Wednesday, 3 June 2015

Playing with Plastic.

No bunny hurt in the taking of this photo
At the risk of doing myself out of a job, and incurring the wrath of hand therapists everywhere, I want to share front-line management of thumb MP joint injuries. Greg Hoy, the hand surgeon I work with, refers to tears of the radial collateral joint of the thumb as "AFL (Australian Rules Football) thumb". Tears to the ulnar collateral ligament are more commonly recognised as "skiers or gamekeepers thumb. 

No matter what the moniker nor whether the ulnar collateral, radial collateral, volar plate, or a combination of all three ligamentous structures of the thumb MP joint are injured, taping is usually not sufficient to allow the player back to sport safely. Splinting is required. 

I find smug, self serving amusement in the fact that so many skilled therapists and doctors shrivel at the thought of using thermoplastic to support a joint. Whilst their trepidation works to my advantage, ultimately it helps no one. So here is a basic recipe.

It should look similar to this too thick, poorly fitted pre-fab thing 
  1. Get a piece of thermoplastic, 1.6mm thick.
  2. Cut out a pear shaped piece, long enough to extend from just proximal to the IP joint of the thumb, to just distal to the CMC joint. 
  3. Put the plastic in hot water just as if you were softening a mouth guard.
  4. When it has softened enough, place it over the dorsum of the thumb, working it into shape so that it contours well
  5. Trim to fit, making sure it doesn't impinge over the CMC with wrist extension and radial deviation.
  6. Tape on
  7. Refer to a hand therapist for treatment (happy with that BC?)

Before something
Different players in different positions like different things about these splints. Some can't have any coverage over the thenar eminence. Some like it to wrap around the proximal phalanx. As long as it protects the MP joint, and restricts movement but permits play, it's good. 

After something

Rehabilitation after that is more involved, and here's where you need to refer to an experienced hand therapist because the splint cannot be expected to do anything more than limit more damage. If you can get that at least half right, it's a start. I can always fix up your smashed up, finger dinted thermoplastic disasters afterwards and no one needs to know but us!

Look after those fingers,


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