Use of casting motion to mobilize stiffness to regain digital flexion following Dupuytren's fasciectomy

Abstract

Background A priority in hand therapy following Dupuytren's fasciectomy is to regain and maintain extension of the proximal interphalangeal joint (PIPJ). Historically this has been achieved through the application of mechanical stress to the affected digit with splinting and exercise. However, loss of a normal pattern of digital flexion in both the operated and non-operated digits is a common complication. Method Four patients who underwent a Dupuytren's fasciectomy presented with persistent digital stiffness and a poor pattern of motion of the operated hand following traditional therapy. The casting motion to mobilize stiffness (CMMS) technique was therefore applied. The type of cast applied, duration of casting, duration of sessions and cast exercises are described. Results All patients regained digital flexion and an improved pattern of motion through the use of the CMMS technique without compromising PIPJ extension. Conclusion This small case series demonstrates the use of the CMMS technique to regain digital flexion and a normal pattern of motion when traditional treatment fails to achieve the desired outcomes following Dupuytren's fasciectomy. The use of the CMMS technique was beneficial in these patients and provides a means to regain digital flexion without the loss of PIPJ extension and is successful even when traditional therapy has failed.