Splint entitled
Splint figure
Functions of the splint
Repaired flexor tendons of the hand
Controlled active flexor splint
Figure 18.1
A controlled active flexor tendon splint is used to allow early active mobilization of the fingers after flexor(s) repair. The active range of motion of the injured finger within the dorsal extension block splint is governed by the splint position. Passive flexion of the finger joints is allowed to maintain their suppleness
Synergistic splint
Figure 18.2
A synergistic splint is a dynamic splint guided by wrist motion used to increase the excursion of the tendons within safe limits: from maximum wrist extension at 30° to full flexion. The interphalangeal (IP) joints of fingers are passively flexed on the “place-and-hold” principle when the wrist extends to the 30° extension block
Differential tendon gliding
Figure 18.3
Individual passive flexion of the IP joints enhances the isolated gliding of the flexor digitorum sublimis (FDS) and flexor digitorum profundus (FDP) in zone II
Repaired extensor tendons of the hand
Controlled passive extensor splint
Figure 18.4
A controlled passive extensor splint is used to allow early mobilization of the fingers after extensor repair. The injured finger is flexed actively and extended passively by the extensor assist within a controlled range. The volar flexion block is adjustable weekly
Immediate controlled active motion splint
Figure 18.5
The immediate controlled active motion splint consists of two components. A finger extension-assist splint supports the injured finger in 20° of relatively more extension than the adjacent fingers, and the finger actively extends supported by the adjacent fingers via the extension-assist splint. A wrist extension splint supports the wrist in 20° of extension to relax the finger extensors
Mobilization and passive motion of fractured fingers
Splints for stable and nondisplaced fractures
Buddy splint and proximal phalanx fracture resting splint
Figure 18.6
The buddy splint straps the injured finger and the adjacent finger together to facilitate the active motion of the injured finger. The night finger extension splint holds the finger and hand in a safe position to prevent potential flexion contracture developing in the IP joints and extension contracture in the metacarpophalangeal joint
Corrective splintage
Belly-gutter splint
Figure 18.7
A belly-gutter splint helps correct flexion contracture of interphalangeal joints by molding a hollow space underneath the contracted joint in order to reinforce the correcting force applied by the strapping from top of the joint
Dynamic mobilizing splint
Figure 18.8
The dynamic mobilizing splint provides low-load tensile stress via its dynamic component, trying to realign the scarred tissue
Serial static web spreader
Figure 18.9
The serial static web spreader gradually widens the tightening first web by serial adjustment or splint remolding
Static progressive proximal interphalangeal joint splint
Figure 18.10
The static progressive proximal interphalangeal joint splint applies passive stretching to gradually restore the passive extension and flexion range of the joint. The inelastic component of the splint is adjusted without change to its main structures
Clinical application: Edema control
Edema control by elevation, active mobilization, and pressure therapy
Pitting edema
Figure 18.11
Edema retention around the injured site, or even the whole hand after the injury. Edematous fluid is movable and soft when direct fingertip pressure is applied in the early stage
Pressure finger tube
Figure 18.12
A pressure finger tube with gentle circumferential pressure will help reduce local swelling over a finger. The choice of materials used depends on the severity of the swelling
Pressure glove
Figure 18.13
A pressure glove, providing gentle and circumferential pressure, helps control swelling if all the fingers and the whole hand become swollen after injury or surgery
Repaired Flexor Tendons of the Hand
Flexor tendon post-repair motion protocols include early-controlled forces, exerted through either passive or active motion (Strickland 2005).
The traditional passive way of splinting (Kleinert et al. 1967; Lister et al. 1997) caused buckling of the repaired tendon within the synovial sheath (Horii et al. 1992). This way of splinting is no longer recommended.
Recent findings verify that flexor tendon rehabilitation should be based on controlled active digital motion (Lund 2000). Here, the controlled active flexor splint is used (Fig. 18.1).
Fig. 18.1
Controlled active flexor splint
The synergistic splint (Fig. 18.2), according to the Mayo Clinic protocol, is used to increase the differences (excursion) between the two digital flexors (Cooney et al. 1989; Savage 1988). It functions at the optimal positions of the extended wrist and flexed metacarpophalanges of the hand joints to produce the least tension on a repaired flexor tendon during active digital flexion (Strickland 2005).
Fig. 18.2
Synergistic splint
Controlled Active and Passive Motion Should be Integrated
Passive flexion movements of the interphalangeal (IP) joints of the injured finger(s) contribute to maintaining joint mobility by influencing the edematous fluid, thus facilitating the active gliding of the tendons (Duran and Houser 1995). Intervention in zone II flexor tendon injuries should include differential tendon-gliding exercise to encourage isolated gliding of the two flexor tendons (Fig. 18.3).
Fig. 18.3
Differential tendon-gliding splints
Repaired Extensor Tendons of the Hand
The same principles are used for mobilization of the extensor tendons. Controlled passive extension motion using a dynamic splint seeks to prevent dense adhesions (Fig. 18.4; Duran and Houser 1995), and to stimulate intrinsic repair processes (Gelberman et al. 1981). The Immediate Controlled Active Motion Extensor Tendon Program (ICAM) gives the professional recommendations on how the pair of a wrist extension splint (wrist extended 20–25°) and a finger extension-assist splint is designed to allow active digital flexion extension. (Fig. 18.5; Howell et al. 2005).
Fig. 18.4
Controlled passive extensor splint
Fig. 18.5
Immediate controlled active motion splint
Mobilization and Passive Motion of Fractured Fingers
The outcomes of managing finger fractures (especially proximal phalangeal fractures) depend on whether a stable anatomic position of the fracture is achieved and whether an early active motion program focusing on tendon-gliding and joint mobility is conducted (Freeland et al. 2003).
Splints for Stable and Nondisplaced Fractures
Buddy taping or splinting (Fig. 18.6) to an adjacent uninvolved finger is sufficient to permit immediate active motion of the IP joints, enabling the extensor mechanism to act as a tension band over the proximal phalanx. Active motion simultaneously compresses the fracture and stimulates periosteal callus formation, initiating the recovery of digital motion (Freeland et al. 2003). A resting splint at night is recommended to minimize the risk of contracture of the proximal interphalangeal (PIP) joint flexion. This splint is adapted to extend the IP joint and to keep the intrinsic tendons in a relaxed position by flexing the metacarpophalangeal (MCP) joint.
Fig. 18.6
Buddy splint and proximal phalangeal fracture resting splint
A dorsal block splint is used for displaced or open fractures repaired with surgical stabilization. This splint is intended to relax the tensions over the fracture and is used to facilitate movement (Freeland et al. 2003).
Passive motion of fractured fingers should generally not begin before fracture callus calcification has been confirmed radiologically. Normally, this occurs 10–21 days after the injury. Gentle passive flexion and extension of the distal IP joint can be allowed with fracture site protected (Freeland et al. 2003).
Clinical Application: Splintage
Corrective Splintage
The OT examines the fingers and the hand through his or her “end-feel,” that is, slow and careful stretching and tightening of soft tissue or finger joint(s). The result indicates the types of splintage to be used.
Static Splint
A static splint holds the finger in one specific position that applies stress to the newly repaired tissue. Its purpose is to prevent joint contracture and correct the new onset of joint flexion tightness (Wong 2002).
A belly-gutter splint (Fig. 18.7) is intended to correct flexion tightness of the PIP joint by holding the injured finger in a safe but corrective position . The splint is positioned over the metacarpophalangeal (MCP) joints at 60–70° of flexion and with the IP joints in full extension.
Fig. 18.7
Belly-gutter splint
Dynamic Splint
A dynamic mobilization splint (Fig. 18.8) applies a passive pulling force to a specific joint in one direction while permitting active motion in the opposite direction, using energy-storing materials such as a “Theraband,” rubber band, springs, and spring wire (Wong 2002). It applies a low-load constant and gentle force to realign the soft tissue under stress, holding tension on the joint, tendon, scar, and adhesions at the maximum tolerable limit (Flowers and LaStayo 1994).
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