Dynamic Splinting for the Stiff Hand after Trauma: Predictors of Contracture Resolution

Randomized Controlled Trial of Daily Total End Range Time (TERT) for Capener Splinting of the Stiff Proximal Interphalangeal Joint

“…First, as in Kolumban's (1969) study, the small sample size limited the power of statistical analyses, increasing the risk of Type 2 error (i.e., inability to detect a true significant difference). Second, data for this study were collected as part of a larger splinting cohort study we conducted (Glasgow et al, 2011). This larger sample included both flexion and extension deficits of PIP or MCP joints, reflective of the majority of stiff joints presenting to the hand clinics at EKCO in Brisbane, Queensland, Australia, during the 3.5-yr data collection period.…”

“…TROM was assessed at 500 g using the Haldex tension gauge (Glasgow et al, 2003), and demographic data were collected for the predictor variables. A dynamic Capener splint was then fabricated, and the mobilizing force was set to 200-250 g. The modified Weeks Test assessment of joint stiffness was then conducted (Glasgow et al, 2011); that is, the splint was applied for 30 min and change in AROM was recorded as the estimate of stiffness. We had previously found that the modified Weeks Test predicted outcome with splinting (Glasgow et al, 2011).…”

“…Twenty-two participants with an extension deficit in one PIP joint were recruited from the hand clinic at EKCO Occupational Services from November 2004 to May 2008. This sample was a subset of a larger cohort of patients with deficits in either MCP or PIP joints involved in a prospective splinting project we conducted (Glasgow, Tooth, Fleming, & Peters, 2011).…”

“…Clinical variables assessed included age (yr), diagnosis (e.g., fracture, soft tissue injury, volar plate), gender, pretreatment joint stiffness (modified Weeks Test; Flowers, 2002;Glasgow et al, 2011), time since injury (wk), digit, and insurance status (workers' compensation, non-workers' compensation). The extent of contracture resolution was measured using three outcome variables: (1) change in AROM (degrees), (2) change in PROM (degrees), and (3) change in torque range of motion (TROM; degrees) from baseline to after 8 wk of dynamic splinting.…”

Management of the Stiff Finger

“…Dynamic splinting applies a passive constant force to maintain the stiff joint in a lengthened position using energy-storing or elastic materials. 30 Static progressive splinting concentrates a force to the stiff joint in order to statically position at the maximal stretch, using inelastic components. 31 Static progressive splints require adjustment of the inelastic components as the range of joint motion improves.…”