From the Guidelines
The recommended anticontracture positions for joints in splints are designed to maintain functional alignment and prevent contractures, with specific positions including wrist in slight extension, metacarpophalangeal joints in 70-90 degrees of flexion, and ankle at 90 degrees neutral position, as supported by the most recent guidelines 1. To prevent contractures, the following positions are recommended:
- Upper extremities:
- Wrist in slight extension (20-30 degrees)
- Metacarpophalangeal (MCP) joints in 70-90 degrees of flexion
- Interphalangeal (IP) joints in slight flexion (10-20 degrees)
- Thumb in abduction and opposition
- Lower extremities:
- Ankle maintained at 90 degrees (neutral position)
- Knee in full extension or slight flexion (5-10 degrees)
- Hip in neutral rotation with slight abduction These positions counteract the natural tendency of muscles to shorten in their resting state, which can lead to contractures when immobilization is prolonged, as noted in the guidelines for adult stroke rehabilitation and recovery 1. Proper positioning helps maintain joint mobility, preserves muscle length, prevents shortening of ligaments and joint capsules, and ultimately facilitates easier return to function after splinting is discontinued, with the use of resting hand splints and other treatments also considered for preventing contractures 1. Regular monitoring of skin integrity, neurovascular status, and periodic removal for range of motion exercises (if medically permitted) are essential complementary practices to prevent complications during splinting, as recommended in the Canadian stroke best practice recommendations 1.
From the Research
Anticontracture Positions for Joints in Splints
- The recommended anticontracture positions for joints in splints vary depending on the specific joint and condition being treated 2, 3, 4, 5, 6.
- For upper extremity joints, dynamic splinting has been shown to be effective in maintaining gains in range of motion and reducing contracture 2.
- Static progressive splinting is another approach that can be used to apply torque to a joint and increase passive range of motion 3.
- For proximal interphalangeal (PIP) joint contractures, a novel roll-on splint has been developed to increase motion with minimal difficulty 4.
- Serial splintage has been used as a preoperative treatment for upper limb contractures, with significant improvements in range of motion and contracture angle 5.
- A programme comprising serial casting, botulinum toxin, splinting, and motor training has been shown to be effective in improving joint range and managing contracture 6.
Key Considerations
- The choice of anticontracture position and splinting approach depends on the individual patient's needs and the specific joint being treated 2, 3, 4, 5, 6.
- Patient adherence to therapy and splinting is critical for achieving good outcomes 4, 5, 6.
- The use of anticontracture positions and splinting can help to reduce the need for surgical intervention and improve functional outcomes 5, 6.