Splinting for the fingers

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: • 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)

10. Indications – Mallet finger

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

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

19. Questions?