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DIPJ arthritis

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Updated Aug 2026
A hand-drawn illustration of a faceless older person struggling to do up a small shirt button with stiff sore fingertips.
X-ray of DIPJ arthritis: the joint space at the tip of the finger has narrowed and small bone spurs are forming around the worn cartilage — the pattern that produces Heberden nodes. Kieran Hirpara 4.0

What you're feeling

You may notice pain and stiffness in the very tip joint of your finger. This is the distal interphalangeal joint, or DIPJ. The discomfort often starts as a dull ache after you use your hand. It can become sharp when you grip objects or press against surfaces. Many people find the pain worse in the morning or after resting for a long time.

As the wear-and-tear arthritis progresses, you might see changes in your finger’s shape. A common change is a 'swan neck' deformity, where the tip joint bends inward while the middle joint bends outward. This happens because the tip joint loses its ability to straighten fully. You may also feel that the joint feels unstable or shifts out of place, especially if you had an injury to the finger in the past.

Daily tasks can become difficult. Simple actions like buttoning a shirt, typing on a keyboard, or holding a coffee cup may hurt. You might struggle to pinch small items between your thumb and index finger. If the arthritis is severe, you may find it hard to make a full fist or straighten your finger completely.

Some patients report that the pain flares up at night, making it hard to sleep comfortably. Others notice that the stiffness improves slightly as they move their hand more throughout the day. However, overuse can lead to increased swelling and tenderness by the end of the day.

If you have had a previous injury to this joint, such as a mallet finger, the arthritis may develop slowly over time. You might not have noticed significant changes at first. But as the cartilage wears down, the bone-on-bone contact causes more inflammation. This can lead to a decrease in your range of motion. You may find it harder to bend or straighten the tip of your finger than before.

In rare cases, you might feel lumps under the skin near the joint. These can be caused by small pieces of cartilage breaking loose. If you notice these lumps, or if the pain becomes constant and severe, it is important to discuss your symptoms with us. We can help determine the best way to manage your discomfort and improve your hand function.

What's actually happening

Your fingertip joint is a small hinge that lets you grip and pinch. Inside, two bones meet at a smooth surface covered in cartilage. Think of this cartilage like a shock absorber or a gasket. It cushions the bones so they slide past each other without grinding. In arthritis, this protective layer wears down. The bones lose their smooth glide. Instead, they rub against each other with every movement.

This wear-and-tear changes how the joint moves. You might notice stiffness or pain when you bend your finger. The joint can also change shape over time. Sometimes the tip bends inward more than usual. This is called a flexion contracture. It happens because the tissues tighten and the joint structure shifts. The deformity often progresses slowly as the arthritis continues.

The tendons that move your finger are attached to the bone near this joint. They act like ropes pulling your fingertip into a fist. When the joint surface is damaged, these ropes can pull unevenly. This imbalance can make the joint feel unstable or weak. In some cases, the bone at the end of the finger may shift slightly out of place. This is known as subluxation. It usually happens if a significant part of the joint surface is injured.

Your surgeon looks at these changes to decide the best path forward. If the pain is severe and limits your daily tasks, fusion may be recommended. This joins the bones together so they no longer move. It stops the grinding pain but removes the joint’s flexibility. For some patients, we may suggest a motion-preserving option. This involves removing the rough bone edges to create more space. It aims to keep the joint moving while reducing pain.

We also consider the size of your finger. The bones in some fingers, especially the small finger or in women, are very small. This can limit the types of hardware we can safely use for fusion. We choose methods that fit your specific anatomy. Whether we fuse the joint or preserve motion, our goal is to restore comfort and function. We tailor the plan to your needs, ensuring the solution fits your hand’s unique structure.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. We guide you through a clear pathway starting with non-operative care. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. Our assessment includes a history, examination, and imaging to confirm the diagnosis. For long-standing wear-and-tear arthritis, we usually begin with conservative measures before considering surgery.

You can start by changing how you use your hand to avoid painful positions. Splinting the distal interphangeal joint (the small joint at the tip of your finger) reduces pain and improves extension. This splinting does not cause stiffness or restrict your movement. Hand therapy aims to keep the rest of your hand strong. Please note that immobilizing this joint reduces your overall grip strength, with the effect being more pronounced in the index finger than the little finger. We advise you to give these measures time to work.

If pain persists, we discuss medical management options. These include pain medication and anti-inflammatories to manage symptoms. We may also offer injections. Cortisone injections can reduce inflammation and pain for a limited time. Hyaluronic acid injections aim to lubricate the joint. Platelet-rich plasma (PRP) injections use your own blood components to support healing. The duration of relief varies by individual and the specific treatment chosen.

Surgery is considered when conservative care has not provided enough improvement. We view this as a shared decision based on your symptoms and goals. Surgical options depend on the severity of your arthritis and whether other joints in the same finger are affected. For severe pain in both the middle and tip joints of one finger, we may recommend treating both simultaneously. The goal is to relieve pain while preserving as much function as possible.

What to expect

Your symptoms will likely persist and may worsen if left untreated. Wear-and-tear arthritis in the joint at the tip of your finger often leads to a progressive change in shape known as a swan neck deformity. This happens because the joint stiffens in a bent position over time. You may also notice a decrease in how far you can straighten your finger. However, this loss of movement usually does not stop you from doing daily tasks or affect your overall satisfaction with your hand’s function.

If you choose treatment, the goal is to relieve pain and restore stability. There are several paths we can take. One option is to fuse the joint. This stops motion at the tip but provides strong pain relief. Another option is a motion-preserving procedure that removes bone spurs and nerves to reduce pain while keeping some movement. You might also be a candidate for a silicone spacer, which can provide excellent pain relief and allow for about 30–40 degrees of movement.

Recovery feels different depending on the path chosen. If you have a fusion, your surgeon will discuss the best approach for you. Some techniques involve smaller cuts and fewer major complications. If you have a silicone spacer, the complication rate is low, at 5%. You may need to wear a splint to reduce pain and improve extension. This splinting does not cause stiffness or non-compliance issues.

If you have diabetes, your risk of postoperative complications is higher. Your surgeon’s experience with these specific procedures also plays a role in your outcome. If you have arthritis in both the middle and tip joints of the same finger, we often recommend treating both at the same time. This helps achieve better flexibility and healing.

If a previous spacer procedure does not work, we can use custom bone grafting to rebuild the joint. This approach has shown reliable healing and high patient satisfaction. Ultimately, your outlook depends on the severity of your arthritis and the specific technique we choose together. We aim for a hand that is pain-free and functional, allowing you to return to your normal activities.

When to see someone

Ask for a specialist review if you have persistent pain that does not improve with rest. Seek care if you notice weakness or instability in the finger joint. See your GP if the joint locks or gives way during use. Medical attention is important if symptoms interfere with your sleep or daily work. Sudden worsening of pain or swelling also warrants a check-up. Early assessment helps manage conditions like wear-and-tear arthritis or deformities such as a swan neck shape. Your surgeon can determine if imaging is needed to spot issues like joint subluxation or radiological osteoarthritis. Timely evaluation supports better long-term function and comfort for your hand.

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Percutaneous DIP joint arthrodesis is advantageous compared with open fusion techniques in select patients [1].
  • Swan neck deformity progresses significantly over time due to increasing DIPJ flexion contracture [2].
  • Simultaneous surgical intervention is recommended for severe painful osteoarthritis of both the PIP and DIP joints of the same digit [3].
  • Denervation with cheilectomy presents a motion-preserving alternative to arthrodesis for symptomatic DIP joint osteoarthritis [4].
  • Lateral approach and plate fixation for DIP joint arthrodesis yields results equivalent to traditional methods but with fewer major complications [5].
  • The combination of DIP arthrodesis and PIP Swanson arthroplasty results in favorable outcomes regarding simultaneous bony union and flexibility [7].
  • Silicone interpositional arthroplasty of the DIP joint is an acceptable alternative to arthrodesis, achieving excellent pain relief and a range of movement of 30–40 degrees [8].
  • Silicone interpositional arthroplasty of the DIP joint has a low overall complication rate of 5% [8].
  • The smile incision and reverse shotgun approach is a good surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary [9].
  • The nonaxial multiple small screws (NMSS) technique is a feasible option for DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required [11].
  • Customized structural bone grafting addresses bone stock loss and medullary absence in failed DIPJ silicone arthroplasty, achieving reliable union rates and high patient satisfaction [13].
  • There is no difference in biomechanical performance between K-wires and compression screws for DIPJ arthrodesis [20].
  • Implant selection for DIPJ fusion should consider factors such as cost and complication profiles given the lack of difference in biomechanical performance between K-wires and compression screws [20].

Anatomy & Pathophysiology

  • Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured [6].
  • Understanding of DIP joint morphology may lend insight into the biomechanics and disease progression within the DIP joints [10].
  • A substantial number of distal phalanges are too small to accommodate commonly available headless compression screws, particularly in females and the small finger [31].
  • Irreducibility was more commonly seen in dorsal than in volar dislocations of the DIP joint [33].
  • Volar dislocations of the DIP joint carried a higher risk of instability immediately after reduction compared to dorsal dislocations [33].
  • Biomechanically, dynamic tenodesis for the DIP joint using the remaining FDP tendon results in a flexion angle greater than 30 degrees [23].
  • In a cadaveric model, tenodesis successfully restored coordinated interphalangeal joint flexion after a simulated zone I FDP laceration with improvements in DIP joint flexion and composite finger flexion [35].
  • Lateral blocking with incremental joint angles allows a safer application of force for the healing tendon during palmar and lateral blocking exercises [26].

Classification

  • Swan neck deformity in the DIP joint progresses significantly over time due to increasing DIPJ flexion contracture [2].
  • Radiological osteoarthritis following a mallet finger fracture follows a similar course to the natural degenerative process in the DIP joint [12].
  • Post-traumatic osteoarthritis of the DIP joint after mallet finger fractures is accompanied by a decrease in range of motion, though this does not clinically affect patient-reported outcome measures (PROMs) [12].
  • The interrater reliability of the Kellgren & Lawrence classification system for post-traumatic osteoarthritis in the DIP joint after mallet finger fractures is considerably lower than initially assumed [34].
  • The interrater reliability of the OARSI classification system for post-traumatic osteoarthritis in the DIP joint after mallet finger fractures is considerably lower than initially assumed [34].
  • Current concepts regarding DIP joint osteoarthritis highlight the roles of cartilage, subchondral bone, and soft tissue structures in etiology, pathogenesis, and evaluation [19].
  • Morphological understanding of DIP joint curvatures may provide insight into the biomechanics and disease progression within the DIP joints [10].
  • Examination of type I and type II nerve endings provides new information on the sensory systems of the DIP joints and surrounding structures [32].

Clinical Presentation

  • Swan neck deformity in the DIPJ progresses significantly over time due to increasing DIPJ flexion contracture [2].
  • Floating DIP joint injuries can be misdiagnosed initially due to minimal deformity [17].
  • Radiological osteoarthritis following a mallet finger fracture is similar to the natural degenerative process in the DIP joint [12].
  • Radiological osteoarthritis after a mallet finger fracture is accompanied by a decrease in range of motion of the DIP joint [12].
  • Radiological osteoarthritis after a mallet finger fracture does not clinically affect patient-reported outcome measures (PROMs) [12].
  • Primary synovial chondromatosis of the DIPJ is an extremely rare entity that requires accurate diagnosis to distinguish from other arthropathies [27].
  • Understanding the morphology of DIPJ curvatures may lend insight into the biomechanics and disease progression within the DIP joints [10].
  • Osteoarthritis of the DIPJ involves roles of cartilage, subchondral bone, and soft tissue structures in its etiology, pathogenesis, and evaluation [19].

Investigations

  • Lateral approach and plate fixation for DIP joint arthrodesis yields results equivalent to traditional methods with fewer major complications [5].
  • Silicone interpositional arthroplasty of the DIP joint is an acceptable alternative to arthrodesis, achieving excellent pain relief and a range of movement of 30–40 degrees with a low overall complication rate of 5% [8].
  • Understanding the morphology of DIP joints may lend insight into the biomechanics and disease progression within the DIP joints [10].
  • Radiological osteoarthritis after a mallet finger fracture is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint [12].
  • Immobilization of the distal interphalangeal joint of any finger reduces the overall grip strength of the hand [16].
  • The reduction in grip strength from DIP joint immobilization becomes progressively more pronounced from the index to the little fingers [16].
  • Open reduction and internal fixation is a viable treatment option for chronic floating DIP joint injuries, though osteoarthritis may develop [17].
  • Arthrodesis of the distal interphalangeal joint often leads to complications [18].
  • Current concepts regarding DIP joint osteoarthritis examine the etiology, pathogenesis, and evaluation of the condition, highlighting the roles of cartilage, subchondral bone, and soft tissue structures [19].
  • A size mismatch existed between the anatomic dimensions of the DIP joint and commercially available headless compression screws [21].
  • A distinct collagen septum exists between the extensor tendon and skin at the DIP joint [38].

Treatment

  • Simultaneous anterograde screw arthrodesis of the DIP joint and silastic PIP joint replacement results in favorable outcomes regarding bony union and flexibility [7].
  • Diabetes and surgeon experience are factors increasing the risk of postoperative complications in DIP/thumb IP joint arthrodeses [14].
  • Splinting of the DIP joint reduces pain and improves extension at the joint without causing non-compliance, increased stiffness, or restriction of range of motion [15].
  • Injection with collagenase Clostridium histolyticum is an option for the treatment of DIP joint contractures in Dupuytren disease, though the potential risk for recurrence should be carefully weighed [36].
  • Open DIP joint cheilectomy is a safe and effective alternative to DIP joint arthrodesis in patients with symptomatic osteoarthritis who wish to preserve joint motion [37].

Complications

  • Palmar subluxation of a DIP joint is expected when more than one half of the dorsal articular surface is injured, even without preexisting arthritic deformity [6].
  • Radiological osteoarthritis following a mallet finger fracture follows a natural degenerative process and is accompanied by a decrease in DIPJ range of motion [12].
  • Diabetes is identified as a factor increasing the risk of postoperative complications in DIP and thumb IP joint arthrodeses [14].
  • Surgeon experience is identified as a factor increasing the risk of postoperative complications in DIP and thumb IP joint arthrodeses [14].
  • Failed Swanson's arthroplasty of the DIPJ can result in bone stock loss and medullary absence [13].

Recovery

  • Radiological osteoarthritis after a mallet finger fracture is similar to the natural degenerative process in the DIP joint [12].
  • The decrease in range of motion of the DIP joint following radiological osteoarthritis from a mallet finger fracture does not clinically affect PROMs [12].
  • Diabetes is a factor increasing the risk of postoperative complications in DIP and thumb IP joint arthrodeses [14].
  • Surgeon experience is a factor increasing the risk of postoperative complications in DIP and thumb IP joint arthrodeses [14].
  • Splinting of the DIP joint reduces pain and improves extension at the joint [15].
  • Splinting of the DIP joint does not give rise to non-compliance, increased stiffness, or restriction of range of motion [15].

Key Evidence

  • [L4] In select patients, this percutaneous DIP joint arthrodesis is advantageous in comparison with open fusion techniques. [1] (10.1007/s11552-010-9265-9)
  • [L5] The swan neck deformity in this individual progressed significantly with time because of increasing DIPJ flexion contracture. [2] (10.1016/j.jht.2009.11.005)
  • [L3] The authors recommend simultaneous surgical intervention in case of severe painful OA of the PIP and DIP joints of the same digit. [3] (10.1177/17531934231191255)
  • [L4] It presents a compelling motion-preserving alternative to arthrodesis for symptomatic DIP joint osteoarthritis. [4] (10.1016/j.jhsa.2026.01.027)
  • [L4] The results obtained in this small series are equivalent to the traditional methods of DIP joint arthrodesis but with fewer major complications. [5] (10.1016/j.jhsa.2007.09.004)
  • [L5] Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured. [6] (10.1016/j.jhsa.2007.09.006)
  • [L4] The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility. [7] (10.1177/17531934231215790)
  • [L4] The study confirms that silicone interpositional arthroplasty of the DIP joint is an acceptable alternative to arthrodesis, achieving excellent pain relief and a range of movement of 30–40 degrees with a low overall complication rate of 5%. [8] (10.1177/1753193411422679)
  • [L4] This technique may be a good surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary. [9] (10.1186/s12891-024-08016-6)
  • [L5] Our understanding of morphology may lend insight into the biomechanics and disease progression within the DIP joints. [10] (10.1007/s11552-014-9605-2)
  • [L4] Thus, the NMSS technique could be used as a feasible option in DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required. [11] (10.1186/s12891-022-05473-9)
  • [L4] Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. [12] (10.1016/j.jhsa.2023.03.027)
  • [L4] A customized structural bone graft using the described technique addresses issues of bone stock loss and medullary absence in failed DIPJ silicone arthroplasty, achieving reliable union rates and high patient satisfaction. [13] (10.1177/17531934231151217)
  • [L3] Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in these DIP/thumb IP joint arthrodeses. [14] (10.1186/s12891-024-07361-w)
  • [L2] It does not give rise to non-compliance, increased stiffness or restriction of range of motion. [15] (10.1016/j.jht.2013.08.004)
  • [L4] Immobilization of the distal interphalangeal joint of any finger reduces the overall grip strength of the hand, with the effect becoming progressively more pronounced from the index to the little fingers. [16] (10.1177/1753193418765068)
  • [Case_report] Floating DIP joint injuries can be misdiagnosed initially due to minimal deformity; open reduction and internal fixation is a viable treatment option for chronic cases, though osteoarthritis may develop. [17] (10.1016/j.jhsa.2010.05.025)
  • [L3] Arthrodesis of the distal interphalangeal joint often leads to complications. [18] (10.1177/17531934221111641)
  • [L5] This current concepts article examines the recent knowledge base regarding the etiology, pathogenesis, and evaluation of osteoarthritis of the distal interphalangeal joint, highlighting the roles of cartilage, subchondral bone, and soft tissue structures. [19] (10.1016/j.jhsa.2010.09.003)
  • [L5] Given the lack of difference in biomechanical performance between K-wires and compression screws, consideration should be given to other factors such as cost and complication profiles when choosing an implant for DIPJ fusion. [20] (10.1177/1558944715627211)
  • [L4] A size mismatch existed between the anatomic dimensions of the DIP joint and commercially available headless compression screws. [21] (10.1016/j.jhsa.2014.02.007)
  • [L5] Biomechanically, dynamic tenodesis for the DIP joint using the remaining FDP tendon is a valuable procedure because it results in a flexion angle greater than 30 degrees. [23] (10.1016/j.jhsg.2020.08.007)
  • [L5] This study supports the concept that lateral blocking with incremental joint angles allows a safer application of force for the healing tendon. [26] (10.1016/j.jht.2020.07.004)
  • [Case_report] Primary synovial chondromatosis of the distal interphalangeal joint is an extremely rare entity that requires accurate diagnosis to distinguish from other arthropathies. [27] (10.1177/15589447211049520)
  • [L4] A substantial number of distal phalanges are too small to accommodate commonly available headless compression screws, particularly in females and the small finger. [31] (10.1007/s11552-014-9679-x)
  • [L5] Our examination of the distribution of type I and type II nerve endings provides new information on the sensory systems of the DIP joints and surrounding structures. [32] (10.1016/j.jhsa.2010.11.050)
  • [L4] Irreducibility was more commonly seen in dorsal than in volar dislocations, while volar dislocations carried a higher risk of instability immediately after reduction. [33] (10.1177/1753193415616957)
  • [L4] The interrater reliability of the Kellgren & Lawrence and OARSI classification systems for post-traumatic osteoarthritis in the distal interphalangeal joint after mallet finger fractures is considerably lower than initially assumed. [34] (10.1016/j.jhsa.2024.03.012)
  • [L5] In this cadaveric model, this tenodesis successfully restored coordinated interphalangeal joint flexion after a simulated zone I FDP laceration with improvements in distal interphalangeal joint flexion and composite finger flexion. [35] (10.1016/j.jhsa.2013.10.009)
  • [L4] Injection with CCH is an option for the treatment of DIP joint contractures in Dupuytren disease, though the potential risk for recurrence should be carefully weighed prior to its use. [36] (10.1016/j.jhsa.2018.07.004)
  • [L4] Open DIP joint cheilectomy is a safe and effective alternative to DIP joint arthrodesis in patients with symptomatic osteoarthritis who wish to preserve joint motion. [37] (10.1016/j.jhsa.2017.07.006)
  • [L5] We confirmed the existence of a distinct collagen septum between the extensor tendon and skin at the DIP joint using MRI and histology. [38] (10.1016/j.jhsa.2008.11.030)

References

[1] Treatment of Symptomatic Distal Interphalangeal Joint Arthritis with Percutaneous Arthrodesis: A Novel Technique in Select Patients. HAND. 2010. DOI: 10.1007/s11552-010-9265-9

[2] Swan Neck Deformity after Distal Interphalangeal Joint Flexion Contractures: A Biomechanical Analysis. Journal of Hand Therapy. 2010. DOI: 10.1016/j.jht.2009.11.005

[3] Does distal interphalangeal joint arthrodesis affect proximal interphalangeal joint arthroplasty outcomes in the same finger?. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231191255

[4] Denervation with Cheilectomy of the Distal Interphalangeal Joint: Technique and Medium-Term Results. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.027

[5] Alternative to the Distal Interphalangeal Joint Arthrodesis: Lateral Approach and Plate Fixation. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.09.004

[6] A Biomechanical Study of Distal Interphalangeal Joint Subluxation After Mallet Fracture Injury. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.09.006

[7] Simultaneous anterograde screw arthrodesis of distal interphalangeal joint and silastic proximal interphalangeal joint replacement for osteoarthritis. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231215790

[8] Joint replacement in 131 painful osteoarthritic and post-traumatic distal interphalangeal joints. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193411422679

[9] Smile incision and reverse shotgun approach in distal interphalangeal joint arthrodesis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-08016-6

[10] Curvatures of the DIP Joints of the Hand. HAND. 2014. DOI: 10.1007/s11552-014-9605-2

[11] Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05473-9

[12] Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.03.027

[13] Salvage of failed Swanson’s arthroplasty of the distal interphalangeal joint. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231151217

[14] Arthrodesis of distal interphalangeal and thumb interphalangeal joint: a retrospective cohort study of 149 cases. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07361-w

[15] Splinting of the Distal Interphalangeal Joint Reduces Pain and Improves Extension at the Joint; Results Front the Splint-OA Study. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2013.08.004

[16] Effect of immobilization of the distal interphalangeal joint of fingers on grip strength. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418765068

[17] Floating Distal Interphalangeal Joint Injury: Case Report. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.025

[18] Risk factors in distal interphalangeal joint arthrodesis in the hand: a retrospective study of 173 cases. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221111641

[19] Osteoarthritis of the Distal Interphalangeal Joint. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.09.003

[20] Biomechanical Analysis of Internal Fixation Methods for Distal Interphalangeal Joint Arthrodesis. HAND. 2016. DOI: 10.1177/1558944715627211

[21] Distal Interphalangeal Joint Bony Dimensions Related to Headless Compression Screw Sizes. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.007

[23] The Effect of Flexor Digitorum Profundus Dynamic Tenodesis on the Distal Interphalangeal Joint: A Cadaver Study. Journal of Hand Surgery Global Online. 2020. DOI: 10.1016/j.jhsg.2020.08.007

[26] Tensile load on the flexor digitorum profundus tendon during palmar and lateral blocking exercises: Influence on blocking force and distal interphalangeal joint flexion angle. Journal of Hand Therapy. 2021. DOI: 10.1016/j.jht.2020.07.004

[27] Primary Distal Interphalangeal Joint Tenosynovial Chondromatosis of the Small Finger: A Case Report With Literature Review. HAND. 2022. DOI: 10.1177/15589447211049520

[31] Dimensional Analysis of the Distal Phalanx with Consideration of Distal Interphalangeal Joint Arthrodesis Using a Headless Compression Screw. HAND. 2014. DOI: 10.1007/s11552-014-9679-x

[32] Distribution of Nerve Endings in Human Distal Interphalangeal Joint and Surrounding Structures. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.11.050

[33] Differences between dorsal and volar dislocations of the distal interphalangeal joint of fingers: a report of 30 cases. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415616957

[34] Rater Agreement of Post-Traumatic Osteoarthritis of the Distal Interphalangeal Joint 12 Years After a Mallet Finger Fracture. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.03.012

[35] Tenodesis for Restoration of Distal Interphalangeal Joint Flexion in Unrepairable Flexor Digitorum Profundus Injuries. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.10.009

[36] Collagenase Clostridium histolyticum for the Treatment of Distal Interphalangeal Joint Contractures in Dupuytren Disease. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.07.004

[37] Cheilectomy for Treatment of Symptomatic Distal Interphalangeal Joint Osteoarthritis: A Review of 78 Patients. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.07.006

[38] Dorsal Digital Septum of the Distal Interphalangeal Joint. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.11.030

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Using Creative Commons Public Licenses

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Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.