Splinting for the fingers Somaya Malkawi, PhD

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

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

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

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

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

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

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

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

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

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)

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

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

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 20-30 PIP ext while allowing PIP flexion) (fig 12-8)

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

Questions?