There are many reasons why Hand Therapists treat stiff joints in the clinic. Stiffness in fingers, wrists, forearms and elbows is caused by initial trauma, stabilization/ immobilization and swelling. Therapists will often fabricate a variety of splints that help patients restore mobility and help them return to normal activity.
Doctors order such splints when a joint is not responding quickly enough to normal manual therapy intervention. The types of splints help restore motion include serial-static, dynamic and static-progressive. A test called the Modified Weeks Test helps us to determine which type of splint is appropriate. First, an angle measurement is taken of the affected joint. Heat is then applied for 15 to 20 minutes followed by manual or mechanical mobilization of the joint. If a gain of 10-20 degrees is realized we fit the patient with a serial-static or dynamic splint. If the gain is less than 10 degrees a static-progressive splint is chosen.
The serial-static splint design uses a low temperature plastic that is heated and applied to the affected joint with a moderate stretch and secured with Velcro strapping. As the joint and surrounding tissues accommodates to the gains in motion, the splint is reheated and the procedure is repeated until the desired motion is gained.
Dynamic splints use a predetermined force that is applied to the distal lever arm of the joint. They use the principle of Total End-Range Time in which gains in motion are often proportional to the wear time and the amount of force that the splint exerts. Dynamic splinting often works best for stiffness caused by muscle and tendon tightness.
Static-progressive splints use the concept of Low Load Prolonged Stretch and Total End-Range Time in which a moderate force is exerted on the joint. As the patient accommodates to the stretch, the force is gradually increased. This allows for a gradual relaxation and elongation of tissues. Static-progressive splinting often works best for the very stiff and fixed joint contractures.
Success of these types of splinting for increased motion programs are often directly related to the length of time the patient has had the stiff joint. Joint stiffness treated early enough often has better outcomes than those that have been untreated for a long time. For more information about custom splinting programs to help joints regain mobility contact Hand & Upper Extremity Rehab Specialists at 724-942-5410.