Transcript
josh MacDonald: I'm Josh McDonald.
Miranda Materi: And I'm Miranda Maceri and we are Hand Therapy Academy.
josh MacDonald: Let's talk about some splinting options for patients with ulnar drift issues. This can be patients with arthritis and maybe sagittal band rupture and those EDCs slip ulnarly, or it can be even for Ehlers-Danlos patients and some of the instabilities they have at the MCP joint. So, man do you have like a preference? do you have like a first choice option you go to for these patients?
Miranda Materi: Yeah, I feel like it depends on how severe the issue is, you know, like how much ulnar drift there is because some of the softer ones that I prefer for as a first line are ones that will not work if someone has severe ulnar drift. So it really depends on the patient. But for maybe an early on patient, it would be the really thin one that used to be able to order from North Coast. And it's it's not, it's thinner than Val foam. and it kind of has that tacky back on it. However, the last few times I've tried to order it from North Coast, they've been totally sold out. so
josh MacDonald: Interesting. Huh. I know that like performance is not carrying as many of the SKUs that they have had. I wonder if that's the case or if they're just having a hard time with the supplier.
Miranda Materi: Yeah, and it's been backordered for so long. so And then they have a thicker one that's like the thicker spandex neoprene type material. But that one, patients don't usually like it because it's so thick.
josh MacDonald: Yeah, it's so bulky. Yeah, yeah.
Miranda Materi: Yeah. And so recently, since they've been sold out of those, I found a couple on Amazon that I ordered just as samples, but they haven't come in yet. So we'll see. How about you? What's your favorite?
josh MacDonald: um I struggle with, yeah, um off the shelf, um probably the the North Coast blue one.
Miranda Materi: We're off the shelf.
josh MacDonald: um We're talking about ahead of time. i don't see a whole lot of those patients, just you know your caseloads ebb and flow. So I haven't seen a lot of those patients with ulnar drift.
Miranda Materi: Mm-hmm.
josh MacDonald: The patients for whom I have needed it, it's typically for arthritis ulnar drift at the MCP joints. And they also technically, I should say, have poor skin integrity or very thin skin. And so too much pull or shear force can cause some skin problems.
josh MacDonald: So if I have a patient whose fingers are actively pulling that direction, I've got like a sample one or two of the thicker, like more like neoprene. I think it's called Comfortpreen because it's ah it's a trademark name, neoprene.
josh MacDonald: And those do better for the active, for the just a light change of direction. I feel like the blue one's effective, but got to be careful with the with the skin integrity on those patients.
Miranda Materi: Yeah, it's so hard, isn't it? And then for a custom option, you can do, you know, where you custom make them, but I think that's even more challenging sometimes.
josh MacDonald: Yeah, it is. I've had a couple times I've had success with the Orphacast. They have a pattern on their website for um like a, it's almost like one long bar across the volar aspect of P1s. And then a whole bunch of like J hooks that all pull each individual finger radially.
josh MacDonald: And then it kind of almost like an anti-claw splint kind of figurates around the hand a little bit. um And I've had some good success with that for patients. I prefer doing it with wet heat versus dry heat because I feel like that fabric stays softer with wet heat.
josh MacDonald: um but your working time is a little tighter with them too. And then you have to make sure you leave those loops open for those patients who have like Bouchard's nodules.
josh MacDonald: If you make it a closed circle for each finger, they struggle to get it on. So it has to be kind of open, then it's not as stable. So there's just so many variables to work around.
Miranda Materi: Yeah, they're very technically challenging to make, right? It's not something you can just do quickly in your clinic upon doing a treatment too. I feel like those take a long time.
josh MacDonald: Yeah, yeah. And i I have a good amount of conversation with the patients ahead of time about, like, I have a couple of the demo North Coast ones so they can feel what it feels like.
josh MacDonald: I don't want to go order it for the patient. And then when it shows up, they're like, oh, this is too bulky. And then I'm left with a splint in my hand. Or I've spent a bunch of time making the Orphacast one.
Miranda Materi: Thank you.
josh MacDonald: I try to really get expectations realistic on the front end.
Miranda Materi: Yeah, that's really key. um I think another thing for those patients, what I've been doing lately, instead of ordering for them, I give them all the ordering stuff and just have them order it themselves.
Miranda Materi: i mean, because you still I used to do all the inventory and ordering them. But then, like you said, sometimes you get it in and they're like, oh, I don't want it. and you're like, well, when they order it, then there's some accountability and responsibility when it shows up.
josh MacDonald: Yeah. Yeah.
Miranda Materi: And it's not something to make money off of, you know.
josh MacDonald: Yes.
josh MacDonald: Yeah. And especially those North coast ones, insurance doesn't cover those. they're not customizable. it's It's like buying band-aids. that d It's not a DME, so it's not covered.
Miranda Materi: Right. So it's like, well, it's almost easier. I think sometimes, unless of course we get our discounts from the vendors, but now lately it's like, feels like it's kind of the same for everyone. So
josh MacDonald: Yeah. Yeah. Do you use resting hand splints with like finger spreaders or elastomer or Otaform in between the fingers at night? Do you use that much to help with kind of like re-centralizing for some nighttime use?
Miranda Materi: yeah, usually I will make nighttime splints for these patients and If it's bilateral, I might have them alternate, you know, hands that they wear it on. But for the insert, I've done elastomere and then I've also done, what's the fabric splinting material that you just talked about?
Miranda Materi: Orphe tape.
josh MacDonald: Yes, yeah, orficat.
Miranda Materi: I've made it out of, yeah, the Orphecast or tape.
josh MacDonald: Yeah, yeah, yeah.
Miranda Materi: I've made it out of those too, but I definitely prefer the elastomere or the Odaform because it's a little softer and I think a little easier.
josh MacDonald: yeah
Miranda Materi: for the the patient to tolerate. How about you? What do you do for your finger spaces?
josh MacDonald: um i I just actually made one today. That's kind of what made me think about it was I did elastomer and elastomal. And it's a finicky product to work with. It's tough, especially when you're making an arresting hand splint and you can't see what it's doing, right? Like you've got this, it's sandwiched between their hand and the splint and it's tough to see. And so it's taken a lot of like practice of, I kind of pre-sculpt it really fast ahead of time for those fingers to fit in. And I get the the little mountain peaks in in those web spaces.
josh MacDonald: solid enough to not break, but not so big that it's shoving their fingers apart a ton. And yeah, it's, it's kind of this whole sculpting thing. and then I take it off their hand before it's done. And start yeah, it's, it's kind of a hot mess sometimes.
josh MacDonald: Um,
Miranda Materi: it really It really is. And then what did you use to get it to stick to the split material?
josh MacDonald: So I like using the perforated material and then I push it and it pushes through the holes and it mushrooms and I kind of flatten on the backside.
Miranda Materi: Yep.
josh MacDonald: The trick is that goes under P1s and now it's all oily on the splint. So I have to heat the splint to get it tacky and heat the Velcro to make it stick.
josh MacDonald: And that worked this time. that In previous times, i don't know if I wasn't patient enough with heating, but the Velcro wouldn't stick where the elastomal was because it's because it was oily underneath there. So that's a whole mess too. But you can't you have to have holes, even if you're poking holes through non-perforated material so that something grabs on because you can't you can't super glue that. Yeah, nothing else works really.
Miranda Materi: Right. Yeah, you're right. So that's what I do too. I always use perforated material and press it between there. So it has something to stick to.
josh MacDonald: Yeah, yeah.
Miranda Materi: Yeah, but you're right.
josh MacDonald: I like it.
Miranda Materi: If it's really oily, it doesn't work
josh MacDonald: Yeah, yeah. I like the Orphocast product idea. um Maybe that gives you little more working time, but the patient I made it on had really progressed MCP lag and sagittal band rupture and flexor tendons had kicked in. And so it was it took a while to stretch her enough so that she could handle any amount of extension.
josh MacDonald: And so I couldn't get her into full extension. That just wasn't going to happen. And so I was building up this block of elastomer under her hand um as a pad to the splint that maybe we can shave down in the future. So yeah, they're just very complicated patients to deal with.
Miranda Materi: Yeah, very complicated, and I feel like one of the more technically challenging patients for making splits on.
josh MacDonald: Yeah.
Miranda Materi: I think that and neuro are, especially if the patient not only has the ulnar drift, but if they have a swan neck deformity in addition to that.
josh MacDonald: Yeah. Yeah.
Miranda Materi: So if it's like a longstanding RA patient and you're trying to get them in a resting hand splint.
josh MacDonald: Yeah. And then skin integrity issues and a prominent ulnar styloid for strapping things. But I do feel like the nighttime resting splints, if they can, if we can make a splint that they can tolerate, and I think it's on us to make a comfortable splint with good strapping and all of that, that can be a lot of pain relief at night.
josh MacDonald: And then it buys them some time in the morning where their hands just don't immediately drop into that position. This is not going to fix their hands, but maybe it buys them some time in the mornings.
Miranda Materi: Right. Yeah, and hopefully prevents them from further progressing with their deformities, right?
josh MacDonald: Yeah, yeah, definitely.
Miranda Materi: Yeah.
josh MacDonald: And that's sometimes you're right. It's about I can't reverse it, but we can try to slow the progress. Yeah.
Miranda Materi: And I will say, like, if you're a neurotherapist and you have problems splinting these patients, you can always start with getting the wrist aligned properly, right? So, and just wearing that at night, if it's too much for the patient to tolerate the MCPs and the PIPs with the new alignment, you could just start simply with the wrist.
josh MacDonald: Yeah, yeah, that's a good option, too, for sure.
Miranda Materi: Yeah.
josh MacDonald: Well, we don't necessarily always answer questions on here. Sometimes we just bring up more questions than we have answers for. But hopefully this was helpful. If you have any ideas or suggestions, feel free to reach out to us. You can email us info at handtherapyacademy.com or reach us on social media at Hand Therapy Academy.
