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Rehabilitation priorities for claw hand deformity: What comes first, MP or PIP joints?

Vita TU, Occupational Therapist and Project Manager

Sunshine Social Welfare Foundation


Post-burn hand deformities are complex by nature, affecting different joints in different ways, and requiring different intervention goals. Take claw hand deformity as an example. It presents as hyperextension of metacarpophalangeal (MP) joints and flexion of proximal interphalangeal (PIP) joints. Both MP and PIP joints present deformity, but the direction of deformity is different.

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When planning our rehabilitation goals and interventions, we ideally want to achieve maximum impact. If addressing one problem can help solve or lessen other issues at the same time, this is rather efficient. So, in the case of claw hand deformity, what will be the rehabilitation priorities? With which joint deformity should we start? Should the problem of the MP joint be dealt with first? Or should the problem of the PIP joint be dealt with first? In terms of intervention effectiveness, which joint should we prioritize for maximum impact?

From our point of view, dealing with MP joint problems comes before dealing with PIP joint problems. This is based on two considerations: functional and anatomical. We’ll explain both considerations below.

Functional consideration

To perform normal grasp, the MP, PIP and even the DIP joints must tend towards flexion. However, in the case of claw hand, the MP joint is in hyperextension, which is a completely opposite direction of normal grasp movement. From a functional perspective, if the MP joint hyperextension problem can be reduced and the ability to perform MP flexion improves, even if PIP joint still has some limitations, the hand can still maintain basic grasp ability. Therefore, when dealing with claw hand, we can start by dealing with the MP hyperextension problem before dealing with PIP flexion.</