(1) full passive movement of the
PIP Joint;
- functional loss in these pts is related to loss of DIP joint extension;
- consider flexor synovectomy, intrinsic release, FDS tenodesis, dermadesis, retinacular
ligament reconstruction or DIP arthrodesis (to correct primary mallet finger deformity);
(2) restriction of PIP flexion depending on MCP position (tight intrinsics)
- flexion of the
PIP Joint is restricted if the MCP joint is extended
due to
intrinsic muscle tightness;
- flexion of MCP joint facilitates flexion of
PIP Joint;
- PIP flexion is limited due to MCP deformity w/ 2ndary intrinsic tightness;
- as expected, the ulnar intrinsics are usually tighter than the radial intrinsics, therefore, placing the finger in radial deviation;
- consider performing an
intrinsic release &
MP joint reconstruction if needed;
(3) restriction of PIP mostion w/ preserved joint space;
- lateral band mobilization w/ or w/o pin fixation & or skin release;
- hemitenodesis of
FDS tendon to base of the middle phalanx is performed to limit hyperextension deformity of
PIP Joint;
- MCP arthroplasty is helpful in many instances;
(4) end stage deformity;
- there is significant loss of articular cartilage w/ a complete loss of active and passive
PIP Joint movement;
- PIP fusion:
- consider for index & or middle fingers if stability is important or if
MP joint requires arthroplasty;
- manditory if flexor tendon has ruptured;
- PIP arthroplasty:
- for 4th & 5th digits if adjacent tendons are intact;
- early treatment involves splinting;
