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The Obstinate PIP Joint

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Quick Overview

Online Course: Learn about new approaches for resolving  PIP joint stiffness with videos of orthotic construction.

2 Credit Hours

Instructor: Judy C. Colditz, OT/L, CHT, FAOTA

Experience Level: Intermediate       NOTE: This course is listed as intermediate, but offers content for all levels of experience: beginners will learn some basic concepts and experienced therapists will gain new insights. AOTA permits only one experience level to be listed.

Video Runtime: 2 hours, 9 minutes

Course description: This two hour course thoroughly explores the anatomy of the PIP joint, causes of stiffness, and practical treatment approaches to resolve stiffness. The author offers innovative solutions for joint motion deficits described, including the new concept of active redirection. Video demonstrations of orthotic construction compliment the information: 1) three active redirection orthoses, 2) a finger gutter orthosis, and 3) a unique serial casting technique. For all experience levels, but suggest novice therapists review other HandLab material about finger motion before this course. Easy to follow and informative with worthwhile evaluation and treatment techniques included.

Learning Objectives: At the conclusion of this 2 hour online course the participant will be able to:

  1. Identify the type of joint for the PIP joint.
  2. Recognize the biomechanics contributing to PIP joint flexion contractures.
  3. Identify the primary muscle forces for PIP joint extension.
  4. Recognize how active re-direction drives power into the dorsal apparatus.


Target Audience: Occupational and Physical Therapists who treat hand patients; Certified Hand Therapists

Prerequisites: None; the course participant should be familiar with the basic bony and muscle/tendon anatomy of the hand.

Cancellation: This online course is available to the subscriber for a period of six (6) months following the date of purchase; refunds are not available.

Completion Requirements: Learner must view video in its entirety and successfully pass the online examination to earn the stated contact hour credit. Only those who satisfactorily meet these requirements will be awarded the contact hours. Note: AOTA CEUs are calculated by dividing contact hours by 10.

AOTA Approved Provider: This course is approved for credit by the American Occupational Therapy Association, Inc. Approved Provider Program and provides information under the AOTA Classification Codes:AOTA provider


Client Factors

  • Body Structures

Activity Demands

  • Required body functions
  • Required body structures

General Questions

How do I access my HandLab online course?

You will receive an email with course access instructions separately from your order confirmation email. You may also download Course Access Instructions here. NOTE: If a course was purchased for you or you chose to not have the course automatically activated during checkout, you will need to activate your course with the serial number from your order confirmation.

What are my payment options?

Online course tuition may be paid only by MasterCard, Visa, American Express or Discover; check payment is not accepted. Upon payment you will receive an email confirmation of your course purchase, and your online course(s) will be available in the My Online Courses and Exams section of your HandLab account.

Will I receive a confirmation of my HandLab online course purchase?

Yes, after completing your order you will receive an email confirmation. To access your online courses you will use your HandLab account login information.

Does HandLab provide discounts for multiple attendees from one facility?

We are unable to offer multiple attendee discounts. To receive continuing education credit each participant must create a HandLab account.

Does HandLab offer volume discounts for purchasing multiple Online Video Courses at one time?

Yes, enter the applicable promo code while on the final order confirmation screen:

Purchase 3 online video courses for 10% discount on each course - CODE: 3VCsale
Purchase 6 online video courses for 20% discount on each course - CODE: 6VCsale
Purchase 10 online video courses for 30% discount on each course - CODE: 10VCsale

What will my credit card statement say?

Your credit card statement will have a charge from “HandLab.”

What is the online course cancellation policy?

Because HandLab online courses are available to you anytime for a period of 6 months, HandLab does not accept cancellations or provide refunds for online courses.


Which Course is Right for Me?

I am a beginning hand therapist—what HandLab courses are best for me?

This is a challenging question for us since we do not know your level of experience/knowledge!  Most of our courses provide a focus on understanding anatomy as a key to understanding pathology and treatment rationale, and new therapists say this approach is valuable. One therapist commented: “I have one year experience in working in a clinic treating only hand pathology. This course addressed my needs to know WHY you do WHAT and WHEN instead of simply following a protocol set out for you.”

I am preparing for the CHT exam—what HandLab courses are best for me?

Therapists have told us HandLab courses help them gain clinical reasoning skills which are vital to passing the exam.  We are unable to identify any one course to specifically help with passing the exam since we do not know the exam content.

I have many years of experience and am not looking for the basics-- what HandLab courses are best for me?

Although HandLab courses review the core knowledge needed for treatment, each course provides current evidence based rationale for treatment. Experienced therapists tell us our courses are a time saver in keeping them up-to-date.  One therapist with 35 years’ experience wrote:  "I am so happy I chose this course… Many thanks! Yes, my skills are going to the clinic in the morning! Wonderful!".

Do you offer hands-on splinting (orthotic construction) courses?

Because therapists find that close up videos of orthotic construction allow them to stop, restart, rewind, and review all the steps of construction over and over again as needed, we now provide only online videos of orthotic construction skills. Since the videos are available for six months, the therapist can integrate the skills fully during this time.

Which Online Video Courses have detailed demonstrations of the steps of orthotic construction?

You will find construction videos in the following courses:

  • The Obstinate PIP Joint
    • PIP serial cast
    • PIP precise gutter
    • PIP Active redirection for flexion and/or extension
  • Radial Nerve: Rehabilitation & Orthotic Intervention
  • Constructing an Effective Intrinsic Stretching Orthosis
  • Thumb CMC Osteoarthritis: Optimal Orthotic Intervention for the CMC Joint
  • Thumb CMC Osteoarthritis: Optimal Orthotic Intervention for the MP & IP Joints
Does HandLab recommend a certain order in which I should complete the Online Video Courses?

Although each HandLab video course can be viewed independently, two groups of courses are optimally viewed in sequence (in descending order listed):


  • Understanding the Dorsal Apparatus of the Finger
  • What Drives Finger Motion
  • Insight into the Interosseous Muscles
  • Interosseous Muscle Tightness Testing
  • Insight into the Lumbrical Muscle & Testing for Tightness
  • Constructing an Effective Intrinsic Stretching Orthosis


  • Thumb Framework: Joints, Ligaments & Motions
  • Scrutiny of the Multidimensional Thumb Muscles
  • Thumb CMC Osteoarthritis: Surgical & Post-Surgical Insights
  • Thumb CMC Osteoarthritis: Precise Examination & Non-Surgical Treatment
  • Thumb CMC Osteoarthritis: Optimal Orthotic Intervention for the CMC Joint
  • Thumb CMC Osteoarthritis: Optimal Orthotic Intervention for the MP & IP Joints
Are the classes Judy Colditz teaches at conferences available as online courses?

Yes and no; information in Online Video Courses is updated and/or expanded from courses at meetings (or vice versa). Some core information may be repeated but the presentations are never identical.

Is information in the Online Video Courses similar to information in the HandLab DVDs?

There is some repetition of information but the Online Video Courses are newer and thus have more updated information.


Continuing Education Credit

How does credit for HandLab online video courses work?

To obtain continuing education credit, you must view the video and pass the online exam. Log in to your account and click on "My Courses & Exams" to access your course. Once you complete the course, your online exam is available.

Upon successful completion of the exam, you can print/save a PDF of your Certificate of Completion with contact hours. If you do not successfully complete the exam, you may take the exam as many times as needed until passed. You have 6 months from the date of purchase in which to pass the exam.

HandLab is an approved provider of the American Occupational Therapy Association.  Individual HandLab Online Courses of less than 3 hours meet criteria “B” for HTCC requirements, but if you complete multiple HandLab online courses you may submit the certificates together to HTCC and receive type “A” credit.  If you do not submit the certificates together, you will not be eligible for type “A” credit.

When can I take my online exam?

You must first view the entire video to gain access to the exam. NOTE: If you watch part of a video and return later, you can resume from the last point you viewed, to assure you do not mistakenly miss part of the video. 

Where do I take my online exam?

You may take the exam from any computer where you can access our website: www.HandLab.com. You must also have the ability to print from www.HandLab.com at your home/work location to print your certificate.  If you are unable to print, you may print the certificate at a later time if needed.

Can I sign on to www.HandLab.com to take the exam and be sure your site is secure? 

Our website uses Secure Sockets Layer (SSL), the industry standard for secure online transactions to protect our customers' privacy and our website's integrity with encrypted links between our website and a customer's computer.

What happens if I fail my exam?

If you do not successfully complete the exam, you may take the exam as many times as needed until passed. You have 6 months from the date of purchase in which to pass the exam.

How can I get another copy of my continuing education certificate?

If you require a replacement certificate, log in to your account, click "My Courses & Exams" and locate your certificate under "My Certificates" to reprint your certificate. 

Will my contact hours be accredited?

HandLab is an approved provider of continuing education by the American Occupational Therapy Association (AOTA).  Individual HandLab online courses less than 3 hours long meet criteria “B” for HTCC requirements, but if you complete multiple online courses you may submit the certificates together to HTCC and receive type “A” credit.  If you do not submit the certificates together, you will not be eligible for type “A” credit.

HandLab online courses may meet individual state continuing education requirements for PTs and OTs. HandLab does not assume responsibility for courses refused by individual licensing boards in the USA. It is the responsibility of the participant to make sure the state to which they are submitting CE credits will approve HandLab course credit.

Does HandLab credit apply to my state license renewal requirements?

Continuing education requirements are different in different states. You must check with your state licensing board to confirm approval or assure prior approval. HandLab cannot guarantee acceptance by your state licensing board. HandLab is an approved continuing education provider of the American Occupational Therapy Association which many states recognize. HandLab will provide information you require to submit for approval. Please contact support@handlab.com for assistance.

Can my contact hours be used for my CHT renewal?

Yes, individual HandLab online courses less than 3 hours long meet criteria “B” for HTCC requirements, but if you complete multiple online courses you may submit the certificates together to HTCC and receive type “A” credit.  If you do not submit the certificates together, you will not be eligible for type “A” credit.


Technical Questions

What are the technical requirements for viewing an online course?

HandLab Online Video Courses consist of a printable/savable handout, video, and online exam.

  • Handout: To view the handout you must have a PDF viewer installed on your computer. Most computers have this automatically installed but if not, you should be prompted by your computer to download the software.
  • Online Video: All course videos stream directly to your computer so you do not need any special software. The speed (and clarity) of your video depends on the quality of your internet connection. If you are trying to access a course from a work computer and having trouble accessing your course, please check with your network administrator. Companies often have firewalls or restrictions that impede access to certain websites/file types.
  • Online Exam: There are no special requirements for taking the online exam.
  • Certificate of Completion: You will need the same PDF viewer installed as needed for the handouts. You may print or save the PDF of your Certificate of Completion.
Which web browser should I use for accessing a course?

The HandLab website and Education Center works best with modern browsers such as Google Chrome, Mozilla FireFox, Safari, and the latest version of Internet Explorer. Our website does not work well with outdated versions of Internet Explorer. Please make sure you are using the most up to date version of your browser if you are having technical difficulties.

Why is my course not listed in the education center?

If someone else purchased a course for you or when you purchased you checked the box to NOT automatically activate the course, you need to activate the course. You can activate a course here using the serial number in your order confirmation email.

Online Video Courses expire 6 months from the date of purchase. The course will no longer be listed if it has passed the 6 month expiration. All of your Certificates of Completion will continue to be available anytime under “My Certificates.”

My course is activated but I still cannot see the course listed in the education center.

Try returning to the main HandLab webpage and logging out of your account. Log back in and return to the Education Center. Select My Courses from the left hand column to see your courses.

30 Reviews

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  1. This has given me more guidance... Review by Anonymous

    Currently, I have multiple patient's with PIP stiffness and I have been doing serial casting for some time but with varying degrees of success. This has given me more guidance as to how to decide what is the best options for my patient, be it splinting/casting/active redirection. After doing this course and reviewing over the biomechanics, I understand better the reasoning for why this joint is so obstinate in the first place. In addition, reviewing over the various techniques used to treat PIP joint stiffness via casting, splinting and active re-direction will help guide me in my decision making for treatment of future patient's with this condition.
    (Posted on 9/6/2017)

  2. Helped me Immensely Review by anonymous

    This information has helped me immensely in selecting the appropriate interventions for a patient I'm currently working with, who has a very obstinate PIP joint!
    (Posted on 7/21/2017)

  3. I often see MCP hyper ext Review by anonymous

    This course made me think about using muscle redirection through splinting techniques as I often see MCP hyper ext with PIP flexion contractures.
    (Posted on 7/21/2017)

  4. Thank you! Review by anonymous

    Clinically, I see numerous stiff PIP joints. It's always helpful to just hear the rationale for effective tx on top of a very helpful review of the anatomy. Thank you!
    (Posted on 6/19/2017)

  5. Thank you. Review by anonymous

    This has been a most beneficial course as I often struggle with the yoyo rehab progression of PIPJ extension and flexion gains post injury. It makes sense to implement active re-direction drive power into the dorsal apparatus to achieve PIPJ extension now. Thank you.
    (Posted on 6/13/2017)

  6. Loved the examples of the various splints for PIPJ extension Review by anonymous

    Loved the examples of the various splints for PIPJ extension
    (Posted on 6/13/2017)

  7. Very well done Judy!! Thank you. Review by anonymous

    First, the information is very relevant to the difficulties we experience in the clinic with many patients. Second, the course provides enough description that I can confidently make the correctional orthotics described. Third, the bio mechanical education was fantastic for a global understanding beyond how I was looking at the dynamics of the finger. Very well done Judy!! Thank you.
    (Posted on 6/13/2017)

  8. Judy once again nails it! Review by anonymous

    Judy once again nails it! The little issues in the clinic we chalk up to a ""decent"" but not perfect outcome are not only studied and understood, but well researched solutions are found and taught. I have always enjoyed Judy's teaching style in that she incorporates OT principles so the maximum learning is achieved. This course in particular took very confusing subject matter and explained it in a retainable fashion. I will use all the info on Monday with several patients struggling with frustrating residual PIP motion limitations.
    (Posted on 6/13/2017)

  9. I already use the RM splint in my practice and it was nice to improve the depth of my knowledge behind its application. Review by Lisa

    I already use the RM splint in my practice and it was nice to improve the depth of my knowledge behind its application.
    (Posted on 5/16/2017)

  10. I enjoyed the active redirection presentation Review by Chuck PT, CHT

    good class with great foundation and clinically relevant information
    (Posted on 4/10/2017)

  11. Review by Christopher

    Great course - nice perspective on using active splits versus passive
    (Posted on 3/16/2017)

  12. Excellent information that can easily be applied to difficult cases involving the PIP joint. Review by Edmund

    This course provided excellent clinical information that can be applied to almost any patient with PIP joint stiffness.
    (Posted on 3/7/2017)

  13. Judy Colditz's ""The Obstinate PIP Joint"" course is the gold standard Review by Lynne

    Judy Colditz's ""The Obstinate PIP Joint"" course is the gold standard for hand therapists treating hand injuries. It provides a knowledge base, anatomical structure explanations, theories, and practical treatments for the PIP joint and surrounding structures. It has in-depth explanations for every level of hand therapist for evaluating and treating this type of patient. This can only carry over for more successful treatment of the patient with this type of condition, which is our ultimate goal.
    (Posted on 3/3/2017)

  14. This was a great course, even for experienced hand therapists. Well presented with numerous clinical applications. Review by Natasha

    I will start incorporating active redirection and also try the different serial casting method, which was very interesting.
    (Posted on 2/23/2017)

  15. Review by Mila

    This course takes the concrete knowledge of the relative and un/balanced forces affecting each joint of the finger & assists the clinical reasoning process of orthosis & exercise implementation involved in restoring IPJ motion when stiffness has occurred due to injury/surgery

    Orthosis fabrication based on active redirection to improve PIP ROM & differential dorsal apparatus tissue gliding
    (Posted on 2/17/2017)

  16. Review by Phyllis

    Currently have a patient exhibiting the hyperextension at MP with flexion contracture. Plan to try the ring splint to block hyperextension at middle finger and re-direct extension to PIP.
    (Posted on 2/7/2017)

  17. You have given me more splinting ideas to try on those stubborn fingers. Review by Kimberly

    Good ideas and better understanding of the anatomy and mechanics.
    (Posted on 2/2/2017)

  18. Review by Lizzie

    I will now reconsider static splinting/static progressive splinting.
    (Posted on 1/31/2017)

  19. Excellent course Review by Cathy

    Excellent course with very useful information for direct clinical application. The presenter spoke clearly and slowly, allowing time for comprehension of complicated material.

    I see small finger injuries frequently in my practice (joint fractures, contractures from poor follow through post Dupuytren's fasciectomy, sprains not treated acutely) so the information in this class will be very helpful.
    (Posted on 1/18/2017)

  20. thank you Review by Ron

    As always I very much appreciate the content and expertise of these courses.
    (Posted on 1/13/2017)

  21. Review by Ginny

    I like the explanations as to why to use the active redirection. It will be easy for patients to understand and be more compliant when they know exactly why they need to wear the orthosis all day
    (Posted on 1/6/2017)

  22. Review by Cris

    I appreciated the live videos on how she performed the casting and orthotics and I will begin to incorporate the redirection orthotics in POC .
    (Posted on 1/2/2017)

  23. Excellent course! Practical and easy to follow. Review by Scarlet

    I will be incorporating active redirection on appropriate patients beginning on Monday!
    (Posted on 12/28/2016)

  24. Applicable for challenging cases Review by Bryan

    Frequently treating patients with challenging PIP joint issues, will use this information for problem solving challenging cases.
    (Posted on 12/8/2016)

  25. Review content was useful, and presentation was done well visually. Review by Liz

    Always great to review the dorsal apparatus, a very complex structure. I enjoyed the casting and splinting demo videos.
    (Posted on 11/9/2016)

  26. Review by Kathy

    Great review of the PIP joint and its movers. Some good tips to think about when treating stiff PIP joints.
    (Posted on 11/7/2016)

  27. The Perfect Balance Review by Allie

    I thought this course was very beneficial, a good balance between anatomy and particle skills to use with patients. I will defiantly be adjusting my therapy practice to include active re-direction.
    (Posted on 11/7/2016)

  28. Review by Jeffrey Mathis

    Very informative and a great alternative to traditional casting and PROM.
    (Posted on 11/7/2016)

  29. Review by Alex

    I enjoy the way Judy explains anatomy and biomechanics and then relates these to clinical application. The dissections are superb examples for teaching. Seeing hands on application of splinting makes it easy to pick up little gems and either confirm current practice or suggest new ideas.
    (Posted on 8/15/2016)

  30. Simple yet very effective treatment options!! Review by Alan

    This was a great course covering the PIP joint. Judy addresses the structures, function, and treatment options pertaining to the PIP joint. The treatment options are simple, yet without Judy's explicit explanation, one cannot appreciate the genius of the treatment options presented. Thanks Judy!!
    (Posted on 1/28/2015)

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