The versatility of the immediate controlled active motion yoke (ICAM)

Abstract

Purpose: To demonstrate alternative clinical applications for the immediate active controlled motion (ICAM) yoke. Methods: Eight patients from two hand centers with various neurological and/or orthopedic problems affecting metacarpophalangeal (MCP) joint alignment, balance, or range of motion were fitted with variations of the ICAM yoke. Patients were photographed with and without the ICAM yoke to document improved alignment, balance, and function. In the two cases where increased range of motion (ROM) of the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint was the purpose of incorporating the yoke into the patient's program, ROM measurements were documented on the day the yoke was applied and after it was discontinued. Diagnoses for which the ICAM yoke has been utilized: 1) C5-6 discectomy with extensor lag of the middle and ring digits; 2) metacarpal fracture with extensor lag; 3) ulnar nerve palsy with resultant MCP hyperextension; 4) rheumatoid arthritis (post-MCP arthroplasty); 5) Parkinson's disease with ulnar deviation and dislocation of the extensor tendon of the middle digit; 6) metacarpal head fracture with malalignment and ulnar deviation deformity; 7) PIP joint stiffness (to limit MCP hyperflexion while exercising); 8) decreased MCP joint flexion, status/post gunshot wound to the metacarpal. Results: In all patients, there was a high compliance rate with wearing the yoke. We believe the patients fitted to improve alignment or balance complied because the yoke is small and comfortable and their function improved. In fact, three of the patients discharged from therapy have subsequently returned for fabrication of a replacement of their “permanent adaptive splint.” The two patients who wore the splint to assist in increasing ROM gained flexion of the MCP or PIP joints being addressed. Their ROM charts will be presented. Conclusion: The ICAM yoke is well tolerated and effective in balancing or aligning many hand problems affecting the biomechanics of the MCP joint. The improved function experienced by some of the patients fitted is demonstrated by their desire to have replacements or “back-up yokes” fabricated. The ICAM yoke is also an effective splint to position one or more finger MCP joints in relative extension or flexion to gain motion at the MCP or PIP joints.