- Call Today: 800-522-5778
Menu
Digit Widget
Downloads
FAQ
Instructional Video
Case Studies
Digit Widget
PIP flexion contractures result from a torque imbalance across the joint. Either there is not enough extensor force, too much flexor force, or a combination of the two. The Digit Widget reverses these contractures by utilizing the principle that gentle force applied over time will stimulate growth of contracted soft tissues. The Digit Widget applies extension torque to reverse the contracture, instead of joint traction used by other methods. The Digit Widget does not prohibit finger flexion. The patient remains more active during treatment, thereby minimizing joint stiffness.
It is important to remember that while the Digit Widget is very effective in reversing PIP contractures, maintenance of active joint extension requires identification and treatment of the underlying cause of each patient’s PIP joint contracture.
Key Benefits
Illustrative Case
Treatment of PIP Flexion Contractures
Patient is diagnosed with recurrent Dupuytren’s Contracture.
Patient following 3 weeks of extension torque
Two Digit Widgets were applied pre-fasciectomy to reverse the contracture: two small incisions were made to divide bands on the little finger with one incision adequate for the ring finger. The Digit Widget needs to be worn full time. The dynamic portion of the device can be “clicked off” the finger for bathing and active flexion exercises.
Patient at 6 weeks
After six weeks of wearing the Digit Widgets, the patient’s extension had plateaued. He was scheduled for the fasciectomy.
Restoration of extension, as a function of time, varies with the etiology of the contracture (i.e. torque imbalance) and the biomechanical properties of the contracted tissues. In Dupuytren’s, a gain of 10 to 20 degrees per week is typical.
Patient at 11 weeks
Following two months of extension torque, the patient gained almost full PIP extension. Surgical excision of the diseased tissue was followed by continued extension torque at three weeks post op.
The device’s skeletal pins should not be removed until voluntary “active” PIP extension demonstrates maintenance of the improved “arc” of motion.
Patient at 23 weeks
The patient’s “widgets” were removed following four months of extension torque.
Night splinting for six to nine months following device removal helps maintain active finger extension.
Digit Widget Sterile Pack A Contains:
Digit Widget Non-Sterile Pack B Contains:
Downloads
Patients & Therapists
Buyers
FAQ
Frequently Asked Questions
Surgeons
When should the Digit Widget be used?
A moderate to severe PIP flexion contracture is difficult to treat with conventional hand therapy splints. The primary reason for splint failure is the amount of pressure they apply to the skin in their efforts to extend the joint. Brand and Hollister1 found that pressure on the skin during splinting should not exceed 50 gm/cm2 if the splint is to be worn for more than 8 hours at a time. Fess2 evaluated four different varieties of commercially available PIP extension splints and found that all of them generate a progressively higher force as the deformity increases. This force is transmitted via pressure on the skin of the finger. Consequently, long standing PIP flexion contractures or those contractures of more than 30-45 degrees cannot be effectively treated with dynamic PIP extension splints3.
The Digit Widget avoids the skin pressure problems associated with conventional splinting by transmitting an extension torque directly to the joint by skeletal pins rather than through the skin, slowly reversing the contracture. If serial plaster casts or splints have failed, consider using the Digit Widget.
Single stage surgical release of a PIP contracture is also problematic. It must be remembered that the joint is not simply flexed. All of the soft tissues on the palmar side of the joint are shortened. Blood vessels and nerves may be compromised with sudden contracture reversal. Several studies have shown that the more structures released to gain PIP extension, the worse the final outcome4-7.
The Digit Widget is an effective tool in the treatment of moderate to severe PIP flexion contractures because it is able to extend a contracted PIP joint without surgical release of the volar structures, if the tissues are compliant and the joint is intact. The contracted tissues, rather than being surgically cut, are stimulated to lengthen over time.
As effective as the Digit Widget is in improving joint extension, in most cases it is not the only intervention needed. The questions below are a starting point in the patients’ evaluation. The surgeon must determine if the underlying cause of the contracture can be successfully treated and, if so, formulate a plan to rebalance the flexor and extensor forces.
How long is the Digit Widget worn?
The Digit Widget should be worn until PIP joint extension has plateaued for several weeks. Most patients will achieve full or nearly full PIP extension. Many factors determine how quickly the joint will respond to the extension torque, including how severe and long-standing the contracture is, the presence of scarring from injury or prior surgery and the patient’s tissue response. A contracture of 90º or more may take eight weeks or longer to reverse. Graphing the patient’s progress will demonstrate changes in range of motion as a function of time and help determine when the device should be removed.
To determine if the extensor tendon is competent to maintain joint extension following the device removal, remove the elastic band (not the bone pins) for a day to assess ACTIVE extension. If PIP extension is rapidly lost, the joint will require prolonged extension splinting, an extensor tendon reconstruction or some other reconstructive surgery.
How much torque does the Digit Widget apply to a PIP joint?
The extension torque ranges from 100g-cm (lightest elastic band) with the PIP joint at maximum flexion to almost 500g-cm (heaviest elastic band) when the joint is flexed to approximately 30 degrees. Many clinicians have quoted certain force or torque values as a maximum tolerated by the patient when correcting a stiff PIP joint. Don’t let these quoted values be confusing. They are not the joint torque that can be tolerated by the contracted tissues of the joint; they are the limitations resulting from the skin pressure imposed during conventional splinting. To our knowledge, no data exists regarding the optimal joint torque required for reversal of a PIP joint flexion contracture. Consequently, the Digit Widget provides a broad range of torque. See the Digit Widget Torque Performance graph here.
What band strength should be worn?
The goal is to use the lowest torque necessary to reverse the contracture. Start with the lightest weight bands, which will be worn continuously. By monitoring both joint extension and the finger’s response to the torque, band strength can be increased as needed. The weight and number of bands used is dependent on the finger’s response to the torque. Decrease the extension torque if pain, swelling, inflammation, or loss of flexion occurs. A lower torque worn continuously without discomfort that results in a gradual increase in joint extension is ideal.
Is it possible to wear more than one Digit Widget at a time?
Absolutely. The Digit Widget is designed so that the torque applied to one finger is independent from the torque applied to another finger. Since the pins are installed dorsally, the device can be used on any finger. Below is a photograph of a patient with three devices on one hand.
Should the bands be removed to exercise?
Yes. For maximum effectiveness, the Digit Widget needs to be worn nearly full time. However, the extension torque can be temporarily removed by either detaching the hook and loop tab from the back of the hand or by removing the elastic band from the posts. This allows unrestricted flexion of the finger. All flexion exercises should be performed actively. Passive or forced flexion of the PIP joint may damage an already compromised central slip and prevent the finger from maintaining maximum joint extension.
Can the hand be washed with the device on?
Yes. The device will not be damaged by water or soap, however, be sure to follow your physician’s advice about when it is acceptable to get the pins wet.
To shower or wash the hand, the cuff and dynamic portion of the device can be removed. In order to “click off” the device, first, remove the elastic bands and then take a coin and slip it between the top of the pin block and the connector assembly. Give the coin a twist and the connector assembly pops off. See photo below. The coin needs to be inserted on the side of the pin block that has the words “Digit Widget” on it.
Is the Digit Widget going to work for every PIP flexion contracture?
The Digit Widget is a very effective device to reverse a flexion contracture. However, the flexion contracture is symptomatic of an underlying problem involving a torque imbalance at the PIP joint. For joint extension to be maintained following device removal, the surgeon must formulate a treatment plan tailored to the unique findings in each patient and in each digit. The treatment plan relies on identification of the etiology of the contracture. Once identified, the cause of the torque imbalance must be something that can be corrected or the flexion contracture will recur once the Digit Widget is removed.
THERAPISTS
When should the Digit Widget be used?
A moderate to severe PIP flexion contracture is difficult to treat with conventional hand therapy splints. The primary reason for splint failure is the amount of pressure they apply to the skin in their efforts to extend the joint. Brand and Hollister1 found that pressure on the skin during splinting should not exceed 50 gm/cm2 if the splint is to be worn for more than 8 hours at a time. Fess2 evaluated four different varieties of commercially available PIP extension splints and found that all of them generate a progressively higher force as the deformity increases. This force is transmitted via pressure on the skin of the finger. Consequently, long standing PIP flexion contractures or those contractures of more than 30-45 degrees cannot be effectively treated with dynamic PIP extension splints3.
The Digit Widget avoids the skin pressure problems associated with conventional splinting by transmitting an extension torque directly to the joint by skeletal pins rather than through the skin, slowly reversing the contracture. If serial plaster casts or splints have failed, consider using the Digit Widget.
Single stage surgical release of a PIP contracture is also problematic. It must be remembered that the joint is not simply flexed. All of the soft tissues on the palmar side of the joint are shortened. Blood vessels and nerves may be compromised with sudden contracture reversal. Several studies have shown that the more structures released to gain PIP extension, the worse the final outcome4-7.
The Digit Widget is an effective tool in the treatment of moderate to severe PIP flexion contractures because it is able to extend a contracted PIP joint without surgical release of the volar structures, if the tissues are compliant and the joint is intact. The contracted tissues, rather than being surgically cut, are stimulated to lengthen over time.
As effective as the Digit Widget is in improving joint extension, in most cases it is not the only intervention needed. The questions below are a starting point in the patients’ evaluation. The surgeon must determine if the underlying cause of the contracture can be successfully treated and, if so, formulate a plan to rebalance the flexor and extensor forces.
How long is the Digit Widget worn?
The Digit Widget should be worn until PIP joint extension has plateaued for several weeks. Most patients will achieve full or nearly full PIP extension. Many factors determine how quickly the joint will respond to the extension torque, including how severe and long-standing the contracture is, the presence of scarring from injury or prior surgery and the patient’s tissue response. A contracture of 90º or more may take eight weeks or longer to reverse. Graphing the patient’s progress will demonstrate changes in range of motion as a function of time and help determine when the device should be removed.
To determine if the extensor tendon is competent to maintain joint extension following the device removal, remove the elastic band (not the bone pins) for a day to assess ACTIVE extension. If PIP extension is rapidly lost, the joint will require prolonged extension splinting, an extensor tendon reconstruction or some other reconstructive surgery.
How much torque does the Digit Widget apply to a PIP joint?
The extension torque ranges from 100g-cm (lightest elastic band) with the PIP joint at maximum flexion to almost 500g-cm (heaviest elastic band) when the joint is flexed to approximately 30 degrees. Many clinicians have quoted certain force or torque values as a maximum tolerated by the patient when correcting a stiff PIP joint. Don’t let these quoted values be confusing. They are not the joint torque that can be tolerated by the contracted tissues of the joint; they are the limitations resulting from the skin pressure imposed during conventional splinting. To our knowledge, no data exists regarding the optimal joint torque required for reversal of a PIP joint flexion contracture. Consequently, the Digit Widget provides a broad range of torque. See the Digit Widget Torque Performance graph here.
What band strength should be worn?
The goal is to use the lowest torque necessary to reverse the contracture. Start with the lightest weight bands, which will be worn continuously. By monitoring both joint extension and the finger’s response to the torque, band strength can be increased as needed. The weight and number of bands used is dependent on the finger’s response to the torque. Decrease the extension torque if pain, swelling, inflammation, or loss of flexion occurs. A lower torque worn continuously without discomfort that results in a gradual increase in joint extension is ideal.
Is it possible to wear more than one Digit Widget at a time?
Absolutely. The Digit Widget is designed so that the torque applied to one finger is independent from the torque applied to another finger. Since the pins are installed dorsally, the device can be used on any finger. Below is a photograph of a patient with three devices on one hand.
Should the bands be removed to exercise?
Yes. For maximum effectiveness, the Digit Widget needs to be worn nearly full time. However, the extension torque can be temporarily removed by either detaching the hook and loop tab from the back of the hand or by removing the elastic band from the posts. This allows unrestricted flexion of the finger. All flexion exercises should be performed actively. Passive or forced flexion of the PIP joint may damage an already compromised central slip and prevent the finger from maintaining maximum joint extension.
Can the hand be washed with the device on?
Yes. The device will not be damaged by water or soap, however, be sure to follow your physician’s advice about when it is acceptable to get the pins wet.
To shower or wash the hand, the cuff and dynamic portion of the device can be removed. In order to “click off” the device, first, remove the elastic bands and then take a coin and slip it between the top of the pin block and the connector assembly. Give the coin a twist and the connector assembly pops off. See photo below. The coin needs to be inserted on the side of the pin block that has the words “Digit Widget” on it.
Is the Digit Widget going to work for every PIP flexion contracture?
The Digit Widget is a very effective device to reverse a flexion contracture. However, the flexion contracture is symptomatic of an underlying problem involving a torque imbalance at the PIP joint. For joint extension to be maintained following device removal, the surgeon must formulate a treatment plan tailored to the unique findings in each patient and in each digit. The treatment plan relies on identification of the etiology of the contracture. Once identified, the cause of the torque imbalance must be something that can be corrected or the flexion contracture will recur once the Digit Widget is removed.
Patients
When should the Digit Widget be used?
A moderate to severe PIP flexion contracture is difficult to treat with conventional hand therapy splints. The primary reason for splint failure is the amount of pressure they apply to the skin in their efforts to extend the joint. Brand and Hollister1 found that pressure on the skin during splinting should not exceed 50 gm/cm2 if the splint is to be worn for more than 8 hours at a time. Fess2 evaluated four different varieties of commercially available PIP extension splints and found that all of them generate a progressively higher force as the deformity increases. This force is transmitted via pressure on the skin of the finger. Consequently, long standing PIP flexion contractures or those contractures of more than 30-45 degrees cannot be effectively treated with dynamic PIP extension splints3.
The Digit Widget avoids the skin pressure problems associated with conventional splinting by transmitting an extension torque directly to the joint by skeletal pins rather than through the skin, slowly reversing the contracture. If serial plaster casts or splints have failed, consider using the Digit Widget.
Single stage surgical release of a PIP contracture is also problematic. It must be remembered that the joint is not simply flexed. All of the soft tissues on the palmar side of the joint are shortened. Blood vessels and nerves may be compromised with sudden contracture reversal. Several studies have shown that the more structures released to gain PIP extension, the worse the final outcome4-7.
The Digit Widget is an effective tool in the treatment of moderate to severe PIP flexion contractures because it is able to extend a contracted PIP joint without surgical release of the volar structures, if the tissues are compliant and the joint is intact. The contracted tissues, rather than being surgically cut, are stimulated to lengthen over time.
As effective as the Digit Widget is in improving joint extension, in most cases it is not the only intervention needed. The questions below are a starting point in the patients’ evaluation. The surgeon must determine if the underlying cause of the contracture can be successfully treated and, if so, formulate a plan to rebalance the flexor and extensor forces.
How long is the Digit Widget worn?
The Digit Widget should be worn until PIP joint extension has plateaued for several weeks. Most patients will achieve full or nearly full PIP extension. Many factors determine how quickly the joint will respond to the extension torque, including how severe and long-standing the contracture is, the presence of scarring from injury or prior surgery and the patient’s tissue response. A contracture of 90º or more may take eight weeks or longer to reverse. Graphing the patient’s progress will demonstrate changes in range of motion as a function of time and help determine when the device should be removed.
To determine if the extensor tendon is competent to maintain joint extension following the device removal, remove the elastic band (not the bone pins) for a day to assess ACTIVE extension. If PIP extension is rapidly lost, the joint will require prolonged extension splinting, an extensor tendon reconstruction or some other reconstructive surgery.
How much torque does the Digit Widget apply to a PIP joint?
The extension torque ranges from 100g-cm (lightest elastic band) with the PIP joint at maximum flexion to almost 500g-cm (heaviest elastic band) when the joint is flexed to approximately 30 degrees. Many clinicians have quoted certain force or torque values as a maximum tolerated by the patient when correcting a stiff PIP joint. Don’t let these quoted values be confusing. They are not the joint torque that can be tolerated by the contracted tissues of the joint; they are the limitations resulting from the skin pressure imposed during conventional splinting. To our knowledge, no data exists regarding the optimal joint torque required for reversal of a PIP joint flexion contracture. Consequently, the Digit Widget provides a broad range of torque. See the Digit Widget Torque Performance graph here.
What band strength should be worn?
The goal is to use the lowest torque necessary to reverse the contracture. Start with the lightest weight bands, which will be worn continuously. By monitoring both joint extension and the finger’s response to the torque, band strength can be increased as needed. The weight and number of bands used is dependent on the finger’s response to the torque. Decrease the extension torque if pain, swelling, inflammation, or loss of flexion occurs. A lower torque worn continuously without discomfort that results in a gradual increase in joint extension is ideal.
Is it possible to wear more than one Digit Widget at a time?
Absolutely. The Digit Widget is designed so that the torque applied to one finger is independent from the torque applied to another finger. Since the pins are installed dorsally, the device can be used on any finger. Below is a photograph of a patient with three devices on one hand.
Should the bands be removed to exercise?
Yes. For maximum effectiveness, the Digit Widget needs to be worn nearly full time. However, the extension torque can be temporarily removed by either detaching the hook and loop tab from the back of the hand or by removing the elastic band from the posts. This allows unrestricted flexion of the finger. All flexion exercises should be performed actively. Passive or forced flexion of the PIP joint may damage an already compromised central slip and prevent the finger from maintaining maximum joint extension.
Can the hand be washed with the device on?
Yes. The device will not be damaged by water or soap, however, be sure to follow your physician’s advice about when it is acceptable to get the pins wet.
To shower or wash the hand, the cuff and dynamic portion of the device can be removed. In order to “click off” the device, first, remove the elastic bands and then take a coin and slip it between the top of the pin block and the connector assembly. Give the coin a twist and the connector assembly pops off. See photo below. The coin needs to be inserted on the side of the pin block that has the words “Digit Widget” on it.
Is the Digit Widget going to work for every PIP flexion contracture?
The Digit Widget is a very effective device to reverse a flexion contracture. However, the flexion contracture is symptomatic of an underlying problem involving a torque imbalance at the PIP joint. For joint extension to be maintained following device removal, the surgeon must formulate a treatment plan tailored to the unique findings in each patient and in each digit. The treatment plan relies on identification of the etiology of the contracture. Once identified, the cause of the torque imbalance must be something that can be corrected or the flexion contracture will recur once the Digit Widget is removed.
BUYERS
What billing codes are used with the Digit Widget?
Please be sure to bill each patient correctly. Click here for downloadable billing guidelines.
Instructional Video
Instructional Video
Case Studies
Case Study 1
Courtesy of John Agee, M.D.
This case study involves an 83-year-old man with severe Dupuytren’s Contracture of the PIP and MCP joints of his long and ring fingers. He has had no prior surgery. The patient sought treatment because he was no longer able to hold a golf club. Prior to performing a fasciectomy, Dr. Agee decided to use Digit Widgets on both affected fingers to facilitate access to the palm and fingers. The Digit Widgets were applied and the Dupuytren’s bands in the palm were cut, but not excised. The patient progressed to wearing heavy elastic bands 24 hours a day, seven days a week without any pin tract problems, pain or swelling. After five weeks, he had gained 35º extension on both PIP joints. At this point, Dr. Agee performed a subtotal palmar fasciectomy. Skin grafts were not necessary, however, there was considerable skin shortage after surgery. The elastic band torque was re-applied one week after fasciectomy. He wore the devices for another three weeks. During this time, the patient gained another 20º extension on the long finger and 38º on his ring finger. His ROM graph showed a continuing gain in motion but after eight weeks of wearing time, the patient requested that the Digit Widgets be removed. Once removed, he was referred to Hand Therapy for splinting and plaster casting as needed. He was seen a total of six times in therapy. One month after the devices were removed, the patient showed excellent functional flexion and he had gained 60º extension on the PIP of the long finger and 74º on the PIP of the ring finger. Illustrative Case
8/21/02. Left-hand of 83 year-old-male suffering from Dupuytren’s Disease on long and ring fingers. Photo taken prior to Digit Widgets. Two Digit Widgets were applied and the palmar bands were released, but not excised.
Active ROM:
Surgery performed: Application of two Digit Widgets, release of palmar bands without excision.
8/21/02. Post Digit Widget application. Extensor torque was initiated at the time of surgery. Light weight bands were applied and the patient was instructed to wear the torque 23/24 hours per day.
9/26/02. After five weeks, PIP extension is now adequate to allow Dupuytren’s Contracture release of MCP and PIP joints with subtotal palmar fasciectomy.
Pre-release ROM – see photo:
10/15/02. Interim ROM (no photo)
10/24/02. The Digit Widget has been worn for a total of 8 weeks; here he is 3 weeks post fasciectomy. His ROM is still improving, but he wants the devices removed.
AROM at time of Digit Widget removal:
* Flexion measured against the resistance of the heaviest elastic band. Prior flexion measurements were taken with the bands removed.
10/24/02. Active flexion with Digit Widgets in place. Note that bone pin placement does not restrict extensor tendon excursion and the patient has excellent DIP motion.
11/26/02. Four weeks after Digit Widget removal demonstrating maximum active extension. Patient has been to six hand therapy sessions for progressive splinting, serial plaster casting and ROM exercises. He still has significant MCP joint flexion contractures.
AROM:
11/26/02. Maximum active extension. Maximum active flexion.
Case Study 2
Courtesy of Robert Slater, MD The following case study illustrates how the Digit Widget can be used to reverse a flexion deformity caused by a sports injury. Illustrative Case
A 35 year-old man injured his right ring finger during a martial arts training session. Nine months later, he was referred for treatment of a persistent finger deformity that was painful and limited hand function. Previous attempts at serial plaster casting and dynamic splints failed to improve the finger’s ROM.
A Digit Widget was used to treat the deformity. When applied, the patient had a 70 degree flexion contracture of the PIP joint with active flexion to 100 degrees. DIP motion was 0-35 degrees.
Patient with Digit Widget applied to finger.
After four weeks, the Digit Widget was removed. Upon removal, the finger lacked 8º of extension and had maintained 100º of active flexion.
Case Study 3
Courtesy of Alonso Escalante, MD Six months prior to being referred to Dr. Escalante, this female patient hyperextended her ring finger. Prior splinting had not been successful in reducing her contracture and she presented with a 90º flexion contracture of her ring finger PIP joint. Illustrative Case
It was decided to use a Digit Widget to treat the contracture. Nine weeks after the device was installed, the contracture was corrected to nearly full extension. However, when the elastic band tension was removed, the joint would lose extension within a few days.
After 14 weeks of wearing the device, the patient had exploratory surgery in her palm. Bone pins were left in the middle phalanx. Exploration of the flexor tendons revealed a rupture of the FDP tendon, with adhesions to the FDS tendon. Dr. Escalante performed a tenolysis and the FDP was excised.
This case illustrates how the Digit Widget can assist in revealing the underlying etilogy of a PIP contracture. As the joint moves throughout a more normal arc of motion, the cause of the contracture can be more easily identified. The Digit Widget was worn for another four weeks and her final PIP motion was 30 – 90º.
Case Study 4
Courtesy of WB Ericson, M.D. This patient is a healthy 60 year old white male who presented with isolated bilateral severe contractures of the small finger PIP joints (~110º) from Dupuytren’s disease. Illustrative Case
Surgery involved the McCash open palm technique and digital fasciectomy with Z-plasty in the small finger after which he still had a 45º flexion contracture of the PIP joint. Kenalog was injected into the collateral ligaments at the time of surgery and the Digit Widget was then applied using the lightest weight elastic bands.
The patient had full extension within 10 days of surgery and the Digit Widget was maintained for a month. No hand therapy was necessary during this period of time. After the Digit Widget was removed, silicone gel tubing was applied along with an LMB dynamic splint. At 10 weeks post op, the skin was soft and he had a residual 15º contracture.
Case Study 5
Courtesy of John Agee, M.D. Illustrative Case
Pre Operative
This case study involves a 73 year-old female with severe Dupuytren’s Contracture of the MCP and PIP joint of the little finger on her left hand. She had no prior surgeries on the left hand. Before surgery, her MCP joint lacked 75º and the PIP joint lacked 80º. During surgery a fasciectomy was performed and one Digit Widget was applied.
After two weeks of wearing the Digit Widget
Her sutures were removed two weeks later and the extension torque was initiated. At this time, the PIP lacked 53º of extension. One week later, she lacked only 10º extension and had some swelling. The patient was told to remove the lightweight bands more frequently and to perform active flexion exercises. The following week, she had a nearly full active range of motion with only minimal swelling.
Seven weeks after the Digit Widget was removed
The patient wore the Digit Widget for six weeks, five of those weeks after she had gained full extension. Keeping the device on for several weeks after full extension is obtained helps with scar remodeling and reduces contracture recurrence due to scar shortening.
© Hand Biomechanics Lab, Inc.