Splinting for the Splinting for the fingersfingers

Somaya Malkawi, PhDSomaya Malkawi, PhD

Introduction Introduction

Finger based splints: Cross the PIP Finger based splints: Cross the PIP and/or DIP leaving the MCP joint freeand/or DIP leaving the MCP joint free

PIP and DIP joints are hinge joints that PIP and DIP joints are hinge joints that have collateral ligaments on each side have collateral ligaments on each side to prevent joint deviationto prevent joint deviation

Volar plate to prevent hyperextension Volar plate to prevent hyperextension Dorsal capsule central extensor tendon Dorsal capsule central extensor tendon

crosses the PIP dorsally crosses the PIP dorsally – Boutonniere and swan neck deformity Boutonniere and swan neck deformity

Introduction Introduction

For any finger problem the most For any finger problem the most important problem is to manage important problem is to manage edemaedema

Edema is incorporated into the Edema is incorporated into the splinting processsplinting process

Compressive wrap under the splint Compressive wrap under the splint

Introduction Introduction

Materials LTT:Materials LTT:– Thin material for small digits, larger for stronger Thin material for small digits, larger for stronger

person person Perforated Vs. non perforatedPerforated Vs. non perforated

– Non –perfortated is better Non –perfortated is better – Use microperforated Use microperforated

Straps: Straps: – Easy to be taken out during sleepEasy to be taken out during sleep– Tape circumferentiallyTape circumferentially– Long velcro strapLong velcro strap–

Diagnostic indicationsDiagnostic indications

Mallet finger Mallet finger Boutonniere deformities Boutonniere deformities Swan-neck deformities Swan-neck deformities Finger sprains Finger sprains

Indications- Mallet fingerIndications- Mallet finger

DIP extensor lag (PROM) or DIP extensor lag (PROM) or contracture (No PROM (unlikely)contracture (No PROM (unlikely)

DIP droop (dropped finger)DIP droop (dropped finger) Axial load when DIP extended or Axial load when DIP extended or

flexion force to the fingertipflexion force to the fingertip Cause: Terminal tendon is Cause: Terminal tendon is

Avulsed or lacerated Avulsed or lacerated

Indications – Mallet fingerIndications – Mallet finger

Goal of splint is to keep DIP extended- Goal of splint is to keep DIP extended- hyperextended (prevent DIP flexion)hyperextended (prevent DIP flexion)

Splint should not impede PIP flexion unless Splint should not impede PIP flexion unless swan neck deformity exists tooswan neck deformity exists too

Splinting is required for 6 weeks to allow Splinting is required for 6 weeks to allow tendon heal tendon heal

Night wear is still recommended for the Night wear is still recommended for the next following weeks (watch out for next following weeks (watch out for extensor lag) extensor lag)

Indications – Mallet fingerIndications – Mallet finger

Indications – BoutonniereIndications – Boutonniere

PIP flexion and DIP hyperextension PIP flexion and DIP hyperextension Could result from (axial loading, Could result from (axial loading,

tendon laceration, burns, arthritis)tendon laceration, burns, arthritis) The central extensor tendon (central The central extensor tendon (central

slip) is disruptedslip) is disrupted If not treated could lead If not treated could lead

to contractureto contracture

Indications – BoutonniereIndications – Boutonniere

Splinting: Maintain PIP ext while Splinting: Maintain PIP ext while keeping the DIP and MCP’s free for keeping the DIP and MCP’s free for about 6-8 weeksabout 6-8 weeks

Or include the DIP joint > MA Or include the DIP joint > MA If there is a contracture a serial splint If there is a contracture a serial splint

or a prefabricated splint might be or a prefabricated splint might be used used

Indications – swan neckIndications – swan neck

PIP hyperextension and DIP flexion PIP hyperextension and DIP flexion Lateral band displace dorsally Lateral band displace dorsally Trauma and RATrauma and RA Goal of splinting is to prevent PIP Goal of splinting is to prevent PIP

hyperextension and to promote DIP hyperextension and to promote DIP extension extension

Splint should have the PIP Splint should have the PIP

In slight flexion (20 degrees) In slight flexion (20 degrees)

Indications – swan neckIndications – swan neck Watch out from allowing the PIP joint to Watch out from allowing the PIP joint to

go into extension while fabricating the go into extension while fabricating the splint splint

Make sure you eliminate the splint bulk Make sure you eliminate the splint bulk to allow function as much as possible to allow function as much as possible

Indications – finger PIP Indications – finger PIP sprainsprain

Normally ignored by clientsNormally ignored by clients Chronic swelling and stiffnessChronic swelling and stiffness Lead to flexion contracture Lead to flexion contracture Sprains are graded by severity (I – III)Sprains are graded by severity (I – III) Read box 12-1 page 262 for grades of Read box 12-1 page 262 for grades of

ligament sprain injuries and proper tx ligament sprain injuries and proper tx

Indications – finger PIP Indications – finger PIP sprainsprain

The goal of splinting is to support the PIP The goal of splinting is to support the PIP joint and promote healing and stability joint and promote healing and stability

If Extension limitation in PIP- splinting is If Extension limitation in PIP- splinting is similar for the boutonnieresimilar for the boutonniere

If PIP flex contracture – serial castingIf PIP flex contracture – serial casting Volar plate injury – dorsal gutter (block 20-Volar plate injury – dorsal gutter (block 20-

30 PIP ext while allowing PIP flexion) (fig 12-30 PIP ext while allowing PIP flexion) (fig 12-8)8)

Buddy taping for the treatment of finger Buddy taping for the treatment of finger injuries.injuries. (A) (A) Self-adhesive wrap. Self-adhesive wrap. (B) (B) Velcro  Velcro wrapwrap

IP collateral ligament injuryIP collateral ligament injury

QuestionsQuestions??