What is the treatment for a 27-year-old male patient with a stable flexion deformity at the proximal interphalangeal (PIP) joint of the fifth finger of the right hand, likely representing a chronic tendon injury?

Treatment for Stable Flexion Deformity of the PIP Joint in the Fifth Finger

For a 27-year-old male with a stable flexion deformity at the PIP joint of the fifth finger of the right hand likely representing a chronic tendon injury, the treatment should include splinting, hand therapy with range of motion and strengthening exercises, and pain management as needed.

Initial Assessment and Conservative Management

Splinting

• A custom-made splint should be provided to help correct the flexion deformity of the PIP joint 1
• The splint should be worn at night as a progressive static orthosis and supplemented with a dynamic orthosis during the day 2
• This approach has been shown to significantly improve PIP joint active extension in patients with flexion contractures 2

Physical/Occupational Therapy

• Evaluation by a hand therapist to assess ability to perform activities of daily living 1
• Implementation of a structured exercise program including:
  • Range of motion exercises to maintain and improve joint mobility
  • Eccentric strengthening exercises to address the tendon injury 1
  • Joint protection techniques to prevent further injury 1

Pain Management

• Local application of heat before exercise sessions 1
• Topical NSAIDs for short-term pain relief with fewer systemic side effects 1
• Oral analgesics (acetaminophen up to 4g/day) may be used for pain control if needed 1

Monitoring and Follow-up

• Regular follow-up every 3-4 weeks to assess progress
• Adjustment of splinting regimen based on improvement
• Most patients with overuse tendinopathies (approximately 80%) fully recover within 3-6 months with appropriate conservative management 1

Advanced Interventions (if conservative treatment fails after 3-6 months)

Corticosteroid Injections

• Intra-articular corticosteroid injections may be considered for painful interphalangeal joints that don't respond to conservative measures 1
• However, these should be used with caution due to potential side effects 1

Surgical Options

• Surgery should be considered only when other treatment modalities have not been sufficiently effective in relieving pain and improving function 1
• Surgical options may include:
  • Soft tissue distraction using pentagonal frame technique for chronic flexion deformities 3
  • Extensor mechanism realignment and augmentation in cases of severe contracture 4

Important Considerations

• The prison setting may limit certain therapeutic options, so emphasis should be placed on treatments that can be consistently implemented in this environment
• Patient education about the chronic nature of the condition is essential
• Compliance with the splinting regimen is critical for successful outcomes
• Avoid activities that exacerbate the condition during the healing phase

The evidence strongly supports that a combination of splinting (both static and dynamic) with appropriate hand therapy exercises offers the best chance for improvement in PIP joint extension while maintaining adequate hand function 2.