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.


  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

Outcomes of Rigid Night Splinting and Activity Modification in the Treatment of Cubital Tunnel Syndrome

November 8, 2020

Shah, C. M., Calfee, R. P., Gelberman, R. H., & Goldfarb, C. A. (2013). Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome (night splint for cubital tunnel syndrome). The Journal of Hand Surgery, 38(6), 1125–1130.e1. By: Sophia Grimm The Skinny: The purpose of this study was to…

Read More

6 of our Favorite Adaptive Equipment Tools for CMC Osteoarthritis

October 20, 2019

Individuals struggling with osteoarthritis of the 1st CMC joint usually have difficulty with daily activities and it can become very frustrating. Everyday tasks such as cutting food, opening containers, and donning a button up shirt can become painful and slow. The largest contributor to the overall function of our hand is the thumb. If the…

Read More

Mechanism of Interneural Edema in Carpal and Cubital Tunnel

May 17, 2020

Mechanism of Interneural Edema Over the last few weeks I have been learning about ultrasonic imaging and carpal tunnel syndrome.  When reviewing carpal tunnel syndrome, I learned that intraneural edema is a common sign of compression injuries such as carpal tunnel and cubital tunnel.  There are numerous causes of carpal tunnel syndrome, and every scenario…

Read More

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.