How to choose the RIGHT mobilization orthosis for a stiff joint

Ever been faced with a stiff joint (stiff PIP joints anyone?) and not know which orthosis is the correct one for your patient? Do they even need one at all - or would manual therapy alone be enough to correct the deformity? Luckily we have the Modified Weeks Test which has proven a reliable, evidence-based tool in our clinical decision making toolkit to help us determine how to progress the patient's therapy. In a nutshell, the setup is as follows:

1. First, the therapist measures the joint’s passive range of motion before any heat application.

2. Next, patient has their hand placed into a heated modality such as a fluido-therapy, or a heated whirlpool for 20 minutes.

3. The patient's joint is then placed at end range position and heat is applied for another 10 minutes.

4. After the 30 minutes of heat the therapist measures the joint's passive range again.

5. The measurement after heat is compared to the “cold” measurement.

The difference between the two can influence your choice of orthotics as follows:

* if you find 20 degrees of improvement - no orthosis is needed

* about 15 degrees - static orthosis needed

* about 10 degrees - dynamic orthosis

* about 5 degrees - static progressive

Glasgow, C., Tooth, L. R., Fleming, J., & Peters, S. (2011). Dynamic splinting for the stiff hand after trauma: predictors of contracture resolution.Journal of Hand Therapy, 24(3), 195-206.