A COTA is educating a client with boutonniere deformity about the use of a circumferential proximal interphalangeal (PIP) joint orthosis. Which statement is correct regarding its use?

• A. Wear the orthosis only at night to maintain the PIP joint in extension when at rest.
• B. Remove the orthosis every hour for passive motion exercises.
• C. Wear the orthosis continuously up to 6 weeks.
• D. Wear the orthosis during the day, but remove it at night.

Answer: (C)

The key idea is that boutonniere deformity requires constant protection of the PIP joint in full extension to let the injured extensor mechanism heal. Using a circumferential PIP joint orthosis keeps the PIP held straight, offloading and securing the healing central slip and volar plate. Wearing it continuously for up to six weeks provides uninterrupted immobilization during the critical healing window, reducing the risk of persistent flexion at the PIP or recurrence of the deformity. If the device were removed periodically—day or night—micro-movements could disrupt repair and allow scar tissue to form in a way that makes full extension difficult later. After this immobilization period, gradual mobilization and therapy are introduced to restore motion while maintaining protection.