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The contraction test to detect and predict recurrence of stiffness in the proximal interphalangeal joint
Vicenç Punsola-Izard1, Manuel Llusà-Perez2, Aroa Casado Rodríguez3
1Hand Therapy Barcelona, Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain.
Background:
Stiffness of the proximal interphalangeal (PIP) joint is a common complication following trauma or surgery. Recurrence remains a clinical challenge due to persistent tissue contractile activity, and no standardized method exists to predict long-term outcomes.
Purpose:
To evaluate the contraction test as a tool for detecting residual contractile activity in patients with PIP joint flexion contracture treated with an elastic tension digital neoprene orthosis, and to assess its usefulness in predicting recurrence of stiffness to guide therapeutic decisions.
Study Design:
Longitudinal retrospective cohort study.
Methods:
Fifty-seven patients with PIP joint flexion contracture were treated with an elastic tension digital neoprene orthosis between July and December 2022. Patients were assigned to wear the orthosis either 20-22 hours or 10-14 hours daily during the first three weeks. Passive range of motion and contraction test values were recorded at baseline and during follow-up for up to six months. Improvements in extension and persistence of contractile activity were analyzed.
Results:
At baseline, the contraction test was positive in all patients. After three weeks, the mean cumulative gain in passive range of motion was 29° in the longer-wear group and 19° in the shorter-wear group. The contraction test remained positive in 95% of patients at this stage. At the end of follow-up, 49% of patients (28/57) achieved a negative contraction test, and no recurrence was observed among those who continued treatment. Conversely, patients with a persistent positive test (51%) showed a higher risk of recurrence despite improvements in extension. The greatest gains in extension occurred during the first three weeks, followed by stabilization at approximately three and a half months.
Conclusions:
The contraction test provides an objective measure of residual contractile activity and is useful for predicting recurrence of PIP joint stiffness after treatment with an elastic tension digital neoprene orthosis. It may support clinical decision-making regarding continuation or discontinuation of orthotic treatment, contributing to more personalized management of contractures.
