1. PRINCIPLES OF SPLINTING PIP JOINT FLEXION CONTRACTURES Virginia Tottenham BScPT CHT Lucy Winston BScOT Reg ( Ont ) CHT

2. OVERVIEW INTRODUCTION EVIDENCE BASED PRACTICE CLINICAL DECISION MAKING EVALUATION CASE PRESENTATIONS CONCLUSIONS

3. EVIDENCED BASED PRACTICE What is it? Lack of scientific studies Biology of scar Torque angle curve measurements T.E.R.T.

4. CLINICAL DECISION MAKING Efficacy Compliance Cost Effectiveness

5. EFFICACY Stage of healing Clinical experience Evaluation

6. COMPLIANCE Patient convenience Comfort Splint cosmesis

7. COST EFFECTIVENESS Material costs Therapist’s time Patient’s time

8. EVALUATION Expected outcome Clinical change Patient satisfaction

9. SOUTHLAKE REGIONAL HEALTH CENTRE HAND PROGRAM Hand therapy model of care Early intervention Close communication with referring specialists and family physicians Home program emphasized ++; modalities as needed English speaking patients, within 45 min of hospital

10. CASE STUDY #1 17 yr old RHD female student & competitive hockey player Hyper-extension injury to (R) D5 PIP Presented to hand therapy 3 months post-injury with flexion contracture D5 Springy end feels, edema and pain after sports

11. CASE STUDY #1 Rx at initial ax: –Night serial static extension digit splint

12. CASE STUDY #1 AROM PIP initial: D5 30/70 AROM PIP @ d/c: D5 10/100

13. CASE STUDY #2 36 year old RHD mill worker Jan 2002 sustained a saw injury (R) hand: –PIP joint injury D3 (bone loss) –PIP collateral ligament injury D3 –Flexor/extensor tendon injury D3 –Intrinsic muscle injury D3 –Common digital nerve injuries

14. CASE STUDY #2 May 2002: Hunter’s Rod insertion D3 September 2002: Tendon graft to D3 December 2002: increased D3 PIP flexion contracture noted despite use of volar, hand based extension splint @ night (since injury)

15. CASE STUDY #2 Rx: –Orfit extension splint (serial static circumferential) 23 hours per day

16. CASE STUDY #2 Decreased compliance with orfit splint Rx: –Capener splint (pre- fab dynamic) in day –Orfit splint at night

17. CASE STUDY #2 Patient stopped wearing splint Contracture increased Increased wear of capener splint in day Orfit splint at night

18. CONCLUSION Base splint choice on literature, scar biology, assessment of the joint Individualize treatment Severity of injury Surgery?