A Functional Thumb Metacarpal Extension Blocking Splint · 2018. 11. 18. · A Functional Thumb...
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A Functional Thumb Metacarpal Extension Blocking Splint As therapists, we frequently perform manual massage, scar massage and joint mobilizations. These types of treatments often can cause pain at the metacarpal joint of the therapist’s thumb. Other professions, as well as activities, may also produce symptoms in this joint. The authors of this article have developed a splint to help protect our thumbs. — PEGGY L. FILLION, OTR, CHT , Practice Forum Editor A FUNCTIONAL THUMB METACARPAL EXTENSION BLOCKING SPLINT Katherine Butler, B Ap(Sc)OT, AHT (BAHT), A Mus A (Flute) Devonshire Hospital London, U.K. Brigit Svens, BSc OT (Sweden) Occupational Therapy Department Royal Adelaide Hospital Adelaide, Australia Hyperextension of the first metacarpophalan- geal (MCP) joint is commonly observed in persons with certain occupations, such as hand therapists (Figure 1) and musicians. 1 People with arthritis 2,3 or hypermobile joints are also prone to this condi- tion. This may be due to reduced stability of the first carpometacarpal (CMC) 2 and/or MCP joint, 3 which subsequently leads to degenerative changes. We describe an alternative splint, based on Van Lede’s 4 anti-swan neck splint for the fingers, which re- stricts MCP joint extension of the thumb. FABRICATION Materials: 1. A 2.5-mm microperforated Orfilightä or 1.6- mm microperforated Orfitä soft (North Coast Medical). 2. A 2.5-cm-wide stretch loop thick elastic strap- ping (Homecraft AbilityOne) self-adhesive hook VelcroÒ (North Coast Medical). Instructions: 1. Cut thermoplastic in a rectangle, with the length being from the CMC joint to tip of the thumb and the width twice that of the thumb (Figure 1). 2. Mold the softened thermoplastic over the dor- sum of the thumb, ensuring that the MCP joint is between 35 and 40 degrees of flexion (Figure 2). 3. Lightly mark the thermoplastic to indicate the lateral borders of the thumb, allowing a little extra length to roll distal and proximal ends. Draw a circle to encompass the MCP joint line. This will form the window allowing MCP flexion (Figure 3). 4. Trim the splint to size. Cut the window large enough to allow MCP flexion, but not too large, as this will weaken the splint (Figure 4). 5. Carefully mark the MCP crease so the volar bar can be applied accurately (Figure 5). Soften a piece of thermoplastic 2 cm wide by 8 cm long and turn its edges in to form a thin smooth bar. 6. Place the trimmed dorsal hood on the thumb and mould the thermoplastic bar around the MCP joint crease. Spot heat and stick the ends to the base (Figure 6). Ensure the volar bar is placed exactly over the MCP crease, to main- tain MCP flexion. If it is too tight, then the radial digital nerve could be compromised. Alternatively, if it is too loose, then there is not enough stability at the MCP joint. 7. Roll back the proximal and distal ends of the dorsal hood and the window to decrease pres- sure areas and increase comfort (Figure 6). 8. Burn ends of the elastic strap to decrease fraying. Spot heat the volar aspect of the dorsal hood and press the strap into the material firmly on an angle so it sits comfortably around the wrist (not over the hypothenar muscles). PRACTICE FORUM Correspondence and reprint requests to Katherine Butler, Devonshire Hospital, 30 Devonshire Street, London W1G 6PU; e-mail: ,[email protected].. doi:10.1197/j.jht.2005.05.001 July–September 2005 375
Transcript of A Functional Thumb Metacarpal Extension Blocking Splint · 2018. 11. 18. · A Functional Thumb...
A Functional Thumb Metacarpal ExtensionBlocking Splint
As therapists, we frequently perform manual massage, scar massage and joint mobilizations. These types of treatmentsoften can cause pain at the metacarpal joint of the therapist’s thumb. Other professions, as well as activities, may alsoproduce symptoms in this joint. The authors of this article have developed a splint to help protect our thumbs. — PEGGY
L. FILLION, OTR, CHT, Practice Forum Editor
A FUNCTIONAL THUMBMETACARPAL EXTENSIONBLOCKING SPLINT
Katherine Butler, B Ap(Sc)OT, AHT(BAHT), A Mus A (Flute)
Devonshire HospitalLondon, U.K.
Brigit Svens, BSc OT (Sweden)Occupational Therapy DepartmentRoyal Adelaide HospitalAdelaide, Australia
Hyperextension of the first metacarpophalan-geal (MCP) joint is commonly observed in personswith certain occupations, such as hand therapists(Figure 1) and musicians.1 People with arthritis2,3
or hypermobile joints are also prone to this condi-tion. This may be due to reduced stability of the firstcarpometacarpal (CMC)2 and/or MCP joint,3 whichsubsequently leads to degenerative changes. Wedescribe an alternative splint, based on Van Lede’s4
anti-swan neck splint for the fingers, which re-stricts MCP joint extension of the thumb.
FABRICATIONMaterials:
1. A 2.5-mm microperforated Orfilight� or 1.6-mm microperforated Orfit� soft (North CoastMedical).
2. A 2.5-cm-wide stretch loop thick elastic strap-ping (Homecraft AbilityOne) self-adhesivehook Velcro� (North Coast Medical).
Instructions:
1. Cut thermoplastic in a rectangle, with thelength being from the CMC joint to tip of thethumb and the width twice that of the thumb(Figure 1).
2. Mold the softened thermoplastic over the dor-sum of the thumb, ensuring that the MCP jointis between 35 and 40 degrees of flexion (Figure2).
3. Lightly mark the thermoplastic to indicate thelateral borders of the thumb, allowing a littleextra length to roll distal and proximal ends.Draw a circle to encompass the MCP joint line.This will form the window allowing MCPflexion (Figure 3).
4. Trim the splint to size. Cut the window largeenough to allow MCP flexion, but not toolarge, as this will weaken the splint (Figure 4).
5. Carefully mark the MCP crease so the volar barcan be applied accurately (Figure 5). Soften apiece of thermoplastic 2 cm wide by 8 cm longand turn its edges in to form a thin smooth bar.
6. Place the trimmed dorsal hood on the thumband mould the thermoplastic bar around theMCP joint crease. Spot heat and stick the endsto the base (Figure 6). Ensure the volar bar isplaced exactly over the MCP crease, to main-tain MCP flexion. If it is too tight, then theradial digital nerve could be compromised.Alternatively, if it is too loose, then there is notenough stability at the MCP joint.
7. Roll back the proximal and distal ends of thedorsal hood and the window to decrease pres-sure areas and increase comfort (Figure 6).
8. Burn ends of the elastic strap to decreasefraying. Spot heat the volar aspect of the dorsalhood and press the strap into the materialfirmly on an angle so it sits comfortably aroundthe wrist (not over the hypothenar muscles).
PRACTICE FORUM
Correspondence and reprint requests to Katherine Butler,Devonshire Hospital, 30 Devonshire Street, London W1G6PU; e-mail: ,[email protected]..
doi:10.1197/j.jht.2005.05.001
July–September 2005 375
Attach a small circle of self-adhesive hookVelcro� on the dorsal aspect of the splintfor receiving the end of the strap. Figure 7shows the final positioning of the splint on thethumb.
Possible modifications to the splint may be:
Lengthen the splint proximally to increase CMCjoint support.Lengthen the splint distally to restrict the inter-phalangeal joint extension.If the strapping requires frequent replacement,apply two small self-adhesive hook Velcro� at-tachments instead of one.
FIGURE 1. The longitudinal loading of the thumbresults in hyperextension of the metacarpophalangealand interphalangeal joints.
FIGURE 2. The thumb is positioned in metacarpopha-langeal and interphalangeal flexion.
FIGURE 3. The border and the circle are marked forcutting the splint to size and for the window.
FIGURE 4. The splint has been cut to size and a windowhas been made for the metacarpophalangeal joint.
FIGURE 5. The metacarpophalangeal joint crease ismarked for attachment of the volar bar.
FIGURE 6. The volar bar has been moulded in themetacarpophalangeal joint crease and firmly attached tothe dorsal hood. The edges have been rolled back at thedistal and proximal ends.
FIGURE 7. The elastic strap around the wrist has beenattached. The functional thumb splint restricts hyper-extension of the thumb.
376 JOURNAL OF HAND THERAPY
Use/Wearing the splint:
Suggested population might be therapists, musi-cians, and industrial workers. It could also beworn during activities such as peeling potatoes,scrubbing/cleaning, gardening, and playing amusical instrument.
SUMMARY
The advantages of this functional thumb splintare: wrist and palm are entirely free allowingmovement and sensation of the thumb and hand,and thumb flexion is limited minimally.
REFERENCES
1. Wynn Parry CB. Managing the physical demands of musicalperformance. In: Williamon A (ed). Musical ExcellenceStrategies and Techniques to Enhance Performance. OxfordUniversity Press, 2004, pp 41–60.
2. Bozentka DJ. Pathogenesis of osteoarthritis. In: Mackin EJ,Callahan AD, Skirven TM, Schneider LH, Osterman AL(eds). Evaluation of the Hand and Upper Extremity. 5th ed.St. Louis: Mosby, 2002, pp 1637–45.
3. Alter S, Feldon P, Terrono AL. Pathomechanics ofdeformities in the arthritic hand and wrist. In:Mackin EJ, Callahan AD, Skirven TM, Schneider LH,Osterman AL (eds). Evaluation of the Hand andUpper Extremity. 5th ed. St. Louis: Mosby, 2002, pp1545–54.
4. Van Lede P. Minimalistic splint design: a rationale told in apersonal style. J Hand Ther. 2002;15:192–201.
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