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Entries with tag pip joint .

Finger Gutter Splints

My favourite thermoplastic material to use for finger gutter splints is Polyform. I usually use the 3mm think (non-perforated) material and thin it slightly when it is warm. You can of course use other materials as well, but what I like about the Polyform is that it conforms so well and you get really nice edges. 

 

Make it long enough so the proximal end of the splint lands just distally to the DPC. That way it is as long as possible, allowing optimal leverage, without restricting MCP joint movement, and it will be more comfortable to wear.

 

When shaping the splint, check the length of the finger, and then do as much of the shaping as possible "in the air", making it slightly straighter than the current PIP joint position. Go back to the patients finger to check the splint several times as it hardens to make sure it still fits.

 

 

Mark out the centre of the PIP joint on the splint and place the self adhesive hook velcro at the back, approximately 2/3 proximally to the PIP joint.

 

Make the splint a few degrees straighter than the current joint position and then adjust it regularly (or even show the patient how to do it themselves). The polyform is easy to adjust by giving it a bend just proximally to the PIP joint. You don't have to heat it up, just use your fingers. Easy!

 

Little fingers can be a bit more tricky to splint as the finger splint has a tendency to twist around the little finger. To help prevent this you might want to consider making the little finger splint with a palmar bar. 

 

In regards to strapping, I have two favourites. If there is a lot of swelling of the PIP joint i like to use the Mafra/Durawrap. It conforms nicely around the joint and helps reduce ane swelling.

 

 

 

I usually sew on a piece of hook velcro to one end of the Mafra to allow more space to attach. Once you have the right tightness of the Mafra, the patient does not have to undo it, but can slide in to the splint, like a slipper. Just make sure they put the strap far back towards the base of the finger. The splint will stay on better that way and it seems to be a more effecient angle for the strap to do its job to help straighten the PIP joint.

 

An other option for strapping is to use Fabrifoam. The advantage with using Fabrifoam is, due to its foam backing, it has less of a tendency to migrate. And because it is elastic, you also get some of that compression to help reduce swelling. The only downside with the Fabrifoam is that it requires more sewing. The Fabrifoam piece needs to be measured quite accurately so that you can attach a folded piece of loop velcro on once side and a piece of hook velcro on the other side.

 

         

 

 

 

Finger Flexion Glove

Stiff fingers can be very tricky to treat. Here is a simple but effective splint for patients with general stiffness of all finger joints. 

You want to block any flexion of joints what already has good flexion eg, if there are no issues with the MCP joints, you want to block the MCP joints to the flextion force will be transferred to the IP joints. If the MCP joints are stiff as well, you will include them in the pull. Hope that makes sense.

You will need:

  • A well fitting off the shelf wrist brace
  • Cotton glove (sold at many pharmacies or even dollar shops
  • Sports tape 
  • Elastic thread (sold by eg Ofit and at craft stores)
  • Off cut of Orfit Classic or other sticky thermoplastic if you want to block the MCPs (Needs to be sticky to stick on to the brace)
  • Safety pins (some cheap safety pins will bend so invest in some good quality ones)

For tools you need scissors, a heat gun if you want to add thermoplastic,  and a hole punch.

1. Place glove on patients hand and tape each tip with the sports tape. This is to reinforce the fabric as this will be your anchor.

2. Pull the tips away from the patient's hand and hole punch through the tape and glove fabric.

3. Fold the elastic in half and feed the folded part through each hole. Feed the two cut ends through the loop and pull to tighten. The threads will now stay put.

4. Place wrist brace on top of the glove and add the first safety pin. The postion of this will depend on the flexion deficiency. 

5. Place the second safely pin at the bottom of the brace. You now want to adjust the tension of the elastic thread according to deformity of each finger. This is a good knot that will not slide: Loop both end bits around your finger and feed through the hole - easy.

 

If you want to block the MCP joints you add a thermoplastic piece. I find dry heating eg Orfit classic works well as it sticks on to the brace well. It still needs to be worked in with your finger tips for a solid attachment. You may also want to pad the inside for extra comfort. Here is one made earlier, which is blocking the MCPs. This one might be good if you want to emphasise on the PIP joints.

If the fingers are very stiff you may want to consider making a small "cushion" for the fingers to rest on (not too big so it restricts the pull). Putting a bit of wadding inside some Tubifast is one idea....

It would be insteresting to hear what you think about this one and if anyone have used something similar. It is a cost effective and easy splint to make, and it seem to be well excepted by many patients. They key is not to pull too hard, but to be patient and go for a gradual increase of tension.