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Night splint for contracture
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04/01/2013 20:50
JohnG 
04/01/2013 20:50
JohnG 
Night splint for contracture

On another thread Wolfgang mentioned a Canadian paper that reported some good outcomes for using night splints. They focused on PIP contracture. It seems to me that this deserves its own thread, so here it is.

Here's what Wolfgang posted:

A night splint after NA might help keeping our finger straight. It is helping with my PIPJ of my right pinkie. I had Xiaflex injected 1.5 years ago. It didn't get the joint fully straight and the contracture came back quickly. I am keeping it stable with wearing a night splint. I wore it for nearly 12 months and afterwards occasionally for a week when I feel it is getting worse.

Splinting and massaging might even help avoiding surgery. Interesting paper: http://www.ncbi.nlm.nih.gov/pubmed/21965179


I downloaded the entire paper. It's by J. Larocerie-Salgado and J. Davidson, both from Ontario Canada. I'll summarize it:


There were 19 fingers in the study, starting mostly with 20 to 50 degrees of contracture. After about two years, only one patient showed progression of the contractures during the followup period. All the others improved somewhat or stayed the same. The paper says that it seems to be common wisdom that splinting doesn't help, but their little study shows that it does seem to help.

Here's the treatment:

The splinting regimen consisted of a hand-based volar extension splint, with an adjustable strap placed over involved PIP joints (Figure 1). Patients were instructed to wear the splint at nighttime (6–8 hours) to allow for prolonged exposure of the contracted tissue to low load forces while permitting unrestricted use of the hand during the day (Flowers and LaStayo, 1994; Glasglow et al., 2003). When appropriate, splints were adjusted to increase PIPJ extension at the time of follow-up visits. Patients were also instructed to perform stretching exercises for the PIP joint into extension within pain-free range as well as friction massage to contracted tissue (i.e. nodules and cords) during the day.

Here's the splint (figure 1):



Here are the results:



Edited 04/01/13 23:53

04/01/2013 23:02
LubaM. 
04/01/2013 23:02
LubaM. 
Re: Night splint for contracture

The splint shown above (following NA of the PIP pinkie finger) makes much more sense to me than the one custom made for me after my second NA on that same finger. My splint was made of hard molded silicone, top and bottom, and therefore the minute the PIP started to bend a bit I had to stop wearing the splint in spite of the few attempts to adjust it to compensate for the bending finger... I stopped wearing the splint within two months of NA... and at six months, the contraction was totally back.

Now that I am considering doing NA on the other hand's pinkie I will definitely look into this kind of splint. I am a believer that splinting for a long period of time can delay recurrence. Thank you for posting this picture.

Edited 04/02/13 02:03

04/02/2013 02:12
Tusk 
04/02/2013 02:12
Tusk 
Re: Night splint for contracture

Would that type splint have to come from a hand therapist or could you perhaps find it online somewhere?

04/02/2013 03:10
JohnG 
04/02/2013 03:10
JohnG 
Re: Night splint for contracture

Tusk:
Would that type splint have to come from a hand therapist or could you perhaps find it online somewhere?

There are lots of ready-to-use splints, along with kit materials, here
http://www.sears.com/search=sammons+pres...ectType=CAT_REC

None of them look like the one in that Canadian paper, so I'm guessing the Canadian authors made their own custom splints, maybe using a kit.

Among the models on that sears website, here are a few that look like they are intended for the PIP joint:

http://www.sears.com/sammons-preston-rol...s_tnt=39869:4:0

Sammons Rolyan Proximal Interphalangeal Extension (P.I.P.E.) Splint can be selected from one of five pairs of interchangeable dynamic coil springs to apply a desired amount of force to extend the PIP joint. As the contracture improves, a new set of springs can be applied to maintain a low magnitude of force. Width of this aluminum splint can be modified to accommodate change in edema.

http://www.sears.com/sammons-preston-rol...s_tnt=39869:4:0


http://www.sears.com/sammons-preston-rol...s_tnt=39869:4:0


http://www.sears.com/sammons-preston-rol...s_tnt=39869:4:0

http://www.sears.com/sammons-preston-rol...s_tnt=39869:4:0

Edited 04/02/13 06:16

04/02/2013 06:42
stephenjeffrey 
04/02/2013 06:42
stephenjeffrey 

Re: Night splint for contracture

Thanks for highlighting this JohnG

Dr Meinel's presentation 45 dupuytrens symposium 2010 on YouTube.
http://www.youtube.com/watch?v=882JB9cXDME

He says he is constantly amazed (2mins25secs) at the extension deficit reduction achieved when night splinting with a silicone gel !

Edited 04/02/13 18:51

04/07/2013 12:49
Chrissie

not registered

04/07/2013 12:49
Chrissie

not registered

Re: Night splint for contracture

Hi there

I have just read about the silver ring splints. But I cannot find an outlet in the UK. Does anyone know where I can buy any of the finger only splints please? I assume Sears are in the US. Still in pain after surgery on 25th Feb. Remove splint for an hour during the day and it flexes noticeably. Surgeon says keep it on continually except when excercising every hour. Physio say leave it off all day :-(

[Same splint as shown by JohnG above]

PS I have a pressure sore developing over the base of my pinkie and the splint I have presses on my thumb muscle uncomfortably. Going back for re assessment on Tuesday.

Edited 04/07/13 15:51

04/08/2013 21:19
JohnG 
04/08/2013 21:19
JohnG 
Re: Night splint for contracture

Chrissie, Sears is a U.S. retailer, but the splints made by SAMMONS PRESTON are sold by many vendors, not just Sears.

I pasted the following into google.co.uk and it turned up vendors that will ship worldwide:

SAMMONS PRESTON Rolyan Proximal Interphalangeal Extension Splint

If you try a splint from them, let us know if you like it.

04/18/2013 03:15
pia2some 
04/18/2013 03:15
pia2some 
Re: Night splint for contracture

I have DD in both hands. Last spring I had Xiaflex in a cord on my right hand. I doubt I'll be doing Xiaflex again. What I wanted was NA but for years couldn't find anyone around Atlanta that did it. Then I discovered Dr. Kay Kirkpatrick from a link on Dr. Eaton's site. She trained with him to learn the NA procedure. So I saw Dr. K in January and she wants to wait a little longer before doing NA. Both hands are full of nodules and cords and I've even got my middle finger pulling sideways under my ring finger. I have a lot of pain and we're not sure why. It may have to do with my diabetes. Anyway, my hands swell during the night and by morning they are very painful and not functional. Dr. K suggested trying extension splints during the night.

Obviously, it does not change the course of the disease or fix anything. But her thinking and experience is that using the splints does help reduce the swelling and can help with the pain. Here is what I got.




As my fingers and hands change and contract more, the splints can be reheated and molded to fit whatever changes have taken place. It's kind of comical wearing these at night. Once they're on, I'm useless. lol. But I've definitely noticed that they feel better in the mornings. It's only been a week though.
~ dawn

04/18/2013 05:53
kenny27dc 
04/18/2013 05:53
kenny27dc 
Re: Night splint for contracture

Dawn,
Good luck with your hands. I had NA with Dr. Eaton 4 years ago on both hands. I just saw Dr. Bourland in Memphis this week. To get the NA procedure again on one hand.
Ll the best
Kenny

04/20/2013 01:22
beamer1 
04/20/2013 01:22
beamer1 
Re: Night splint for contracture

This message is for Dawn regarding the extension splints that she is shown wearing. Can you tell me where you got these splints? I assume they were probably made by a therapist from a prescription but just in case you purchased them somewhere else I would really like to know. The idea that they can be reheated and remolded when needed would be great. I have worn splints on both hands for some time now but need to replace and prescription splints are soooo expensive. Any help you can give me would be appreciated and thanks.

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