Hi all: I am part of an online hand surgery club that bounces cases off each other. This case came up recently regarding an elderly shooter and I wondered if you could supply any hardware solutions:
"I saw a 75 year old man who is an avid shooter. He shoots forearms (rifles and pistols) with his grandkids frequently, He has fairly significant arthritis in his right index finger, and is having difficulty pulling the trigger because of limited PIP flexion. On exam he flexes to about 60 degrees at the PIP joint. He wanted to know if there was anything I could do for him. He has very little pain. I usually do not do PIP arthroplasties in index fingers, but in this case I might consider it. That said, I usually consider 60 degrees of flexion to be a reasonable result, so I’m not sure that I would be helping him at all. (I go volar.)
I asked him about using his middle finger to pull the trigger, but that puts his index finger close to where the chamber expels the used shell casing, I also asked him about building up the trigger, but he said that he didn’t think that was possible in the firearms that he uses. "
I strongly discouraged this physician from doing a fusion (arthroplasty) of the PIP (Proximal InterPhalangeal Joint) of this gentleman's finger. As Mike Voight says, the PIP is the joint you use to win matches:
https://youtu.be/cBk-X54m_YA?t=212 start at 3:32.
The question is: what other strategies could be used for a person with limited PIP flexion.
A joint replacement is an option, but it seems rather extreme for the gentleman to pursue his hobby especially as he has no pain. Usually we don't replace the index PIP due to the possibility of instability of the joint which is almost always worse than stiffness.
Maybe I need to introduce him to that middle finger pulling point shooting crazy dude.