A commentary from the pioneers on the innovation of the relative motion concept: History, biologic considerations, and anatomic rationale.

The relative motion concept is simply recognition of the normal functional anatomic relationships that allow powerful extrinsic muscles, the extensor digitorum communis (EDC) and flexor digitorum profundus (FDP), to vary forces on individual finger joints and function in response to the relative position of adjacent metacarpophalangeal joints (MCPJs) in the hand, one to another. First identified as a cause of complications after surgery, a better understanding now allows us to harness these forces by way of differential metacarpophalangeal joint (MCPJ) positioning using an orthosis. This can reduce undesirable tension and allow immediate controlled active motion while permitting functional use of the hand. Tissue gliding with active motion prevents restrictive scarring, maintains joint mobility and avoids unnecessary limitations and stiffness on normal neighboring structures. The historical development of this concept is shared with explanation of the anatomic and biologic rationale for this approach. Acute and chronic hand conditions that may benefit from better understanding of relative motion are numerous and growing.

How controlled motion alters the biophysical properties of musculoskeletal tissue architecture.

INTRODUCTION: Movement is fundamental to the normal behaviour of the hand, not only for day-to-day activity, but also for fundamental processes like development, tissue homeostasis and repair. Controlled motion is a concept that hand therapists apply to their patients daily for functional gains, yet the scientific understanding of how this works is poorly understood. PURPOSE OF THE ARTICLE: To review the biology of the tissues in the hand that respond to movement and provide a basic science understanding of how it can be manipulated to facilitate better functionThe review outlines the concept of controlled motion and actions across the scales of tissue architecture, highlighting the the role of movement forces in tissue development, homeostasis and repair. The biophysical behaviour of mechanosensitve tissues of the hand such as skin, tendon, bone and cartilage are discussed. CONCLUSION: Controlled motion during early healing is a form of controlled stress and can be harnessed to generate appropriate reparative tissues. Understanding the temporal and spatial biology of tissue repair allows therapists to tailor therapies that allow optimal recovery based around progressive biophysical stimuli by movement.

Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts.

Patients with common hand fractures are likely to present in a wide variety of outpatient orthopedic practices. Successful rehabilitation of hand fractures addresses the need to (1) maintain fracture stability for bone healing, (2) introduce soft tissue mobilization for soft tissue integrity, and (3) remodel any restrictive scar from injury or surgery. It is important to recognize the intimate relationship of these 3 tissues (bone, soft tissue, and scar) when treating hand fractures. Fracture terminology precisely defines fracture type, location, and management strategy for hand fractures. These terms are reviewed, with emphasis on their operational definitions, as they relate to the course of therapy. The progression of motion protocols is dependent on the type of fracture healing, either primary or secondary, which in turn is determined by the method of fracture fixation. Current closed- and open-fixation methods for metacarpal and phalangeal fractures are addressed for each fracture location. The potential soft tissue problems that are often associated with each type of fracture are explained, with preventative methods of splinting and treatment. A comprehensive literature review is provided to compare evidence for practice in managing the variety of fracture patterns associated with metacarpal and phalangeal fractures, following closed- and open-fixation techniques. Emphasis is placed on initial hand positioning to protect the fracture reduction, exercise to maintain or regain joint range of motion, and specific tendon-gliding exercises to prevent restrictive adhesions, all of which are necessary to assure return of function post fracture.

Fracture healing: bone healing, fracture management, and current concepts related to the hand.

Bones fracture frequently and often result in significant impairments, functional limitations, and disabilities, especially when the hand is involved. When fractures occur, there is a disruption of the skeletal tissue organization and a loss of mechanical integrity. The goal of fracture healing is to regenerate mineralized tissue in the fracture area and restore mechanical strength to the bone. Of equal importance is the reconstitution of the normal soft tissue gliding and movement about the fracture site. This article briefly reviews the history of fracture healing and the advances in mechanics and cellular and molecular biology, which should help the reader better understand the current mechanisms related to bone healing (primarily and secondarily). Fracture fixation modes also are described along with the temporal sequencing as to when to protect or move the fractured region.

Rehabilitation for proximal phalangeal fractures.

Proximal phalangeal fracture stability is crucial for the initiation of early and effective exercises designed to recover digital and especially proximal interphalangeal joint motion. Active digital flexion and extension exercises are implemented by synergistic wrist motion. Joint blocking exercises and active tendon gliding exercises in protective blocking splints are instrumental elements of early treatment. Dynamic splinting and serial finger casting are used in recalcitrant, severe, and late presenting cases. Surgical release is a last resort in regaining proximal interphalangeal joint motion. This measure is reserved for a failure of treatment when residual proximal interphalangeal joint contracture is persistent and severe enough to cause serious impairment of digital motion and hand function.