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Sugar Tong vs Muenster
109 Plays1 day ago
Sugar tong vs Muenster—Miranda and Josh break down what each splint does and when to use them in clinical practice.
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Transcript
Introduction and Orthosis Choice Question
00:00:05
josh MacDonald
Hi, I'm Josh McDonald.
00:00:07
Miranda Materi
And I'm Miranda Materia, and we are Hand Therapy Academy.
00:00:10
josh MacDonald
We're going to talk, we're going to answer a question we got on Instagram from someone about when we would choose to use a sugar tongue versus a Munster style orthosis for like TFCC or DRUJ instability for that blocking that forearm rotation. So, Miranda, do you have a preference one versus the other in general?
Munster vs Sugar Tongue: Flexibility and Design
00:00:28
Miranda Materi
Yeah, I definitely usually go more with the Munster. I like that you can open up the backside of the elbow where they can do flexction elbow extension and flexion versus the sugar tongue. They can do it within a shorter arc, but they can't ever like fully extend their elbow.
00:00:43
Miranda Materi
So I think that's a limitation of it. And I guess maybe we should explain what is the difference between a Munster and sugar tongue? Right, which we just did.
00:00:50
josh MacDonald
Yeah.
00:00:51
Miranda Materi
But just to recap, a Munster is where the back usually has a strap or pieces that go around, but you can open up that strap so they can bend and extend their elbow versus a sugar tongue is a continuous piece of plastic that goes from the volar to the dorsal side of the hand.
00:01:06
Miranda Materi
and It goes all the way around the elbow kind looking like a sugar tongue.
00:01:11
josh MacDonald
Yeah. Yeah. And the Munster is more radial based and has the pull for the thumb, kind of like a radial gutter, but it usually stops at the distal palmar crease unless you've got some other traumas going on.
00:01:23
Miranda Materi
Right. And then the sugar tongue basically has an opening on the radial and the ulnar side.
00:01:26
josh MacDonald
Yeah.
Orthosis Structural Challenges and Solutions
00:01:27
josh MacDonald
Yeah. Yeah.
00:01:27
Miranda Materi
Sometimes people think, well, you know, this they have a, you know, an ulna fracture or something like that. And the sugar tongue would be more immobilization, but not really. Right. Okay.
00:01:36
josh MacDonald
Yeah, yeah. the The Munster can be pretty near full circumferential with just very little opening on the ulnar border. And I find that on smaller forearm patients, the sugar tongue, the two pieces end up very short.
00:01:53
josh MacDonald
And I feel like it just doesn't have as much purchase on their forearm as the Munster does. But on larger patient, maybe a labor or someone with that with ah just a larger forearm, you need a lot of material to get all the way all the way around on a Munster.
00:02:06
josh MacDonald
So maybe just a preference there.
00:02:06
Miranda Materi
Right. And then how, you know, how do you put all that material on your splint pan, right? Especially if you're in a smaller, we have a smaller splint pan, then, you know, you're having to lay the material down and then fold the material on top.
00:02:11
josh MacDonald
Yeah.
00:02:18
Miranda Materi
So it's not sticking to the material on the bottom.
00:02:21
josh MacDonald
Yeah, yeah.
00:02:21
Miranda Materi
And then how do you do that, you know?
00:02:23
josh MacDonald
and And I've seen like, we're very fortunate, very blessed. I kind of inherited this giant splint pan at one of our offices.
00:02:28
Miranda Materi
again
00:02:29
josh MacDonald
And then we have some small ones at the others. So the the way I'll do, ah like if I have to do a very long piece, maybe even in our smaller splint pans, a longer like dorsal blocking for flexor tendon or resting hand splint.
00:02:42
josh MacDonald
If I have to, if it doesn't all fit, I'll lay some paper towel. over top of the half of it that's already in the water and then fold the other half over the paper towel. So there's no splint to splint contact. The paper towel is in between. And then it comes right out pretty darn easy. So you can fold it in half on itself as long as you don't let those two splint materials touch those two layers.
Fabrication and Comfort: Munster Orthoses
00:03:03
Miranda Materi
Yeah, paper towel works great.
00:03:03
josh MacDonald
Yeah, yeah. Yeah, yeah. um I prefer a Munster. I think it is an easier position for the patient to have a splint made on them. I can do it while they're sitting in the clinic, just sitting up in a chair. I tell them just to pull their elbow out from their body a little bit and keep that elbow at 90 degrees. I just have to make sure they stay in a true supinated pronated neutral position and they don't start to like turn that palm up on me. But that's an easier position.
00:03:31
josh MacDonald
The sugar tongue, I feel like to to let gravity help or to not be fighting gravity, pulling it away from their hand only, have to have them hold their elbow up at like a shoulder at 90 degrees. And then I'm pulling it up and tagging to the distal palm crease, maybe in supine. It just takes a little bit more time for them to be on tension, holding their arm up in space.
00:03:51
Miranda Materi
Right. Yeah. And maybe a couple more hands, you know, maybe having someone help you fabricate it then because is a lot of material to manage.
00:03:57
josh MacDonald
Yeah, yeah.
00:03:58
Miranda Materi
Yeah.
00:03:59
josh MacDonald
I feel like the Munster has more like post stuff to do, like post forming stuff. You got to add more edging and padding and straps and cut the hole for the thumb. And there's more to do on that aspect, but the patient's much more comfortable while I make the Munster.
00:04:14
Miranda Materi
Yeah, that's true. And then you can have it off while you're adding all that stuff onto it.
00:04:18
josh MacDonald
yeah Yeah. Yeah. And they get to rest and they're in a very neutral position. And yeah. Yeah. I prefer that.
00:04:22
Miranda Materi
And I also think it's nice, you know, because it's usually a softer interface on the back of, depending on you how you make it on the back of the Monster versus the sugar tongue is a hard plastic, right? So it sometimes it hits those bony prominences and is less comfortable.
00:04:37
josh MacDonald
Yeah. If I have a patient who's a little more, has more bony prominences, specifically medial and lateral epicondyle, I'll put that blue slow foam memory foam with a sticky back padding on both of those. um And I don't feel like I have to prep for those ahead of time. The thickness of those is kind of just, it pushes those two wings of the thermoplastic out on either side of the elbow, but those pads will just kind of be a little more comfortable on those epicondyles if they need it.
00:05:02
Miranda Materi
Yeah, definitely.
00:05:03
josh MacDonald
Yeah. Yeah.
00:05:04
Miranda Materi
Thicker memory foam.
00:05:05
josh MacDonald
Yeah. Do you feel like there's any clinical decision-making that would say, oh, I should use this one instead, or I should use this one instead? Any, any rules about that?
00:05:15
Miranda Materi
No, I guess if the the physician wanted to limit elbow extension totally, then I might go with sugar tongue or honestly, if the physician was specifically requesting that, I might ask why.
Clinical Decision-Making and Preferences
00:05:24
Miranda Materi
Sometimes I think it's just a lack of knowledge or knowing what a monster is, you know, but I think, um, I can't think of a reason why someone would get a sugar tongue, but not necessarily a monster, right? They're kind of in, I feel like in our field, they're a little bit interchangeable.
00:05:37
josh MacDonald
Yeah. Yeah. I think so too. I don't think one has a, I don't think there's any diagnosis reasons why you would have to do one versus the other.
00:05:44
Miranda Materi
Right. And then one other like caveat is that when you get an order for a sugar tongue, sometimes it means a sugar tongue finger splint as well. Right. So I've seen that.
00:05:52
josh MacDonald
Yeah.
00:05:52
Miranda Materi
So then you're like, so you really need to look at the diagnosis and what you're seeing the patient for, because you wouldn't want to be making a long elbow orthosis when it's just a finger sugar tongue splint.
00:06:01
josh MacDonald
Right. Right. Yeah. And the sugar tongue just refers to the shape. That is the the little thing you pull the sugar cubes out of the out of the bowl with. It's just that shape. You can put it on a finger. You can put it on a forearm.
00:06:13
Miranda Materi
there are So you need to know what diagnosis you're treating, which usually we do, right is
00:06:16
josh MacDonald
Yeah. Yeah. Yeah. You'd probably figure pretty quick when you started making it on their around their forearm and elbow. And they're like ah, this is just
Alternative Approaches and Audience Engagement
00:06:23
josh MacDonald
my index finger. Yeah.
00:06:24
Miranda Materi
right? Well, so this is another thing.
00:06:25
josh MacDonald
Yeah.
00:06:27
Miranda Materi
When I worked at um Mayo, they wouldn't do really sugar tongs or Munsters. We would just do really long forearm splits.
00:06:37
josh MacDonald
Oh, interesting.
00:06:38
Miranda Materi
So it's like really long where it would come all the way down to where it would limit them. They wouldn't totally immobilize them like a Munster would, but it would immobilize them some. So it was almost, you know, for whatever reason we had a physician that would do, don't even really remember the procedure, but, and we we would just do a really long arm form based splint.
00:06:47
josh MacDonald
OK.
00:06:57
josh MacDonald
OK, OK, interesting. all right. Well, hopefully that answers the question for the person that asked us. But if you have other questions, certainly reach out to us on our platforms at Hand Therapy Academy, or you can me email us at info at handtherapyacademy.com.