Splinting for Hand Contractures

Question: I have a patient who experienced a CVA 2 years ago - Left hemi with finger contractures in extension mostly.

What are you views about splinting? He has not worn his splint in 2 years because he says it hurts.

Thank you.

Answer: I would be more apt to splint a patient with hand flexion contractures because of the risk for skin breakdown and hygiene issues that occur inside the palm. If the patient has no active hand movement and has a long term extension contracture, I personally would leave it alone. If the patient has active finger flexion, and you want to increase it through composite flexion splinting then I think that is fine as long as the patient can tolerate it and wears it properly.

I don't typically order splints to increase flexion but rather:
1) Teach the patient & caregiver stretches
2) Use heat along with coban or ace bandages holding the fingers bent down for 20-30 minutes daily (or several times a day if the patient will comply), and/or
3) Use e-stim to increase flexion.

This is just my own technique, but it is by no means the only technique or necessarily the most effective. Splinting is acceptable as well. Honestly, it all boils down to patient compliance. If the patient doesn't follow through with instructions or cannot tolerate a certain method, then they will not make improvement with that method.

Another option might be a hand cpm (continuous passive motion) device. They have cpms that can be used at home. .