Management of the stiff proximal interphalangeal joint

The stiff digit occurs most frequently after posttraumatic injuries and as a postsurgical complication. The identification and precise participation of the structures involved may be difficult. A step-wise algorithmic approach trying to minimize morbidity may help to obtain the best results. A review of the literature reveals that a midaxial approach is versatile, can accommodate skin deficiencies, and offers appropriate volar and dorsal exposure. Sequential joint release is achieved by complete capsular incision, collateral ligament excision, and volar plate release or partial excision. Tenolysis also may be required for full passive range of motion. Neuroleptoanalgesia is important in proving reconciliation of active and passive discrepancies. Severe cases may require staged reconstructive efforts and represent a higher risk for neurovascular complications. A ray resection may be an appropriate alternative in these individuals. Dedicated rehabilitation including a tendon acceleration program should maintain the motion accomplished during surgery.