Learn Why Your Finger Tendon Snaps And How A Custom Orthosis Stops It

Transcript

What Causes The Snapping

Why Healing Keeps Re-Tearing

The Ring Splint Solution

Exam: Differentiating From Trigger Finger

Healing Timeline And Weaning Plan

Thermoplastic Splint Fabrication

Fit Checks And Fine Tuning

Relative Motion Orthosis Explained

Note: All timestamps are within duration

Wear Instructions And Precautions

SPEAKER_00 0:02

Welcome back to the hand to shoulder solution, giving pain the middle finger. I'm Carl Pentito, I'm an occupational therapist and a board certified hand therapist. I specialize in rehabilitating orthopedic conditions that affect the fingertips through the shoulder. Today I want to follow up on a previous episode when we discussed snapping of the tendon on the back of the knuckle, and that's called sagittal band rupture. The snapping that you're experiencing on the back of your knuckle is because there's a paper thin little ligament. Ligaments connect bone to bone. Over the top of this tendon, tendons connect your muscles up here to your finger bones. So when these muscles contract, they open your fingers. So when the muscle pulls on the tendons, it's pulling your fingers out straight. And you can see on my hand, those tendons really pop up quite a bit. When you close your hand, they are being pulled taut around the back of your knuckle. It's very common with your condition that the tendon is rolling off the back of the knuckle into this trough right here, and then when you open it up, it snaps back into place. Now, if you picture that that thin little ligament over the top is ripped, every time that tendon rolls off, any healing that has occurred has now ripped that out again. So what we need to do is make a little finger splint, like a ring splint, that will go around and prevent this knuckle from bending all the way. So your hand will be allowed to move into a fist, you'll be able to be functional. And what I recommend we do is just mold a little piece of splinting material around so it'd be like wearing two rings with a bridge in the center that will prevent this from tearing out that area that has to heal. Let me show you a little closer on your hand. Now, right here, go ahead and make a flat little hook fist like this. Now push up into my finger and see that tendon that pops up. When you close your fist, your tendon is snapping off and going in here as you open, pops out. This is, you know, and for the audience, this is often misdiagnosed as a trigger finger because there's a lot of catching that happens. Trigger finger is occurring in the palm, and then we talked about that in previous videos. But on the back of the hand, where this ligament is torn right here, I'm going to heat up this material and we'll mold it around your fingers so that this area stays protected so it can be allowed to heal. The tendon has to stay in place for a total of six to eight weeks in order for this thin little ligament to heal up fully, so you can stop wearing the splint after about eight weeks. Now, even if you had surgery to sew this back together, we would still have to protect this for approximately eight weeks. Then at around eight weeks, I would coach you in weaning yourself away from the splint. Now, let's take a measurement. And the trick with these is it has to be tight enough so it stays in place, but not so tight that it's too hard to remove. Because you will be able to remove this for bathing, but you just can't make a full fist. So I have my length, and this material is really nice. I heat it up in hot water, cut it out, then I heat it up again, and then mold it right onto you. And as it cools, it hardens. So this material, it's hard right now. Before I heat it, it's it's hard. It's called thermoplastic. So when I heat it up in hot water, it gets nice and soft. And it takes oh about 20 or 30 seconds or so to warm up. In the clinic, we have a nice big pan, nice and deep water with a more effective thermostat. And and I like to joke with my patients that if your splint is a little bit oily, it's okay, it's just olive oil. I made a chicken cachetori in here earlier. So that softens it enough so I can I can trim it to size. I just want it, I don't want it too wide or too narrow. It has to fit the patient's finger just right, and I want their correct angles because the patients have been wearing this all day long and using their hand functionally for activities. Another nice thing about this material is that it sticks to itself, but it has to be dry. So I'm gonna remove it from the heat, and I also use a heat gun to spot heat it as I need to in order to make fine adjustments. Alright, so now let's bring your fingers out straight. I'm gonna go around like this. We're gonna bring these two down and the center one up. Good, that's okay. You can just relax your hand. And we're gonna let that cool right there. This commonly happens with boxers, uh, with anybody who punches anything or anyone, and also from arthritis, and the joint starts to get degenerated. Perhaps sometimes bone spurs uh occur, and even just from wear and tear, this thin little ligament will rupture, and then this tendon will start snapping back and forth. It also becomes quite painful. And either way, with surgery or no surgery, we still need the splint to protect the healing ligament. So we always work to use the splint first instead of surgery, and it's only very rarely that surgery needs to be performed to repair this condition. So, more often than not, the large majority of the time, conservative treatment, meaning without surgery, is the most effective treatment for this. Okay, so that should be hard enough. We're gonna slide it off. Now, any therapist watching, if the splint is a little bit too tight on one finger and the skin is gathering, just pull the skin back and rock it back and forth a little bit slowly, then you can slide that off. And that's the splint. So the bridge in between is keeping this tenon on slack so this thin little ligament can heal. Now, what I like to do in a situation like this where it was too tight on that ring finger is I'll just heat up one portion, then I'll push that out a little bit. So that should be a little wider now. We don't want it too loose out of sloppy, but not too tight. It's uh uncomfortable to go over the the joints. So now we're gonna go, and that's perfect. So that position, now when you close down, this is called a relative motion orthosis because relative to the neighboring fingers, the finger that's involved, the finger that's injured, is up higher, and that's taking stress away from this to allow it to heal. Now, this is called a relative motion orthosis because relative to the neighboring fingers, the involved finger, the injured finger, is up higher, so that pressure is removed from this healing ligament so that it is allowed to heal. When you get in the shower, or if you're just gonna you know wash your hand, you can slide this off, just keep your fingers straight. If you close your fist and this rolls off, now you're starting from square one again. And then what I'm gonna do for you here is just put an arrow. This is the top of it, this arrow points toward you, and that's that part is gonna go underneath your middle finger. So when you slide that on, yeah, that's all it is, and that will allow you to heal. You can think of it as a cast that you have the luxury of removing so that you can wash your hand. But remember, you just cannot close your hand fully without that on. So, any therapist watching, what I like to do is roll these edges a little bit on the ends because when the patient is flexing and that the splint is tilting and extending and is tilting back here, I like to take those edges and I just contact the water, heat that up, and then I dry it well. I just dab it on a paper towel, and then roll the edge back. Then I have a nice little flare just on the edge, so it's nice and smooth. So I don't want I don't I don't want any sharp edge digging into the patient and wearing a wound into the skin. So I just make a dent on top of the water and just heating the edge right there. The water is nice versus uh a heat gun because you can be you know very focused on exactly where you want it, and the water is heating up both sides simultaneously, so for a lot of applications, little it's a little bit quicker. So then I'll just take this and just flare that edge. I don't really roll many many things anymore. I primarily just flare that, so now I have a nice, round, nice, smooth surface right there. Well, thank you for watching the techniques for fabrication of a relative motion orthosis. And one of the many reasons why we use these with this splitting material, this thermoplastic material, we're able to make splints for carpal tunnel syndrome, which I'm going to show in another video. Ligament ruptures, we're patients perhaps need a ligament repair with bone anchors. Uh also, we even make splints that have cables that actually stretch joints. So there's there's really a an endless possibility of different applications for these custom splints, and custom splints are very crucial because every hand is different, even on the same patient. The left hand is a lot different from the right hand most of the time. So, an over-the-counter brace, for example, that you know it's very cookie-cutter, and I've seen those more often than not cause a lot of harm. And there's actually another video in the collection that discusses the uh the dangers of over-the-counter splints. I invite you to go back to view other videos on this channel. We discuss the details of the cons of over-the-counter braces in much more detail. That will, I think, really open your eyes to a lot of dangers of those. Because I know that a lot of you are out there, you have wrist and hand pain, and you go to the store and say, Well, I'm just gonna get a wrist brace. Unfortunately, it's not that simple, it's not that easy. There are a lot of pitfalls involved. Thank you for watching.