Is a dorsal blocking splint used for flexor digitorum superficialis (FDS) tendon sprain?

Management of Flexor Digitorum Superficialis (FDS) Tendon Sprain

Dorsal blocking splints are generally not recommended for FDS tendon sprains as splinting may prevent restoration of normal movement and function, potentially exacerbating symptoms.

Assessment of FDS Tendon Sprain

• Evaluate for:
  • Location and severity of pain
  • Presence of swelling around the tendon
  • Functional limitations in finger flexion
  • Associated deformities or pre-ulcerative lesions

Treatment Approach

First-Line Management

• Rest and activity modification to reduce stress on the injured tendon
• NSAIDs for pain management and potential anti-inflammatory effects
• Gentle progressive exercises to maintain range of motion without overstressing the tendon

Why Avoid Dorsal Blocking Splints

According to occupational therapy consensus recommendations 1, splinting presents several potential problems:

1. Increases attention and focus to the injured area, potentially exacerbating symptoms
2. Promotes accessory muscle use and compensatory movement patterns
3. Leads to muscle deconditioning through immobilization
4. Results in learned non-use
5. May increase pain

Alternative Approaches

Instead of splinting, the evidence supports:

1. Therapeutic resting postures and normal movement patterns:

   • Encourage optimal postural alignment at rest and during functional activities
   • Promote even distribution of weight and normal movement techniques 1

2. Graded activity progression:

   • Gradually increase the time that the affected digit is used within functional activities
   • Employ distraction techniques when undertaking tasks 1

3. Pain management strategies:

   • Muscle relaxation techniques
   • Supporting the affected limb when at rest 1

Special Considerations

If the FDS tendon sprain is associated with a flexion deformity or positional contracture of the proximal interphalangeal (PIP) joint that doesn't respond to conservative treatment, surgical intervention may be considered:

• In severe cases with persistent contracture, FDS tendon excision has shown good outcomes with mean postoperative positional contracture reduced from 24° to 4° 2

Monitoring and Follow-up

• Regular assessment of pain levels and functional improvement
• Evaluation of range of motion in the affected digit
• If using any supportive devices, monitor for adverse effects such as skin breakdown or increased pain 1

Pitfalls to Avoid

• Prolonged immobilization: Can lead to stiffness and muscle weakness
• Aggressive stretching: May exacerbate the tendon injury
• Ignoring persistent symptoms: Continued pain or dysfunction may indicate more serious pathology requiring surgical intervention

The evidence strongly suggests that promoting normal movement patterns and therapeutic resting postures is preferable to splinting for FDS tendon sprains, as this approach better preserves function while allowing healing.