Finger MP Splints

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The metacarpophalangeal joints of the index, long, ring, and small fingers are condyloid with the rounded metacarpal head fitting into a small concavity at the base of the proximal phalanx. The ligamentous arrangement at each MP joint consists of two collateral ligaments and one palmar ligament that allow anteroposterior and mediolateral motion in addition to a slight amount of phalangeal rotation. Since the ligaments must extend around the cam-shaped palmar portion of the joint, the collateral ligaments are slack when the MP joint is in extension and taut when the joint is flexed. Pathologic conditions involving the metacarpophalangeal joints of the fingers frequently result in periarticular stiffness and eventually contracture in a position of extension or hyperextension. This deformity in a protracted state is extremely difficult to correct through conservative means. It is important to anticipate this problem and make appropriate efforts to maintain adequate length of the metacarpophalangeal collateral ligaments through preventive antideformity flexion splinting and exercise programs that emphasize full metacarpophalangeal joint flexion.

In addition to the MP splints illustrated in this section, other chapters in this book include designated sections that describe splints that affect the MP joints. Refer to Chapter 16, Hand and Wrist Splinting for the Patient with Rheumatoid Arthritis, and Chapter 13, Splints Acting on the Wrist and Forearm.

Immobilization Splints

Finger MP immobilization splints may be used to promote healing, control early postoperative motion, or enhance functional use. These splints may involve one or more joints and, depending on the specific requirements, may be fitted dorsally, palmarly, or laterally. While some specialized postoperative splints immobilize the MPs in extension, it is far more common to immobilize the MP joints in flexion. The antideformity position for the MP joints is 70-90° of MP flexion, but other positions are used depending on patient-specific needs. For example, finger MP joint extension immobilization splints protect extensor digitorum communis repairs; and MP flexion immobilization splints prevent MP collateral ligament shortening. As noted above, the antideformity position holds MP joint collateral ligaments at full length, thereby preventing their recurrent predisposition to shorten when not under stress.9,10,29

Type 0. Type 0 finger MP immobilization splints incorporate only the MP joints as primary joints (Fig. 11-1, A). There are no secondary joints in type 0 MP immobilization splints and the wrist and finger interphalangeal joints are permitted full, unencumbered motion. The MP joints may be positioned in abduction, adduction, extension, flexion, radial deviation or ulnar deviation.

Type 1. In addition to incorporating the MP joints, type 1 finger MP immobilization splints incorporate one secondary joint either proximal or distal to the primary MP joints, depending on individual patient requisites.

Type 2. Finger MP immobilization splints, type 2, incorporate two secondary joints in addition to the primary MP joints. Secondary joints may lie proximal, distal (Fig. 11-1, B), or one proximal and one distal to the MP joints.

Mobilization Splints

Splinting for mobilization of a metacarpophalangeal joint should incorporate a 90° rotational force on the

Mcp Joints Capsule Tape Ring Finger

Fig. 11-1 A, Index finger MP extension immobilization splint, type 0 (1) B, Small finger MP flexion immobilization splint, type 2 (3)

A, Fitted dorsally, this immobilization splint prevents articular motion at the metacarpophalangeal joint. B, Incorporation of the lateral aspect of the fifth digit provides stability to this splint that maintains the metacarpophalangeal joint in flexion, allowing the radial collateral ligament to heal.

distal aspect of the proximal phalanx. This force must also be perpendicular to the axis of rotation in the mobilization plane of the involved joint. If a perpendicular pull is not achieved, unequal force will be applied to the periarticular ligaments, which may cause attenuation and result in harmful ulnar or radial deviation of the digit. To allow full flexion, the palmar metacarpal bar of an MP flexion splint should not extend beyond the distal palmar flexion crease. If distal migration of the splint limits metacarpopha-langeal motion, an elbow cuff, triceps cuff, or diagonal splint straps may be added to further stabilize the splint on the extremity. A lining of nonskid material such as Dycem* may assist in limiting distal migration

*Dycem, P.O. Box 6920, 83 Gilbane St., Warwick, RI 02887

of the splint. The choice between a hand-based or forearm splint design depends on the presence or absence of extrinsic adhesions producing a tenodesis effect or on poor habitual posturing of the wrist. Mobilization assist design and material depend on the degree of contracture, length of time, and presence of end-range "give" of involved MP joints.

Type 0. Finger MP mobilization splints affect motion only at the primary MP joints. Secondary joint levels are not included in type 0 MP mobilization splints. These splints may be designed to improve MP abduction (Fig. 11-2, A), adduction, extension (Fig. 11-2, B), or flexion (Fig. 11-2, C-E).

Type 1. Type 1 MP mobilization splints incorporate one secondary joint, either proximally or distally to the primary focus MP joint(s). If the wrist is included as a secondary joint, extrinsic musculo-tendinous units are affected in addition to articular motion at the MP joint. Type 1 MP mobilization splints may be designed to improve finger MP abduction (Fig. 11-3, A,B), adduction, extension (Fig. 11-3, C-E), flexion (Fig. 11-3, F-J), supination, pronation, or circumduction.

Type 2. In addition to the primary MP joints, two secondary joints are included in MP mobilization splints, type 2. Secondary joints may be split with one proximal and one distal to the MP joints, or both secondary joints may be situated distal to the MPs. Two proximal secondary joints would include the elbow in addition to the wrist—an unlikely clinical scenario. Type 2 MP mobilization splints may be fitted to improve MP abduction, adduction, extension (Fig. 114, A), flexion (Fig. 11-4, B,C), supination, pronation, or circumduction.

Type 3 and More. Type 3 MP mobilization splints incorporate three secondary joints in addition to the primary MP joints. Usually, the secondary joints are split with one proximal (wrist) and two distal levels (PIP and DIP) (Fig. 11-5, A,B). Type 5 MP mobilization splints may exhibit idiosyncratic designs reflecting individual patient needs. For example, they may have unusual designs that include an innovative combination of same-level and distal secondary joints within two or more adjacent finger rays (Fig. 11-5, C-E).

Mobilization/Restriction Splints

Type 1. Type 1 splints that both mobilize and restrict the MP joint have one secondary joint level, usually the wrist. MP extension mobilization /flexion restriction splints, type 1, typically are used to treat extensor tendon injuries in Zones V, VI, and VII (Fig. 11-6).

Text continued on p. 290

Wrist Mobilization Increase ExtensionHospital Finger Splint

Fig. 11-2 A, Index, ring-small finger MP abduction mobilization splint, type 0 (4) B, Small finger MP extension mobilization splint, type 0 (1) C, Ring-small finger MP flexion mobilization splint, type 0 (2) D, Small finger MP flexion mobilization splint, type 0 (1) E, Ring finger MP flexion mobilization splint, type 0 (1)

Type 0 finger metacarpophalangeal mobilization splints may augment abduction (A), extension (B), or flexion (C-E). A, To improve finger MP abduction, the fingers are extended and mobilizing forces are directed toward the ulnar side of the index proximal phalanx, the radial sides of the ring, and small proximal phalanges, away from the stable long finger ray. D-E, This specialized outrigger maintains a 90° angle to the proximal phalanx as MP joint motion changes, and the unique inelastic mobilization assist facilitates tension adjustments. [Courtesy (D,E) Nelson Vazquez, OTR, CHT, Miami, Fla., and Damon Kirk, WFR Corporation, Wyckoff, N.J.]

Finger Mobilization

Fig. 11-3 A,B, Index-long finger MP abduction mobilization splint, type 1 (3) C, Long finger MP extension mobilization splint, type 1 (2) D, Index-long finger MP extension mobilization splint, type 1 (3) E, Index-small finger MP extension mobilization splint, type 1 (5) F, Small finger MP flexion mobilization splint, type 1 (2) G,H, Index-ring finger MP flexion mobilization splint, type 1 (4) I, Index-small finger MP flexion mobilization splint, type 1 (5) J, Index-small finger MP flexion mobilization splint, type 1 (5)

These type 1 finger MP mobilization splints are designed to increase abduction (A,B), extension (CE), or flexion (F-J) of the MP joints. Despite different configurations and force directions, these splints function mechanically in a similar manner. H, Radial view of the splint shown in G. [Courtesy (A,B) Jerilyn Nolan, MA, OTR, CHT, Norwalk, Conn.; (C) Kathryn Schultz, OTR, CHT, Orlando, Fla.; (D) Esther May, PhD, OT, Adelaide, South Australia; (E,F) Helen Marx, OTR, CHT, Human Factors Engineering of Phoenix, Wickenburg, Ariz.; (G,H) Barbara Smith, OTR, Edmond, Okla.; (J) Rachel Dyrud Ferguson, OTR, CHT, Taos, N.M.; (i) Karen Schultz-Johnson, MS, OTR, FAOTA, CHT, UE-Tech, Edwards, Colo.]

Fig. 11-3 A,B, Index-long finger MP abduction mobilization splint, type 1 (3) C, Long finger MP extension mobilization splint, type 1 (2) D, Index-long finger MP extension mobilization splint, type 1 (3) E, Index-small finger MP extension mobilization splint, type 1 (5) F, Small finger MP flexion mobilization splint, type 1 (2) G,H, Index-ring finger MP flexion mobilization splint, type 1 (4) I, Index-small finger MP flexion mobilization splint, type 1 (5) J, Index-small finger MP flexion mobilization splint, type 1 (5)

These type 1 finger MP mobilization splints are designed to increase abduction (A,B), extension (CE), or flexion (F-J) of the MP joints. Despite different configurations and force directions, these splints function mechanically in a similar manner. H, Radial view of the splint shown in G. [Courtesy (A,B) Jerilyn Nolan, MA, OTR, CHT, Norwalk, Conn.; (C) Kathryn Schultz, OTR, CHT, Orlando, Fla.; (D) Esther May, PhD, OT, Adelaide, South Australia; (E,F) Helen Marx, OTR, CHT, Human Factors Engineering of Phoenix, Wickenburg, Ariz.; (G,H) Barbara Smith, OTR, Edmond, Okla.; (J) Rachel Dyrud Ferguson, OTR, CHT, Taos, N.M.; (i) Karen Schultz-Johnson, MS, OTR, FAOTA, CHT, UE-Tech, Edwards, Colo.]

Finger Splinting Static Extension Splint

Fig. 11-4 A, Index-small finger MP extension mobilization splint, type 2 (9) C, Index-small finger MP flexion mobilization splint, type 2 (9)

Incorporating two secondary joints, type 2 mobilization splints may use elastic (A) or inelastic (C) traction to remodel adherent soft tissues. (A) Rigid thermoplastic slings prevent full PIP joint motion, making this splint a type 2. Note the lack of MP flexion before splinting initiated (B) and after 2 weeks of serially applied MP flexion mobilization splints (C). [Courtesy (A) Paul Van Lede, OT, MS, Orfit Industries, Wijnegem, Belgium; (B,C) Christopher Bochenek, OTR/L, CHT, Cincinnati, Ohio.]

Fig. 11-4 A, Index-small finger MP extension mobilization splint, type 2 (9) C, Index-small finger MP flexion mobilization splint, type 2 (9)

Incorporating two secondary joints, type 2 mobilization splints may use elastic (A) or inelastic (C) traction to remodel adherent soft tissues. (A) Rigid thermoplastic slings prevent full PIP joint motion, making this splint a type 2. Note the lack of MP flexion before splinting initiated (B) and after 2 weeks of serially applied MP flexion mobilization splints (C). [Courtesy (A) Paul Van Lede, OT, MS, Orfit Industries, Wijnegem, Belgium; (B,C) Christopher Bochenek, OTR/L, CHT, Cincinnati, Ohio.]

Ms13 Finger Joints Supination Joint Mobs

Fig. 11-5 A, Index-small finger MP extension mobilization splint, type 3 (13) B, Index finger MP supination mobilization splint, type 3 (4) D,E, Ring finger MP supination mobilization splint, type 5 (6)

A,B, Type 3 MP mobilization splints that incorporate two distal secondary joints utilize longer lever arms to affect MP joint motion. C-E, An innovative type 5 MP supination mobilization splint pairs the involved fourth finger with the normal fifth finger to achieve supination of the fourth MP joint, the only primary joint included in the splint. [Courtesy (A) Jason Willoughby, OTR, Richmond, Ky.; (C-E) Sandra Robinson, OTR, CHT, Elmira, N.Y., and Jill Townsend, PT, CHT, West Chester, Pa.]

Fig. 11-5 A, Index-small finger MP extension mobilization splint, type 3 (13) B, Index finger MP supination mobilization splint, type 3 (4) D,E, Ring finger MP supination mobilization splint, type 5 (6)

A,B, Type 3 MP mobilization splints that incorporate two distal secondary joints utilize longer lever arms to affect MP joint motion. C-E, An innovative type 5 MP supination mobilization splint pairs the involved fourth finger with the normal fifth finger to achieve supination of the fourth MP joint, the only primary joint included in the splint. [Courtesy (A) Jason Willoughby, OTR, Richmond, Ky.; (C-E) Sandra Robinson, OTR, CHT, Elmira, N.Y., and Jill Townsend, PT, CHT, West Chester, Pa.]

Restricted Wrist Supination Wrist Joint Mobilization

Fig. 11-6 A-C, Index-long finger MP extension mobilization / flexion restriction splint, type 1 (3)

With one secondary joint—the wrist—this splint (A) assists extension of the index and long finger MP joints and (B) restricts index and long finger MP flexion. C, Dorsal view. (Courtesy Lori Klerekoper DeMott, OTR, CHT, Columbus, Ohio.)

Fig. 11-6 A-C, Index-long finger MP extension mobilization / flexion restriction splint, type 1 (3)

With one secondary joint—the wrist—this splint (A) assists extension of the index and long finger MP joints and (B) restricts index and long finger MP flexion. C, Dorsal view. (Courtesy Lori Klerekoper DeMott, OTR, CHT, Columbus, Ohio.)

Restriction Splints

Splints designed to partially limit finger MP motion may affect motion in one or more planes and they may or may not incorporate secondary joints. Both articulated and nonarticulated MP restriction splints are used to control partial arcs of MP motion. Splint design and strap placement are predicated on specific criteria for fitting the splint and the need to obtain a firm purchase on the finger metacarpals and proximal phalanges while simultaneously allowing controlled motion of the primary MP joint(s).

Type 0. Type 0 finger MP restriction splints incorporate no secondary joints. They may be used to limit MP joint abduction, adduction, extension, flexion, supination, pronation, radial deviation (Fig. 11-7, A), ulnar deviation23 (Fig. 11-7, B-D), or circumduction. The proximal aspects of type 0 MP restriction splints should not impede wrist motion, and to provide optimum mechanical advantage, phalangeal bars on these splints should extend as far distally on the proximal phalanx as possible without interfering with PIP joint motion. Finger MP restriction splints, type 0, allow healing of specific MP joint capsule structures while permitting motion that is not disruptive to the reparative process. They are also used to enhance finger function through improved MP joint positioning.

Type 1 and More. Finger MP restriction splints with one secondary joint level are classified as type 1, those with two secondary joint levels are type 2, and so on. Secondary joint levels lie proximal or distal to the primary focus MP joint(s) or they may be split with the primary MPs situated between the secondary joints.

Torque Transmission Splints

Finger MP torque transmission splints transfer moment to primary joints that are situated beyond the boundaries of the splint itself, or if primary joints are included within the splint, they are "driven" by harnessed secondary joints that are also included within the boundaries of the splint. Torque transmission splints may transfer moment longitudinally or transversely. Often referred to as "exercise" splints, these splints are used to remodel soft tissue structures and improve joint motion, and are often paired with specific exercises and with functional activities.

Type 1 and More. Torque transmission splints affecting finger MP joints may have one, two, or three secondary joint levels incorporated in these splints and are categorized as type 1, type 2, or type 3, respectively. Splints that function longitudinally to transmit torque to the MP joints limit motion of the IP joints distally so that extrinsic muscle power is focused on the MP joints. These splints also may be paired with MP torque transmission splints that limit secondary wrist motion proximally (Fig. 11-7, E).

Torque Transmission Splint

Fig. 11-7 A, Index finger MP radial deviation restriction splint, type 0 (1) B,C, Index-small finger MP ulnar deviation restriction splint, type 0 (4) D, Index-small finger MP extension, flexion, and ulnar deviation restriction splint, type 0 (4) E, Index-small finger MP extension and flexion torque transmission splint, type 2 (12) \\ Index-small finger MP extension and flexion torque transmission splint, type 1 (13)

Articulated (A-C) and nonarticulated (D) MP deviation restriction splints align MP joints to improve hand function. C, Palmar view of the splint shown in B. E, Torque transmission splints that affect the MP joints may control secondary IP joint levels, they may control the wrist secondarily, or the two splints may work together to transmit extrinsic muscle power to the MP joints. Note that the type 2 splint includes the wrist and the type 1 splint includes the fingers. [(B,C) from Rennie HJ: Evaluation of the effectiveness of a metacarpophalangeal ulnar deviation orthosis, J Hand Ther 9(4):371-7, 1996. Courtesy (D) Barbara Smith, OTR, Edmond, Okla.]

Fig. 11-7 A, Index finger MP radial deviation restriction splint, type 0 (1) B,C, Index-small finger MP ulnar deviation restriction splint, type 0 (4) D, Index-small finger MP extension, flexion, and ulnar deviation restriction splint, type 0 (4) E, Index-small finger MP extension and flexion torque transmission splint, type 2 (12) \\ Index-small finger MP extension and flexion torque transmission splint, type 1 (13)

Articulated (A-C) and nonarticulated (D) MP deviation restriction splints align MP joints to improve hand function. C, Palmar view of the splint shown in B. E, Torque transmission splints that affect the MP joints may control secondary IP joint levels, they may control the wrist secondarily, or the two splints may work together to transmit extrinsic muscle power to the MP joints. Note that the type 2 splint includes the wrist and the type 1 splint includes the fingers. [(B,C) from Rennie HJ: Evaluation of the effectiveness of a metacarpophalangeal ulnar deviation orthosis, J Hand Ther 9(4):371-7, 1996. Courtesy (D) Barbara Smith, OTR, Edmond, Okla.]

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Responses

  • iolanda loggia
    How to splint finger at MP joint?
    2 years ago
  • marco
    How to immobilize the metacarpophalengeal joint?
    6 months ago
  • petra konig
    How to increase MP flexion?
    2 months ago
  • zane
    How to splint an mcp joint index finger?
    2 months ago
  • Niklas
    How to measure mp width for hand splint?
    1 month ago

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