How much torque does the Digit Widget apply to a PIP joint?

The extension torque ranges from 100 g-cm with the lightest elastic band to over 400 g-cm with the heavy band when the joint is flexed to more than 90 degrees. To our knowledge, no data exists regarding the optimal torque required for reversal of a PIP joint flexion contracture. However, for optimal patient tolerance, 300g-cm is generally thought to be the maximum torque that should be used.
 

Typically, how long is the Digit Widget worn?

The device should be worn until extension at the PIP joint has plateaued for several weeks. Most patients are able to achieve full or nearly full extension. Since there are several factors which affect the response of the contracture, including magnitude and duration of contracture, prior surgery, and the patient’s tissue response, the length of time the device must be worn varies from patient to patient. A contracture of 90 degrees or more may take eight weeks or longer to reverse. If you are unsure if the central slip of the extensor tendon will be competent to maintain active extension following device removal, remove the elastic band for a day to assess ACTIVE extension. If the patient rapidly loses active extension, the joint will probably require prolonged extension splinting or an extensor tendon reconstruction. DIP flexion exercises performed when the PIP is held in extension helps to rebalance the extensor mechanism.
 

Should the bands be removed to exercise?

Yes. The extension torque can be removed by either detaching the velcro tab from the back of the hand cuff or by removing the elastic band from the posts. Click here to see a trick for easier removal. 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. Follow your physician’s advice about when it is okay to get the pins wet, but the device will not be damaged by water or soap.
 

What band strength should be worn?

Start with the lightest band worn continuously. Monitoring both joint extension and the finger’s response to the torque, band strength can be increased as needed. The goal is to use the lowest torque necessary to improve joint extension. If pain, swelling, inflammation, or loss of joint range of motion occurs, the extension torque should be decreased. A low torque applied over a long period is preferable to a high torque applied for a short duration.
 

Can more than one device be worn at a time?

Yes. The design of the device is such that the torque at one finger is not affected by the torque at another finger. Because the pins are installed dorsally, the device can be used on any finger. Below is a photograph of a patient with three Digit Widgets on one hand.
 

What billing codes are used with the Digit Widget?

The following codes may be used:

CPT 20690--”application of an external fixator” used when Digit Widget application is the only procedure.

CPT 20650--”insertion of bone pin with application of skeletal traction”. Alternative code for Digit Widget application alone.

If applicable:

CPT 26525--If a joint release is performed in addition to the application of the Digit Widget-- “capsulectomy or capsulotomy; interphangeal joint, each joint” could be used in addition to CPT 20690.

CPT 26045--”faciotomy, palmar (eg. Dupuytren’s contracture) open partial” may be used in addition to CPT 20690.

CPT 26123--If the contracture is associated with Dupuytren’s, and a more extensive release is done along with the Digit Widget, “fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)” could be used in addition to CPT 20690. If the release only involves the palm use CPT 26121.

These are guidelines. Please be sure to bill each patient correctly. Click here for downloadable information.