Replacement of MCPJ's with silastic spacers, normally for RA patients to help decrease pain and increase function and improve deformity
 In hospital for 4 days
 Forearm based POP holding affected digits in extension
 Elevation ++ for 2/52
 OPA for next Hand Clinic
 Rehab begins after R/O POP @ 2-3/52
 Volar based forearm splint keeping IPJ's free and MP's in natural cascade position.  Wear full time for 6/52

EXERCISES (2-4 Weeks)

In splint

 flex fingers over edge of splint (x 20 every hour)

Out of splint

 MP flexion with PIP's extended (shelf position)
 In shelf position, active/assisted flexion of PIP's & IP's into palm
 Radial walk fingers

4 weeks 

  • Late fibroplastic stage
  • Co-ordination and light strengthening starts

5 weeks 

  • Light ADL's & functional activity
  • Do not carry any bags by hand
    Avoid static postures

6 weeks 

  • Implant is encapsulated.
  • Stop splint during day but continue at night for next 2/52
  • Return to light work

8 weeks 

  • Scar maturation well underway
  • Increase strength

Outcome - Aim for an arc of movt. Of about 70 degrees i.e., 0-70°

Look out for:

 Lack of extension at MP's.  If so, use a  full extension splint at night and increase wear of day splint for another 6/52
 Ulnar drift.  May need outrigger or functional ulnar deviation splint


The Hand to Elbow Clinic
29a James Street West
Bath BA1 2BT

Tel 01225 316895
Fax 01225 484949
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