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Favorite and least favorite splints
632 Plays1 year ago
Miranda and Josh talk about some of our favorite splints to make along with some of our least favorite.
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Transcript
Introduction to Hosts and Topic
00:00:05
Speaker
Hi, I'm Josh McDonald. And I'm Miranda Materi, and we are Ham Therapy Academy. Let's talk about splinting. Everyone has their favorites, or more importantly, maybe their least favorite splints. So we're going to talk about some of ours and why there are favorites or least favorites.
Challenges with Specific Splints
00:00:19
Speaker
So let's talk about least favorites first. Miranda, what's your least favorite splint to make?
00:00:25
Speaker
Oh gosh, I think one that I don't really love making is the Munster splint. So that would be one of my least favorites. And I think it's one of my least favorites because I hate when splints have to go around the thumb, like a radial gutter or a Munster where you're creating that hole and then you're trying not to get it to rub on there in that first web space. So that's definitely my least favorite. And if I would hate to wear it as a patient,
00:00:52
Speaker
And probably next to that would be making a sarmiento brace. Yeah, sarmiento is an interesting one. It's a tough, just the strapping, I feel like. Like, I don't mind making the curvature around the shoulder, the internal cuff pieces, but finding a way to strap that thing to keep it on and keep it secure, I feel like you're kind of fighting against yourself a lot.
00:01:13
Speaker
Yeah, and then, you know, trying to get everything to attach and make sure the patient maintains their precautions is not fun. And I think, yeah, either a monster or a sarmiento would definitely be my least favorite. What about you? What's your...
00:01:27
Speaker
So I think for similar reasons, I was going to say radial gutter for the hand, because we talked about cutting around the thumb. I think more the ulnar gutter, hand-based ulnar gutter. And I think more so, especially with smaller hands, you just end up with a lot of really tight corners, cutting around at the distal end around the fingers. Lots of little tight cuts around there and down in the distal palmar crease and trying to make it comfortable.
00:01:51
Speaker
but still enough support to hold the, you know, if it's a fourth metacarpal, giving it enough dorsal support. And so there's a lot of tight corners to work around there. The stretch and tag does a good job of making it conform easily, but then depending on what material you're using, if it's trying to get it cut without jagged, if it's perforated and then edging and all the tight corners makes it tricky. And I think we mentioned this in one of our other podcasts. I think a mallet splint that has to have a swan neck component to it. So if you're doing like we do this little figure eight,
00:02:21
Speaker
that starts a bowler and these two little halves of the strip lay over dorsally and then they travel proximally or if I'm trying to do a normal mallet and an oval eight and it's just really tricky to manage all of that especially if you've got to manage your mallet precautions at the same time especially if it's a one-piece unit you're trying to do it is tough to get that on and you're just bound to end up with that DIP dropping into flexion at some point if they're trying to do it by themselves one-handed.
Patient Preferences and Practicality
00:02:50
Speaker
Yeah, that's definitely one of my least favorites as well. Totally agree with that one. Um, and then what are some of your, one thing I thought about when you were talking to was I remember when we used to work with that large group of hand surgeons and I remember one of the surgeons always telling me like, I'll never order a hand base because they're so uncomfortable. So if he was going to do a hand based older gutter, he would always prefer that we make it forearm based. Um, do you think you as a patient, would you rather have your wrist included or your wrist free, um, in terms of comfort?
00:03:18
Speaker
Oh, I'd for sure rather have the wrist free. If it's allowed by precautions, I feel like the stiffness of the wrist and just the immobilization of it, I'd much rather have it free. I feel like there's a lot of ways to stay out of impingement zones, even if you're going to lightly flare the proximal edge around the wrist, just to give you a little bit more freedom of movement. I'd much rather have the hand base. How about you?
00:03:40
Speaker
Yeah, I don't, you know, being someone that hasn't worn a splint, not very long, I think I get the idea of why, you know, because it wouldn't slide around, you know, if your wrist is included, it kind of anchors it down and it doesn't slide around. So you probably have a little bit more comfort in terms of that. And so I, I don't know, I guess I think I would need to try it. And I don't want to try it. You haven't been willing to commit to that. Yeah, I'm not committed to that yet.
00:04:07
Speaker
Yeah, I'm curious on the Munster. Let's go back to when you said the Munster. It was about the thumb hole was the part that you disliked. Does the rest of the fabrication of a Munster hang you up at all? Like the tabs and the draping of it, does that kind of slow you down at all?
00:04:22
Speaker
Uh, no, I don't think so. Cause you know, you're draping with gravity. So I think that's like the easy part. You're just laying it on top and tagging it on the bottom and taking it around the back. So that doesn't, um, seem to really touch me up. It's just that part with the end. Cause I, I see when patients come back, that's what they come back for is that web space. So, you know, sometimes I'll put padding there, but then I'm like, well, that's not going to last that long or. Yeah. Yeah. I, I've tried a variety of different kinds of padding.
00:04:49
Speaker
And in that first web space, the padding just doesn't stay well. If it's padding on a strap or padding on a rigid piece of thermoplastic there, it's just a high traffic area for like contact. So it's just bound
Preferred Splints and Their Benefits
00:05:00
Speaker
to come off. I feel like sometimes I'll send them with extra pieces to say like, hey, just stick this on when you need it. You know, when the other one falls off, stick this one on in its place.
00:05:09
Speaker
And they need it, right? You have to have that component in the first web space. I mean, unless you can find another way to secure it, but you are blocking forearm rotation, so you really need some support there. Yeah, definitely. Okay, so let's talk favorites. What splint do you like to make? What's your favorite?
00:05:25
Speaker
My favorite is probably the type of wrist support we make, which is an ulnar-based wrist support that goes high on the volar and dorsal side. So you're strapping it on the radial side of the hand, so it gives you a lot of good support. We make them a lot for a CT carpal tunnel, wrist fractures, wrist tendonitis, all those things. It's kind of my go-to. I think it's comfortable. Patients rarely come back with problems, and I feel like I can do it in five minutes and hear in and out.
00:05:55
Speaker
you
00:05:56
Speaker
Yeah, that's a much quicker one and the volar version of a wrist cock up that is the alternative to what we're making on an owner-based. I feel like every time I made one of those before I started making the owner-based, I'd have patients come back complaining about that bar that travels around the first web space and it's load through the soft tissues or that second metacarpal head or you just there's that bar is just uncomfortable and this doesn't have that as a soft strap instead. So I agree. That's a good alternate splint to make for that.
00:06:25
Speaker
Yeah, and it's very versatile, right? It can do a lot of things. So if they need a splint later, because they develop carpal tunnel, that's your splint. It's easy to wear, it's easy to sleep in.
00:06:35
Speaker
So there's a lot of good purposes, yeah, for sure. I think my favorite to make is a yolk splint. I feel like that's another one that serves a bunch of purposes, is super quick to make, whether you want to make it out of Orphacast or you're making it out of thermoplastic. It's great for a lot of those zone four through seven extensor tendon injuries if they're not a polytrauma. It gives you a lot of mobility and keeps them safe.
00:06:59
Speaker
and patients come in wearing this giant bulky post-operative dressing and you send them out with this little thing that goes between their fingers and they're just elating like, are you sure this is safe? I'm like, absolutely. And it's funny you mentioned you're not being willing to wear a split to test it out. The first time I heard about, I think it was at one of the hand surgeon's conferences, I heard that Dr. Merritt
00:07:21
Speaker
I forget which one does the, but he was talking about, I'm like, I think it's gonna fall off. For sure it's gonna fall off. So I made a yoke split for myself and wore it for like a week. I'm like, this thing's bound to fall off while I'm sleeping, all these, and it didn't. It stayed on the whole time. And I was even like shaking it every once in a while. And so I was thrilled with it. Like, hey, this is a super low profile way to give them the precautions that they need. And now it's, they're finding it's great for a whole bunch of other stuff.
00:07:48
Speaker
PIP contractures, possibly even flexor tendon stuff, although that's way early in the studies yet. So I like making it super quick, just a matter of not impinging on those web spaces, but otherwise it's a super quick split to make.
00:08:00
Speaker
Yeah. And I think, um, you know, you make it seem really easy. I don't think it's that easy of a splint and I have lots of students that struggle with that one. Um, and so I think you just have to practice like for me anyways, that one took a lot of practice for me to get it down where patients liked wearing it. And I might make, I used to make them two or three just to see which one they liked the best and gave me more practice. And usually it's made out of scrap piece of material. So.
00:08:23
Speaker
Yeah, that's another reason why I like it because I'm using all those little scraps left around. It's like, hey, I can use this thing. I can use it now. And I find that the larger patients need it out of eighth inch thermoplastic and I'll use a non perforated material, but smaller or medium sized patients, I'll take Orphacast and double it up. And that's usually just enough bulk to hold them as long as I give a good, good differential in positioning and not let it kind of sneak down a little bit. It holds them just fine. So yeah.
00:08:52
Speaker
I think a funny story was when Josh and I both worked for the hand surgeon group. I remember I had this patient and we ended up branching out on our own, but this patient had seen Josh in our Phoenix Clinic, but she didn't want to drive all the way to West Valley to see Josh. He had made her a relative motion splint or a yolk splint, and she loved it. That patient still sees me. I see her every year to make iMaker and RMO.
00:09:19
Speaker
It took me forever to get it to where it was up to how she was always like, well, Josh just did this whole class on his first time. So she always reminded me of that. So I think that's another reason why it just kind of makes me laugh when I talk about those. Maybe now it's your least favorite splint because every time it comes up, you think, ah, stupid Josh. Yeah, Josh made it so well. And then I was always trying to live up to the one that Josh made her first.
00:09:42
Speaker
And I guarantee if I made her a second one, it wouldn't have come close to the first. Sometimes you make a splint and it's just like, oh, great. Perfect. It worked. And they're happy. Send them off the door and they think it's great. And you're like, I have no idea how that happened, but I'll take it. It's a win.
00:09:56
Speaker
Yeah, I know she loved it and we still laugh about it.
Listener Engagement and Call to Action
00:09:59
Speaker
That's funny. That's funny. Yeah. Well, share with us in the comments what your favorite or least favorite splint is and why, and maybe what you do to kind of work around it. If you have any questions for us, feel free to reach out info at handtherapyacademy.com or email or on our social media platforms at handtherapyacademy.