The results of serial casting in the treatment of proximal interphalangeal joint contractures in patients with systemic sclerosis

Abstract

Background: Systemic sclerosis can lead to significant disability. Flexion contractures of the proximal interphalangeal joints are common in systemic sclerosis. Serial casting can be used to correct these contractures. The literature lacks data on the use of this method for this purpose. Purpose: To analyze the results of serial casting intervention in the treatment of proximal interphalangeal joint flexion contractures and identify the factors that may affect outcomes. Study Design: Retrospective case series. Methods: The data of 10 patients treated with serial casting for their proximal interphalangeal joint contractures were analyzed. Range of motions of the finger joints, grip pressures, pinch strengths and hand functions at the initial and final evaluations were compared. A finger goniometer, a modified sphygmomanometer, B&L pinchmeter and Duruöz Hand Index were used for the measurements, respectively. Results: A total of 38 fingers were serially casted. The serial casting intervention resulted in significant (p < 0.001) reduction in the average proximal interphalangeal joint extension loss. Some flexion decreases in this joint accompanied this gain (p < 0.001). Range of motions of the other finger joints increased (p < 0.001). The average grip pressures (p = 0.005 and 0.007), lateral pinch strengths (p = 0.04) and total hand function (p = 0.013) improved. The magnitude of the extension loss in the beginning, severity of Raynaud phenomenon, disability and disease durations were all moderately important factors in predicting the gains in the proximal interphalangeal joints. Sixty percent of the gains (adjusted R2 = 0.6) could be explained by these factors. Conclusions: Serial casting may be an effective method to decrease flexion contractures of proximal interphalangeal joints as an adjunctive method to other rehabilitation modalities in patients with systemic sclerosis. Clinicians should consider disease-specific constraints both in the selection of patients for serial casting application and their follow-up.