1. Splinting for the fingers
Somaya Malkawi, PhD

3. Introduction
Finger based splints: Cross the PIP and/or DIP leaving the MCP joint free
PIP and DIP joints are hinge joints that have collateral ligaments on each side to prevent joint deviation
Volar plate to prevent hyperextension
Dorsal capsule central extensor tendon crosses the PIP dorsally
Boutonniere and swan neck deformity

4. Introduction
For any finger problem the most important problem is to manage edema
Edema is incorporated into the splinting process
Compressive wrap under the splint

5. Introduction Materials LTT: Perforated Vs. non perforated Straps:
Thin material for small digits, larger for stronger person
Perforated Vs. non perforated
Non –perfortated is better
Use microperforated
Straps:
Easy to be taken out during sleep
Tape circumferentially
Long velcro strap

6. Diagnostic indications
Mallet finger
Boutonniere deformities
Swan-neck deformities
Finger sprains

7. Indications- Mallet finger
DIP extensor lag (PROM) or contracture (No PROM (unlikely)
DIP droop (dropped finger)
Axial load when DIP extended or flexion force to the fingertip
Cause: Terminal tendon is
Avulsed or lacerated

9. Indications – Mallet finger
Goal of splint is to keep DIP extended- hyperextended (prevent DIP flexion)
Splint should not impede PIP flexion unless swan neck deformity exists too
Splinting is required for 6 weeks to allow tendon heal
Night wear is still recommended for the next following weeks (watch out for extensor lag)
Clarify with dr. if he wants hyperextension .. Some dr.s prefer that

10. Indications – Mallet finger
Clarify with dr. if he wants hyperextension .. Some dr.s prefer that

11. Indications – Boutonniere
PIP flexion and DIP hyperextension
Could result from (axial loading, tendon laceration, burns, arthritis)
The central extensor tendon (central slip) is disrupted
If not treated could lead
to contracture

13. Indications – Boutonniere
Splinting: Maintain PIP ext while keeping the DIP and MCP’s free for about 6-8 weeks
Or include the DIP joint > MA
If there is a contracture a serial splint or a prefabricated splint might be used

14. Indications – swan neck
PIP hyperextension and DIP flexion
Lateral band displace dorsally
Trauma and RA
Goal of splinting is to prevent PIP hyperextension and to promote DIP extension
Splint should have the PIP
In slight flexion (20 degrees)

15. Indications – swan neck
Watch out from allowing the PIP joint to go into extension while fabricating the splint
Make sure you eliminate the splint bulk to allow function as much as possible

16. Indications – finger PIP sprain
Normally ignored by clients
Chronic swelling and stiffness
Lead to flexion contracture
Sprains are graded by severity (I – III)
Read box 12-1 page 262 for grades of ligament sprain injuries and proper tx

17. Indications – finger PIP sprain
The goal of splinting is to support the PIP joint and promote healing and stability
If Extension limitation in PIP- splinting is similar for the boutonniere
If PIP flex contracture – serial casting
Volar plate injury – dorsal gutter (block PIP ext while allowing PIP flexion) (fig 12-8)

18. Buddy taping for the treatment of finger injuries
Buddy taping for the treatment of finger injuries. (A) Self-adhesive wrap. (B) Velcro wrap
IP collateral ligament injury

19. Questions?