannot be reliably assessed. Future studies must ensure methodological consistency to generate evidence-based recommendations.