Stretching Alone Can Change P1 Bone Shape in Patients with Camptodactyly

Woo Hong, S. Kim, J., Sang Kwon, O., Ho Lee, M., Sik Gong, H., Hyun Baek, G., (2019). Radiographic Remodeling of the Proximal Phalangeal Head Using a Stretching Exercise in Patients With Camptodactyly. J Hand Surg Am, 1.e1-1.e10

The Skinny – Camptodactyly is a congenital, nontraumatic flexion contracture of the PIP in fingers other than the thumb. Type 1 Camptodactyly ( Isolated anomaly in children <36 months) also includes volarly angulated and beak-shaped flat proximal phalangeal head. This study investigated the impact of a stretching-only camptodactyly treatment plan on restoration of Proximal Phalangeal head angulation as well as joint contracture.

In The Weeds – In a retrospective cohort study using radiographic series, 48 digits in 20 patients <36 months with >12 months of follow up were studies.  2 indexes were created to measure Head Angle (HA) and Head Triangle Ratio, or head shape (HTR).

Camptodactyly Stretches: Parents conducted a minimum of 20 sessions/day of a minimum of 5 minutes/session on affected fingers.  Wrist and MCP were held in extension to increase FDS and FDP tension while force was applied to DIP joint flexion crease.  This was done for 12 months.

camptodactyly stretches

Results: “roundness and concentricity of the proximal phalangeal head was restored in all cases” with statistical significance.  Flexion contracture of the PIP decreased from 34 degrees ± 13 to 6 degrees ±7.

camptodactyly stretches

Bring it Home – Radiographic imaging indicates that stretching alone can restore the shape and angulation of the proximal phalangeal head and decrease flexion contracture. There was no correlation between contracture angle and boney shape throughout the study. This study had significant intra and inter-rater reliability for HA and HTR measures and control group illustrated that bone growth alone did not account for change in these parameters.

While other types (i.e. ages) of camptodactyly need to be studied, this study supports the strong value in stretching exercises for this diagnosis (camptodactyly exercises).  Younger patients are particularly more receptive due to soft tissues being more extensile and the joint is more flexible. While the stretching protocol in this study is extensive, and may not be maintainable by many families, this approach is highly effective in achieving results non-surgically.

2 Comments

  1. Celeste Freeman, OTR/L,CHT on June 20, 2019 at 4:51 pm

    Is it possible for me to obtain a copy of the full article?

    • Josh MacDonald on June 21, 2019 at 6:16 am

      We can’t distribute the article itself, but the reference is provided so you can still find it. If you have a connection at a local university they may be able to pull it for you. Or Google Scholar will often have articles available in full print for viewing.

Leave a Comment






More To Read

Dorsal Scapular Nerve Entrapment and Thoracic Pain

January 22, 2023

Don’t Forget to Evaluate for Dorsal Scapular Nerve Entrapment By Delaney Wright If your patient presents with any upper thoracic pain, it is critical to take measures to evaluate for dorsal scapular nerve entrapment. In a study completed by Sultan et al. (2013), 55 patients with interscapular pain were evaluated clinically and via nerve conduction…

Read More

Putting Occupation in Hand Therapy

February 5, 2019

It was early in my career, maybe a year out of school. I was working with a veteran physical therapist that had been practicing for thirty plus years. She was somewhat intimidating and one of those old school physical therapists that thrived on being aggressive. We were chatting about what areas of occupational hand therapy…

Read More

Mirror therapy after a peripheral nerve repair in hand therapy

July 24, 2022

Rapid Review Paula, M. H., Barbosa, R. I., Marcolino, A. M., Elui, V. M., Rosén, B., & Fonseca, M. C. (2016). Early sensory re-education of the hand after a peripheral nerve repair based on mirror therapy: a randomized controlled trial. Brazilian journal of physical therapy, 20(1), 58–65. https://doi.org/10.1590/bjpt-rbf.2014.0130 The Skinny: Therapy is often provided following an…

Read More

Factors that influence orthosis adherence in patients with acute traumatic tendon injuries to the hand

September 12, 2021

Savaş, S., & Aydoğan, Ç. (2020). Factors affecting orthosis adherence after acute traumatic hand tendon repairs: A prospective cohort study. Journal of Hand Therapy, S0894113020301848. https://doi.org/10.1016/j.jht.2020.10.005 World Health Organization. (2003). Adherence to long-term therapies: evidence for action. World Health Organization. The Skinny Adherence to orthosis wear is vital for protecting healing tendons after a traumatic tendon…

Read More
Envelope_1

Sign-up to Get Updates Straight to Your Inbox!

Sign up with us and we will send you regular blog posts on everything hand therapy, notices every time we upload new videos and tutorials, along with handout, protocols, and other useful information.