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Tennis Elbow Splinting
534 Plays5 months ago
What are some of your favorite splints for treating tennis elbow.
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Transcript
Introduction and Tennis Elbow Treatments
00:00:05
Speaker
Hi, I'm Josh McDonald. And I'm Rhonda Materi, and we are Hand Therapy Academy. Let's talk a little bit about tennis elbow, lateral epicondylalgia, and splinting, any devices we may use for it. A lot of variation there, so let's start with counterforce strap. Rhonda, do you use a counterforce strap with many patients?
00:00:24
Speaker
No, never. Do you? I never do. And that's not to say that, you know, there isn't some, you know, I wouldn't say never, ever, right? There might be someone that it helps. And if it provides symptom relief, then I'm about that. But I've also found like, sometimes they'll have more cubital tunnel symptoms then. And it's really not a good solution. I think it just provides a little bit of pain relief.
Counterforce Straps: To Use or Not?
00:00:51
Speaker
Yeah, let's definitely start this conversation by saying that a lot of this stuff is gonna be our preferences. And so if you find your patients love a counterforce strap and they get better, use it by all means. So we're gonna talk about maybe what our preferences are, but that doesn't mean it's the only answer to the question. So I tend to agree with you. I don't feel like it has long lasting benefits. I feel like it takes a bit of an edge off the patient. I feel like it gives them maybe
00:01:18
Speaker
10 to 15 percent. When patients ask about it, I say it's like putting on a weight belt because it holds everything together and so that one painful muscle tendon unit doesn't have as much excursion. But if you still pick up your toolbox or swing a hammer or type all day or pick up your baby, that weight book can only hold so much and you're putting more load than that can handle. So if you can chill out and wear that,
00:01:43
Speaker
Great, but if you still have to go do all the things that put us here in the first place, that's probably alone not gonna be enough.
00:01:49
Speaker
Yeah, and you could potentially load the other areas and cause other pain. But unlike you, if something really works and you find the patient finds it beneficial, then I'm all about, you know, I think it's really going to be detrimental to them. Yeah. I see your point about the cubital tunnel, about some of that nerve compression, because that can be kind of a hot corner.
Educating Patients on Brace Use
00:02:09
Speaker
And I hadn't thought about that, but you're right. That is leading it to, you know, especially if you're talking like medial tennis or medial epicondylalgia.
00:02:17
Speaker
Like that's going to really flare that whole corner up a bit. So that may be, or radial tunnel if it's lateral, those kinds of things. Yeah, and I feel like radial tunnel is another thing, especially since they're so close together and then you're kind of teasing out which one it is. I think the counterforce brace can make it worse.
00:02:33
Speaker
And if I've got some deep seated pathology in that tendon, the whole area may be inflamed and that added pressure may just put them over the edge on an additional concomitant diagnosis of radial tunnel. Right. Yeah, definitely. And I think the thing with telling these patients is these are all, even all this once we make like a favor and I like to do is just a simple risk cock up, right? Cause you unload the extensors and it forces them to rest. But most people I know don't really enjoy wearing the brace, right?
00:03:01
Speaker
Yeah. Yeah. So you're really educating them saying, Hey, you really knew it should try to rest with this Flint on. Usually, you know, depending upon how severe their inflammation is, I might tell them two to three weeks, trying to wear it most of the time and then start to wean out of it as it starts to feel a little better.
Holistic Approach to Tennis Elbow
00:03:17
Speaker
And regardless of what brace and what diagnosis, I'll consistently have patients say like, oh, this brace is so much in the way and I hate it. And my usual conversation is to say, listen, you're an adult. You can make decisions about this. You tell me which is worse, the pain you have on a regular basis or the annoyance of the splint. Because the annoyance of the splint is going to last about six to eight weeks. And then it's gone. The whole issue is gone. The pain has been there for a long time. And I kind of sell them on that like, listen, if you can tolerate this for a little while, it's annoying.
00:03:47
Speaker
It's a big thing on your hand. If it's debilitating and keeps you from doing your job, that's a different thing. But if it's just super annoying, that's a different, yeah, that's. Yeah, probably wear it. And I think for some people though, it provides a lot of pain relief, right? So they don't mind wearing it. Another thing I like to tell patients is that tennis elbow can take months and months to go away. So this isn't going to be the end all be all solution.
RMO Splints for Varying Support
00:04:12
Speaker
It's only going to help manage your symptoms and hopefully get it to go away a little sooner.
00:04:16
Speaker
Yeah, and I'll tell patients whether it's a counterforce track or risk support or whatever it is, whatever we're throwing at this complicated long-term problem, if everything I give you addresses 10% of it, and then this address is 10%, and maybe dry needling address is 10%, and the home exercise, the e-central, eventually we're going to add up to 100%, but no one thing is going to be the magic bullet.
00:04:39
Speaker
Yeah, that's what I tell them to, same thing. And then the other split I like to do sometimes is the RMO putting the long finger and extension relative to the other digits. I think it just helps unload the extensors a bit, even though it's not doing the ECRB, which is the most commonly.
00:04:58
Speaker
um, the most common muscle to be affected. I think it just helps unload the structures just a bit to provide a little bit of pain relief. And I feel like people are more compliant with that. So it's kind of like, and in between from not wearing, um, from wearing a wrist support to wearing nothing in RMO can be somewhat in between and I'll have them test it. You know, I'll have them put the pencil test in their finger and have them grip. And if they can grip a little easier and not have so much pain, then I think the RMO is probably going to be beneficial.
00:05:25
Speaker
Yeah. Yeah. And so I'll oftentimes start with what I'll call low hanging fruit on the first session or two with the patient.
Strategies for Splint Use
00:05:33
Speaker
If they're not in crisis mode, if they're in crisis mode, I'll say, let's throw everything at this and just kind of get you out of pain and then we'll figure out what's the most effective later.
00:05:41
Speaker
But if they're in this, like it's annoying, I may not make a splint for them on day one. I'll say, let's see what helps initially. And then if we have to add a splint, let's do it on visit two or three. That may give me time to get authorization and all that and Dr. Scripps in place. But will you do the RMO splint for the more involved patients sometimes too? Or do you keep that to a lesser need patient? What's your kind of approach there?
00:06:07
Speaker
Oh, I would say it varies all the time. It depends on the patient's need. Like do they have to go to work? Um, you know, are they going to continue to have those same demands every day because that's their lifestyle and that's what they have to do. Then I would just do the RMO, um, to provide some relief. So it, it varies. I think I'm doing it. And then sometimes it's the patient, you know, they don't have to do a lot, but they just need a little relief. I'll do it for them as well. After they've had a successful test, like the pencil test,
00:06:35
Speaker
Yeah. Okay. Very cool. I feel like the market drives the off-the-shelf prefab splints. I feel like not the hand therapy market, but the Amazon market and Walmart and patients want to buy the thing with more features listed on the Amazon profile, right?
00:06:53
Speaker
They want something with a gel pad, they want something with maybe copper lining and they want something with double velcro on it. And honestly, I tell patients if they really want one of those, they can do it. But by the cheapest, simplest one they can, because all that other stuff is just to up the price. None of those things add any value to the mechanism at play.
00:07:13
Speaker
Just like the wrist support they can buy one if they're not going to do the custom you can buy one for 25 20 bucks sometimes less on Amazon You don't have to have all the fancy features on it. Just sometimes just the basic hold you steady Take the load off that's sufficient. And then when you're doing the wrist immobilization, what angle are you putting them in extension?
00:07:35
Speaker
I usually just go with a functional like a 15 degrees of extension neutral. I know I probably could be doing more wrist extension. I just feel like that's going to make them less functional, less comfortable and less likely to use it. And then are you doing a thicker? What size of material are you doing?
00:07:52
Speaker
Depends on their workload. If it's a set of computer most of the day kind of person, I'll do the thinner 16th inch. If it's a laborer, I may do the thicker material, but that is awfully heavy and bulky in our world of splints. So I'm usually reserving the heavier material for someone who's really going to be putting a lot of load on it. Yeah. How about you? Very similar. I'll do a heavier one if they're expected to do a lot of loading, a lighter one for
00:08:20
Speaker
someone that maybe isn't as active. And then if they're older, I might do a lighter one too. So it varies, but usually I reserve the fixed stuff for the people I know that are gonna really try to overdo it. Yeah. And I try to help, I try to make sure they understand this is a short term thing. Like we want to get you out of the splint as quickly as possible.
Weaning Off Splints
00:08:41
Speaker
This is to get us through that first phase of rehab that says, let's just turn the dial down on pain. And this is gonna make it so that your daily life
00:08:50
Speaker
doesn't hurt because you can't aggravate that inflamed tendon and hopefully we can back up that tendinosis process and then when you start to have less pain and you're starting to get a little more pain-free active movement out of the splint during therapy and home program then we can wean out of it more consistently in your day. Yeah and then how
00:09:11
Speaker
Like what level of pain do you expect them to have when you're weaning out of it? Do you tell, like I usually say when your pains around like a two or a three are gonna start coming out of it more, what do you tell them?
00:09:21
Speaker
I'm less about a generalized number and more about situationally. Like if you have pain all the time, then let's put you in a splint. And then if you only have pain when you're doing things that you know would aggravate and you probably shouldn't be doing it, but you got to do it anyway, then I would say wear it just during those tasks and take it off when you're brushing your teeth and getting dressed and feeding the kids. And if you can be pain free,
00:09:45
Speaker
And then we slowly add activities to the list of times when you don't need to wear it, as things in the clinic are pain-free, as you are successful with home things pain-free. So it's more situational than global, because their pain will fluctuate depending on the tasks. Yeah, no, that's true too. I always say, what is it overall? And then I feel like when I kind of get an overall idea that they're diminishing, similar to you, they're overall diminishing their pain and they're getting a little better with their tasks than... Yeah, yeah.
00:10:14
Speaker
There aren't many diagnoses and patients that we expect them to wear their splints long-term, right? Neuro-patients maybe, maybe like an anti-claw, something like that, where it's going to be a really long-term, if not anti-spasticity, but most of these patients, especially the soft tissue, our goal is to get them out of the splint as quickly as we can, the, you know, the smote we just made. Yeah, you almost, you want to stress the structures in some way, a protective stress load, so it can heal. Yeah, but they got to be able to live their life and, you know, work. So, yeah.
00:10:41
Speaker
All right, well, if you have other splinting options and suggestions, whether it's an RMO or support or something else entirely, let us know what you think down in the comments below. You can reach us with any questions on our email info at handtherapyacademy.com or on our social media platforms, Hand Therapy Academy.