Series part 6 - What Type of Splint Should I Make for a Suspected Flexor Tendon Injury
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[00:00:00] Hey there. So today I have a question from a fan that asked a splinting question. What type of splint should I make for a suspected flexor tendon injury? So I'm going to answer that and I'm going to share with you the exact questions she sent to me. I think it's a she. Well, anyway, my name is Wong. I'm an occupational therapist and certified hand therapist.
And over 10 years ago, I started my own therapy clinic. And then five years ago, I started Hand Therapy Secrets in order to help more therapists develop their clinical and business skills. So, let's get into this question. The question is, um, basically, I have a patient, I'm working in acute care, and the patient has a suspected flexor tendon injury to the first and second digit.
Is it the first and second digit, um, if these are fingers, or if you're talking about the first and second digits, then it's the thumb and the index finger. So patients pointer finger [00:01:00] rest in extension and they cannot actively flex patient may have surgery on it later next year but would limit their mobility and be able to wait there.
I'm trying to solve a problem. I'm trying to problem solve a finger splint the patient can rest that can wear at rest in comfort. Um, any ideas? So all right. So when it comes to making splints, what type of splint? would I make for suspected flexor tendon injury? I would then go and think, well, do you really need a splint?
Cause a splinting principle is all about, do you really need a splint? And what are you using it for? Is it comfort or is it for function or is it for protection? So here I would really question, Is it a flexor tendon injury or potentially a nerve type of injury, especially when it's the thumb and the index finger, because these two belong to a very specific nerve.[00:02:00]
So, flexor tendon injuries don't just Come out of nowhere, right? Flexor like actual flexor tendon injury. The tendons of the fingers are really tough and strong So you can rupture it because there is something hard and pulling right or you can cut it It just doesn't just come out of nowhere. So that makes it really hard to say okay, what splint would they need because A true flexor tendon injury You wouldn't just wait like a year before you do surgery because if you cut the tendon or the tendon ruptured, the tendon goes and pulls back to its original, um, position, right?
And then after a while, the muscle gets short and, and the body depends on it. deposits fat there and then the quality of the tendon, the quality of the muscle no longer has that elasticity that it needs to be [00:03:00] able to get long and get short, right? So I'm gonna suspect that if you're, if this person is waiting for potentially a year to do any kind of secondary surgery, my guess is going to be that this isn't really a full surgery.
flexor tendon injury, but rather a nerve injury that has now impaired the ability for, um, flexion of the D. I. P. Potentially flexion of the P. I. P. Now I'm coming from like very little information. So in this particular case, what split would I make for this? Particular type of nerve injury. I wouldn't necessarily make a splint, um, to the thumb and to the index finger.
You You don't necessarily need to put them into any kind of position if you're looking at if you're looking at the principles of splinting. Do I need to position them somehow or another, [00:04:00] right? Usually the positioning is to protect a particular joint structure, surgery, anything like that. And based on the little bit of information that I have, Um, there isn't necessarily anything to protect, uh, from a positioning standpoint.
There is no, um, functional, what's the word I'm looking for? There's no functional benefit to put the hand into any kind of flux position that, um, or allow them to use it. because there is no active flexion. So even if you were to put them into, um, MP flexion, IP extension, they wouldn't be able to fully flex through if that flexor tendon isn't working.
So ideally you would put them in no split. Um, if the index finger isn't working, but the [00:05:00] middle finger is working, you might buddy strap them together because the fingers are somewhat the same height and so you could buddy strap them here and here and then the long finger, right, the middle finger will help the index finger move.
Let me know if that makes sense. Um, so if you have a splinting question or if you're not really sure about what splint to make, really go back to the actual injury itself and then think through the principles of splinting and, um, and ask yourself, do I really need to splint? Just because we want to make a splint doesn't mean that the patient necessarily needs a splint.
Another splinting principle is that the patient has to like see a benefit, right? It has to be comfortable. They have to see a benefit. And if it doesn't somehow make them more functional, um, it's not necessarily going to, and it's not going to help them. They won't necessarily wear it. [00:06:00] And I wouldn't really, Worry about, you know, a splint that the patient can wear at rest for comfort because their fingers should, will just rest in that comfortable position of extension.
The key thing now is like you have to maintain passive range of motion. If they don't have active range of motion, you need to maintain passive range of motion. in order to, um, when, if whatever other surgery they are going to have, then there'll be able to functionally use their hand, right? If you don't have any passive range of motion, they're going to get really stiff in the joint.
The tendons are going to get really stiff as well and not flexible. And then the skin hardens and then nothing is moving. So why would you do another surgery? So these are all the things that I'm thinking of when you ask me a type of question like this. Um, of like, you know, what splint do you need? Um, I would encourage you to kind of think [00:07:00] through your particular case.
I know the nature of the injury and the nature of the surgery in order to make the decisions about what splint and what treatments and basically what are the expectations, right? So you can make the best recommendation. This is something that I do all the time inside my mentorship program. I'll leave the links below for you, but I hope this question and answer helps you to think through your cases.
If you're an occupational therapist working, no matter what setting, you're going to have patients with hand and arm injuries. You're going to have patients with hand and arm problems that you're trying to help them. improve, recover, adapt for a short period of time until they can improve and recover, right?
Um, and that expands beyond the setting. So I just, I hope this helps you to think through no matter where you work, because this is a question coming from an acute care therapist. Uh, and I personally love acute care [00:08:00] because That's where I was for a really long time before I moved into hand therapy. So I hope this video helps you.
And again, my name is Huong Tran. If, uh, I'm going to leave some links below for you to, um, explore other videos as well pertaining to splints. All right. Uh, if this type of video helped you click the like and subscribe button, and I hope to, uh, see you next time for another question and answer.
