Medscape is available in 5 Language Editions – Choose your Edition here.


Intrinsic Plus Hand Workup

  • Author: Bradon J Wilhelmi, MD; Chief Editor: Harris Gellman, MD  more...
Updated: Jan 21, 2015

Imaging Studies

Radiography of the hands should be included as part of the workup for stiff joints. Although radiography is not helpful in diagnosing intrinsic contracture, it may be useful for ruling out other diagnoses or causes of a contracture.

Contributor Information and Disclosures

Bradon J Wilhelmi, MD Leonard J Weiner Professor and Chief of Plastic Surgery, Plastic Surgery Residency Program Director, Hiram C Polk Jr Department of Surgery, University of Louisville School of Medicine

Bradon J Wilhelmi, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Hand Surgery, American Society for Reconstructive Microsurgery, Association for Surgical Education, Plastic Surgery Research Council, American Association of Clinical Anatomists, Wound Healing Society, American Society for Aesthetic Plastic Surgery, American Burn Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

Thomas R Hunt III, MD is a member of the following medical societies: American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Southern Orthopaedic Association, AO Foundation, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand, Mid-America Orthopaedic Association

Disclosure: Received royalty from Tornier for independent contractor; Received ownership interest from Tornier for none; Received royalty from Lippincott for independent contractor.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.


Jessica Nguyen Gillespie, MD Plastic and Reconstructive Surgeon, Franciscan Physician Network

Jessica Nguyen Gillespie, MD is a member of the following medical societies: American Society for Reconstructive Microsurgery, American Society of Plastic and Reconstructive Surgery, Indiana State Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

  1. Jupiter JB, Goldfarb CA, Nagy L, Boyer MI. Posttraumatic reconstruction in the hand. Instr Course Lect. 2007. 56:91-9. [Medline].

  2. Brody GS. Management of stiff metacarpophalangeal and interphalangeal joints. In: McCarthy JG, May JW Jr, Littler JW, eds. Plastic Surgery. Vol 7. The Hand, Part 1. Philadelphia, Pa:. WB Saunders, Co. 1990:4655-4670.

  3. Watson HK, Weinzweig J. Stiff Joints. In: Green DP, ed: Green's Operative Hand Surgery. 4th ed. Philadelphia, Pa:. Churchill Livingstone. 1999:552-562.

  4. Wong JM. Management of stiff hand: an occupational therapy perspective. Hand Surg. 2002 Dec. 7(2):261-9. [Medline].

  5. Revol M, Servant JM. [Paralysis of the intrinsic muscles of the hand]. Chir Main. 2008 Feb. 27(1):1-11. [Medline].

  6. Formsma SA, van der Sluis CK, Dijkstra PU. Effectiveness of a MP-blocking splint and therapy in rheumatoid arthritis: a descriptive pilot study. J Hand Ther. 2008 Oct-Dec. 21(4):347-53. [Medline].

  7. Pitts DG, O'Brien SP. Splinting the hand to enhance motor control and brain plasticity. Top Stroke Rehabil. 2008 Sep-Oct. 15(5):456-67. [Medline].

  8. Bowers WH, Wolf JW, Nehil JL, Bittinger S. The proximal interphalangeal joint volar plate. I. An anatomical and biomechanical study. J Hand Surg [Am]. 1980 Jan. 5(1):79-88. [Medline].

  9. Ling MZ, Kumar VP. Myofascial compartments of the hand in relation to compartment syndrome: a cadaveric study. Plast Reconstr Surg. 2009 Feb. 123(2):613-6. [Medline].

  10. Guyton GP, Shearman CM, Saltzman CL. Compartmental divisions of the hand revisited. Rethinking the validity of cadaver infusion experiments. J Bone Joint Surg Br. 2001 Mar. 83(2):241-4. [Medline].

  11. Paksima N, Besh BR. Intrinsic contractures of the hand. Hand Clin. 2012 Feb. 28(1):81-6. [Medline].

  12. Espiritu MT, Kuxhaus L, Kaufmann RA, Li ZM, Goitz RJ. Quantifying the effect of the distal intrinsic release procedure on proximal interphalangeal joint flexion: a cadaveric study. J Hand Surg [Am]. 2005 Sep. 30(5):1032-8. [Medline].

  13. Lansmeer JMF. The anatomy of the dorsal aponeurosis of the human finger and its functional significance. Anat Rec. 1949. 104:31.

  14. Smith RJ. Surgery of the hand in cerebral palsy. In: Pulvertaft RG, ed. Operative Surgery. The Hand. 3rd ed. London, England:. Butterworth. 1977:215.

  15. Pitts DG, O'Brien SP. Splinting the hand to enhance motor control and brain plasticity. Top Stroke Rehabil. 2008 Sep-Oct. 15(5):456-67. [Medline].

  16. Lannin NA, Cusick A, McCluskey A, Herbert RD. Effects of splinting on wrist contracture after stroke: a randomized controlled trial. Stroke. 2007 Jan. 38(1):111-6. [Medline].

  17. Smith RJ. Intrinsic muscles of the fingers: Function, dysfunction and surgical reconstruction. In: AAOS Instructional Course Lectures. Vol. 24. St. Louis, Mo:. Mosby. 1975:200-220.

  18. Thevenin-Lemoine C, Denormandie P, Schnitzler A, Lautridou C, Allieu Y, Genêt F. Flexor origin slide for contracture of spastic finger flexor muscles: a retrospective study. J Bone Joint Surg Am. 2013 Mar 6. 95(5):446-53. [Medline].

The metacarpal head is uniquely shaped in that it is ovoid in the sagittal plane, and it widens from the dorsal to the volar dimension. The collateral ligaments are eccentrically mounted dorsal to the axis of rotation of the metacarpophalangeal joint. This anatomy causes variable degrees of tightness on the collateral ligaments based on the position of the joint by a camlike effect. When the joint is in extension, the collateral ligaments are lax. In flexion, the collateral ligaments span a greater distance and are tight.
Proximal interphalangeal (PIP) joint collateral ligaments originate close to the axis of rotation, providing a smaller change in length with joint position and providing lateral stability. The PIP joint ranges in only 1 plane, and its trochlear shape also adds to its lateral stability.
Edema is the initial response to any insult to the hand and leads to adverse sequelae. Joint stiffness develops as intra-articular hematoma and fluid accumulate within the synovial space, distending the capsule. Increased fluid content within the articular capsule and collateral ligaments effectively shortens these structures, favoring extension.
With injury, checkreins form at the IP joints. Checkreins are collagenous bands connecting the lateral sides of the proximal volar plate to the assembly lines on the volar lateral surfaces of the phalanx. Assembly lines are the 2 ridges along the volar lateral surfaces of the phalanx to which are attached volar ligamentous structures, such as the flexor sheath, Cleland and Grayson ligaments, and the oblique retinacular ligaments of Landsmeer.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.