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Ehlers Danlos and Splinting Options
254 Plays20 days ago
Megan and Miranda sit down on Hand Therapy Academy to discuss splinting strategies for managing hypermobility in Ehlers-Danlos syndrome. Tune in for actionable insights and clinical pearls every hand therapist can use.
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Transcript
Introduction and Guest Introduction
00:00:05
Miranda Materi
Hello, I'm Miranda.
00:00:06
Megan
And I'm Megan, and we're Hand Therapy Academy.
00:00:11
Miranda Materi
Academy, welcome back, Megan. All right, today we have Megan on. She is a therapist in our East Valley office and a certified hand therapist.
Favorite Splints for Ehlers-Danlos Syndrome
00:00:21
Miranda Materi
And she is going to be talking about splinting and EDS.
00:00:23
Miranda Materi
So I'll first start just by asking Megan, what are your favorite splints for, and shouldn't just say EDS for Ehlers-Danlos, which is a hypermobility syndrome. And I know each patient is unique, but sometimes they present with some trends. So what would you say your favorite splint is for EDS patients for managing managing a hypermobile PIP joint?
00:00:46
Megan
Hypermobile PIP joints, I definitely tend to go with a silver ring splint, either the brand name or like a an off-brand silver ring, more like this one that isn't soldered in the middle.
00:01:00
Megan
um Those ones I actually like for patients with Ehlers-Danlos Syndrome that have a lot of swelling changes. Again, not all of them do, but a lot of them tend to, so they're more adjustable, but they do help prevent hyperextension.
00:01:13
Miranda Materi
Yeah, and then I would say, so there there's the Silver Ring Splint Company, which is like the the original, and they're nicely soldered, and you have to have very specific sizing to get those.
00:01:23
Megan
Yes.
00:01:23
Miranda Materi
so So those are very nice because they don't get caught in your hair. And then the other one Megan was talking about is there's other makers that do them, but they have an opening in the bottom, so you can adjust it for changes in swelling, like you said.
00:01:27
Megan
yes
00:01:35
Miranda Materi
But I felt like those do get caught in your hair. Oh, and on things.
00:01:38
Megan
They do. They get caught in your hair and on just like things you're grabbing sometimes, but it is nice to have the adjustability and it's main mainly a cost
Comparing Splints: Silver Rings vs. Oval 8
00:01:48
Megan
difference.
00:01:48
Megan
I usually recommend those because I have patients coming in and they need them for all of their fingers and it's much more cost effective because it's hard with insurance and ring splints for them to get the off-brand rings.
00:02:02
Megan
Yeah.
00:02:03
Miranda Materi
Yeah, yeah. Or you mean to get the name brand ones.
00:02:06
Megan
Yeah, it's more expensive for the neighbor and more cost effective to get the off brand. Yeah.
00:02:10
Miranda Materi
Right, yeah. Which makes sense. So, okay, so you like the silver ring splints. What do you ever do like an oval eight first or do you feel like those don't really hold them?
00:02:20
Megan
No. I mean, if a patient wants to try them, I will, but i just feel like they don't prevent hyperextension. They're just too like flat. They're not angled enough.
00:02:30
Megan
I've tried melting them to change them before, but I just think it's it's not worth the time. I'll fabricate them a custom thermoplastic ring splint before I would use an oval 8.
00:02:42
Miranda Materi
Okay, yeah, that's good.
Recommendations for MCPs and Anti-Drift Splints
00:02:44
Miranda Materi
That's good input. And then what's your favorite for managing the MCPs?
00:02:49
Megan
The MCPs, I actually didn't like this one before, but now I've had a few patients that get it blocks hyperextension of the MCP.
00:02:51
Miranda Materi
Oh,
00:02:58
Megan
It's another type of silver ring splint. And I've had a lot of patients really liking that lately, which is surprising.
00:03:03
Miranda Materi
that's good to know. Yeah, no, that's great. And then what about, um like, do you ever do like the anti-drift splints or anything?
00:03:12
Megan
We don't do anti-drifts a lot, but I do use like kind of like a relative motion, but not in a relative motion, just in a neutral position. I found that a lot of patients, especially if they're having like PIP sub or sorry, small finger MCP subluxation.
00:03:28
Megan
or that that one hyperextends more than any of the others. If we put them in either thermoplastic or ring splint, or I had a patient that her father-in-law 3D printed it for her, um that holds that finger to the middle finger, it helps prevent a lot of that subluxation and irritation.
00:03:46
Miranda Materi
Oh, that's a good idea. So you're putting in an RMO and you're putting the ring finger like below the level or kind of at the same level as the...
00:03:55
Megan
Usually just at the same level. If it's really irritated, then I will put it in like relative extension to the ring finger. But most of the time it's just in neutral.
00:04:05
Megan
So it's just like a bar that goes under the ring finger just to hold it all together. It just keeps them in line
Long-Term Stability and Splint Use
00:04:12
Miranda Materi
Yeah. Okay. That's a good point.
00:04:12
Megan
and prevents it from abducting too far.
00:04:15
Megan
Cause I think a lot of them get hurt when their small finger abducts really far and it kind of holds them all together.
00:04:20
Miranda Materi
Okay. And that's a good idea for stability. And then with these patient populations, I think the silver rings are nice because they're nicer long-term options.
00:04:29
Megan
Right, because most of these patients, it's not like wear it for eight weeks and then it'll get better.
00:04:29
Miranda Materi
So.
00:04:34
Megan
It's a for the foreseeable future, wear these ring splints.
00:04:35
Miranda Materi
Right.
00:04:38
Miranda Materi
Right. Right. So that's why it's a
CMC Joint Splints and Patient Preferences
00:04:40
Miranda Materi
little bit different. Okay. And then what about your, what are you doing for the CMC joint of the, um what's one of your go-to?
00:04:46
Megan
For the CMC joint, I usually present to patients a comfort cool, a push metagrip, and a custom thermoplastic short opponents orthosis. And it depends on what the patient wants to do, needs to do, and how they feel.
00:05:01
Megan
um A lot of those patients have like sensory sensitivities, so that'll also determine what splints I'm recommending for them, if they're allergic to the plastic or if they prefer the plastic versus the neoprene.
00:05:14
Megan
material. I think a custom short opponents is my favorite because it's custom and we can kind of adapt it to what they need it to be, put them in the right position.
00:05:19
Miranda Materi
Yeah, that's good
00:05:24
Megan
It's really stable for the MCP, but I actually tend to use those more for the CMC joint. And then I do use the silver ring splint when they have a lot of MCP mobility, but they don't want like a rigid
Adaptive Strategies for Comorbidities
00:05:40
Miranda Materi
yeah and that's a good idea And then that's the other thing i think we should mention to our audiences with Ehlers-Danlos, a lot of times they'll they will present with skin sensitivities or they may have mass cell that goes along with it. So they'll often say there's, you know, other, there's a lot of comorbidities and co-conditions that come along with these. So I think as a therapist, it's really good to, you know, listen to your patient and understand what other issues and why yeah you might have to be a little more creative than just a straight up orthopedic case.
00:05:40
Megan
splint.
00:06:08
Megan
Yeah. And having all those things in mind, like if a, at a patient that needed to wheel her wheelchair. And so, you know, that's more of an orthopedic consideration. How are you going to use this plant? But then she also reacts to compression on her hand sometimes.
00:06:21
Megan
And like, basically is like allergic to it. So then we have to consider that like a neoprene comfort cool is not going to be a good option for her because it's
00:06:31
Miranda Materi
Right. And then you have to think about, can we modify your wheelchair too? Right. Like there's but there's special grips for wheelchairs that you can get to put less pressure on the hands.
00:06:40
Megan
Yeah, yeah.
00:06:42
Miranda Materi
Yeah. Lots of thought. Okay.
00:06:43
Megan
Lots to consider.
00:06:44
Miranda Materi
And i think we tell what is your, what would you say for like a wrist instability?
00:06:50
Megan
I typically go with an ulnar gutter custom wrist splint for wrist instability. I haven't found a lot of off the shelf I like.
00:06:54
Miranda Materi
and when Yeah. And then when you say ulnar gutter, you're kind of coming far over on the radial side.
00:07:01
Megan
Yeah, so I'm starting from the ulnar side just as opposed to a volar splint. um I find they're more comfortable and easier to put on, but I'm still coming all the way over as far radially as I can to still allow them to slip it on and off with the Velcro.
00:07:14
Miranda Materi
Okay. And then, so with all these instabilities, are you ever having them wear them at night? Are you saying just wear these splints during the day? i know it probably depends, but.
00:07:22
Megan
It depends a lot for the ring splints, finger splints. Those are during the day. um or for some people that just can't handle wearing them all day, it's specifically when they're doing a functional task that irritates that joint in their hand for the wrist splints.
00:07:36
Megan
Again, it depends, but usually I'm recommending they sleep in the splint at night to rest the wrist. Um, a lot of times they'll have some carpal tunnel syndrome symptoms
Daytime Use of Splints and Ligament Health
00:07:44
Megan
going on as well. So it helps with that. And then not have the splint on during the day because they want their ligaments working out during the day, not becoming even more lax because we're doing the work for them with a splint.
00:07:55
Miranda Materi
Right. And then why do you want their ligaments to work?
00:07:58
Megan
I want their ligaments to work because they're not working. And those patients with Ehlers-Danlos syndrome, it's a connective tissue disorder. And so their collagen is not formed correctly. Their ligaments are loose and that's why their joints are hypermobile.
00:08:12
Megan
So I don't want to take all of the work away from those ligaments and allow them to just stop trying more or less and become even more lax.
00:08:19
Miranda Materi
Right. Right. Because do ligaments work?
00:08:24
Megan
I mean,
00:08:24
Miranda Materi
kind of, how do you work them? So they, they, yeah, it's like where you, it's good for them to get input, right? So they have to fire and.
00:08:31
Megan
Yeah. And if you're in a splint, it's not getting that input to send the proprioceptive input to your sensory system to control the muscles to stabilize your wrist.
00:08:31
Miranda Materi
Okay.
00:08:40
Megan
That system is kind of interrupted. It feels better for the patient, but long term, it's not going to help them if they're wearing it constantly.
00:08:47
Miranda Materi
It's very true. All right. Awesome, Megan. Thanks for all your words of wisdom on splinting more complex cases.
Contact Information and Further Resources
00:08:55
Miranda Materi
ah So for more information, or if you have any cases you want to share, please reach out to us info at hand therapy Academy or on Instagram at hand therapy Academy.
00:09:03
Miranda Materi
Thank you.