Touch the Dots,
Clinical Pearl No. 1 – July 2008

HandLab Clinical Pearls

July 2008                                     No. 1



The active hook position provides numerous benefits when working to regain finger flexion, not the least of which is elongation of the interosseous muscles. Although active hook exercises alone cannot remediate significant interosseous muscle tightness (the MP joint must be blocked in extension/hyperextension), accurate active hook exercises can relieve very mild interosseous muscle tightness and can also retain the gains made by other means. Specific patient instruction is the key. When the patient is asked to flex the finger tips but keep the MP joint extended, the patient may appear to do well but concentration on finger flexion invariably allows MP joint flexion to occur, defeating the goal of a precise stretch to the interosseous muscles.Active hookPatient attempts ‘active hook’ position. Note that the MP joints are not fully extended.

Perhaps a better way to assure accurate exercise is to place a mark (a dot) on each fingertip pulp and on the volar base of each finger at the proximal finger crease (just distal to the MP joint) and ask the patient to “touch the dots together.” This command immediately elicits a strong component of MP joint hyperextension, recruiting the extensor digitorum communis muscles while also fully flexing the interphalangeal joints. The dots don’t even have to be present for the patient to remember how to do the exercise correctly!!

active MP joint hyperextension The patient is attempting to ‘touch the dots together,’ creating active MP joint hyperextension with accompanying interphalangeal joint flexion.

 Download Clinical Pearl No. 1, Touch The Dots, July 2008



Clinical Pearl No. 32 – Immobilizing the MP Joint in Extension?

Clinical Pearl No. 26 – Use of a Relative Motion Orthosis for Regaining PIP Joint Flexion or Extension

Clinical Pearl No. 22 – Lumbrical Muscle Tightness & Testing

Clinical Pearl No. 21 – Nuances of Interosseous Muscle Tightness Testing

Clinical Pearl No. 20 – Quantifying Interosseous Muscle Tightness

Clinical Pearl No. 19 – Interosseous Muscle Tightness Testing

Journal Article – Exercise Splint for Effective Single-Finger Active Hook Exercises by Ahearn, D and Colditz, JC, Journal of Hand Therapy – 2005

Journal Article – Lumbrical Tightness: Testing and Stretching [Abstract only], Journal of Hand Surgery 2002

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Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.