Will a finger splint help a patient with impaired finger function and potential for further decline?

Finger Splints: When They Help and When They Harm

Finger splints can be beneficial for specific acute injuries like middle phalanx fractures or trigger finger, but they are NOT recommended for preventing or treating finger stiffness after stroke, brain injury, or distal radius fractures, where they may actually worsen outcomes by promoting immobility and contractures. 1

When Finger Splints ARE Indicated

Acute Fracture Management

• Rigid finger splints are appropriate for displaced or unstable middle phalanx fractures that require immobilization of the proximal interphalangeal (PIP) joint while allowing metacarpophalangeal (MCP) joint motion 2
• Duration should be limited to 3-4 weeks with radiographic follow-up, as over-immobilization leads to unnecessary stiffness 2
• For non-displaced finger fractures, buddy taping with immediate active motion is superior to rigid splinting 2

Trigger Finger

• Splinting the metacarpophalangeal joint at 10-15 degrees of flexion for 3-9 weeks successfully treats 66% of trigger fingers, though corticosteroid injection has higher success rates (84%) 3
• This offers an alternative for patients who refuse injection 3

Jersey Finger Injuries

• Immediate splinting in flexion is required followed by urgent hand surgery referral within 7-10 days 4
• This is a temporizing measure before definitive surgical repair, not a treatment itself 4

When Finger Splints Are CONTRAINDICATED

Post-Stroke and Brain Injury

• The American Heart Association/American Stroke Association explicitly recommends AGAINST using splints for prevention of wrist and finger spasticity after stroke (Class III recommendation, Level B evidence) 1
• A randomized controlled trial found that overnight hand splinting in the functional position produced no clinically beneficial effects in adults with acquired brain impairment, with outcomes actually slightly favoring the control group 5
• Range of motion favored non-splinted controls by 2 degrees, and function favored controls by 0.2 points 5

Distal Radius Fractures

• The American Academy of Orthopaedic Surgeons recommends active finger motion exercises immediately following diagnosis of distal radius fractures, as finger motion does not adversely affect adequately stabilized fractures 1
• Hand stiffness is one of the most functionally disabling adverse effects following distal radius fracture and can be very difficult to treat after fracture healing, requiring multiple therapy visits and possibly surgical intervention 1
• Splints can obstruct finger motion and contribute to finger stiffness through pain, swelling, and patient apprehension 1

Functional Neurological Disorder

• Splinting may prevent restoration of normal movement and function in patients with functional limb weakness 1
• Potential problems include: increasing attention and focus to the affected area (exacerbating symptoms), increasing accessory muscle use, promoting compensatory movement strategies, causing muscle deconditioning from immobilization, promoting learnt non-use, and increasing pain 1
• Serial casting for fixed functional dystonia has been associated with worsening symptoms and onset of complex regional pain syndrome 1
• The consensus recommendation is to try strategies that encourage normal movement patterns and resting postures before considering splinting 1

Critical Pitfall: The Quadriga Effect

• Isolated finger stiffness from splinting causes significant dysfunction in adjacent normal digits 6
• Splinting any individual finger results in a significant reduction (26-47%) in total active range of motion of all adjacent fingers 6
• This emphasizes the need for a focused and proactive approach to restore full active motion following isolated finger injuries 6

The Bottom Line Algorithm

For acute injuries (fractures, trigger finger, jersey finger): Use splints judiciously with specific indications and time limits 2, 4, 3

For neurological conditions (stroke, brain injury, functional disorders): Avoid splinting and prioritize active motion exercises instead 1, 5

When in doubt: Active motion is safer than immobilization for preventing the devastating complication of finger stiffness 1, 2