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A-1182 Solving boutonniere, PIP joint extensor lag and hand pain problems with relative motion splinting
Donald Lalonde, Canada
Friday, June 15, 2018 · 2:32 p.m. · 19m 30s
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talk
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uh but i do have a disclosure there is a wide awake answered reebok but i'm not making any
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money on all of the money goes to the lean in green effort of the hand association
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which is promoted to less unnecessary care bitch and
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unnecessary cost and hand surgery there's also
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wall and website for hand surgeons unfair costs to get free information
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i mean with your with us bangor what looked like a week ago when you fell off a horse so it wasn't just the next morning
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the next morning right yeah and when i went to straight managers lee planet important question flat now's not there
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was no you couldn't straight no one but you couldn't actively extended now show me again whatever quite
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about like that and you couldn't straighten up till now and put flouting
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wanted to push down flat no no go to seven days
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after work panic you where when you fell off a horse for right now when you
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first came in uh uh you had a definite do here and that day
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we put you in this role emotion inflections in human where unless
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all through the day except for nine where you're wearing a little hard straight split it
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just keeps the thing extended right right so go ahead and make a first
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then straight no
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i make a first
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and straight no no you say you've been using a crap over the last
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week i kinda like that but what does that mean for you
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uh so i mean i dunno work horses ridden horses and on loan to pass a cost a lot
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we're just saying innovation by hand while and you did at all with this little right and you were able to do
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pretty cool yeah i mean that's this is this is really good and i just want to show the s. k.
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flex that right and straight uh_huh and do it again and straight uh_huh beautiful not do the whole thing
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and straight him now that make the dark like us good and when
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we got m. p. flexion look at that p. i. p.
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so this is a look you will near one week after with night planning with the p. i. p. in exchange
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in here you see him at eight weeks and a eight
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weeks uh it's probably too early they come off completely
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you still see that he has some extent or like a but is the i. p. flexion is even better
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and there's no question that in my hands uh before relative motion splitting
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my results with good near we're not nearly as good a i've been using these for at least
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uh twelve years and they've totally revolutionised the way that i deal
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with them i still don't get perfect results every time but
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of small extent sir lake with full d. i. p. flexion
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for me is a six s. input near management
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and i can get a lot of success is both an acute and chronic women's explained how it works
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uh this is a chronic one so this one i got in
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march uh it had been like that for quite some time
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and um in my hands surgery is not a great answer for boot nears
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because the forces are too great an extent servers or two thousand
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and so this was treated without surgery and what we did for this one
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to get from march to july and the result that you see
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is we did as quinn suggested we serially cast to the p.
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i. p. until we got down to about minus twenty
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uh and we need the i. p. complete flexion before we start the eight weeks
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so full time but near splintering and allowing d. i. p. active flexion
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and the problem that i used to have before as i would take people out
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of the split after eight weeks and watch the boot near come back
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now what's different is that we transition them to relative
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motion flexion splitting for at least another two months
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sometimes longer as quinn said sometimes they need several months
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but the patience can tell the i'll tell you you know might that weird things coming back in my knuckle well then
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you go back on the split it's very simple until the tissues are used to it but here's the set
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central slow
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and here's the well yes no one owns one
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or so
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and this
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oh the other side there's well i have
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refer sometimes
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are there other all of along spencer oh here's the
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yeah
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oh there we go
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great resistance
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when am here six then when blacks
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oh
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why does
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we see that the finger host right
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oh where oh
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or ah of when he i think why yeah and
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so all of us is going to somehow over
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two or three months just like a mouse thing ah you have a motion flight one full time
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wow three months yeah yeah the important messages here are thus
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m. p. flexion is good for boot nears m. p. extension
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is bad for two years and p. hyper extension
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is terrible for brood mares and that's why they have
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such a hard time unless you stop m. p.
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extension and and the hyper extension that's why put near the small fingers the hardest
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because that's the one that hyper extends the most so you gotta think about
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the enemy of p. i. p. extension is n. p. hyper extension and the the
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second thing is the central slipped doesn't heal when you do this stuff
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all of that stuff heels in one matt of scar so you have to
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have enough time to create enough college and for all of that stuff
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to make one matt of scar before it's going to flex and
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extend that takes time but it works just like a mel
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so we've used no relative motion flexion splitting and all our to patrons patients
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for the last couple of years because it works for the same reason
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so this patient uh i've got all the cord out
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unlucky kinetic stand because of m. p. hyper extension
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so i bring down his m. p. joint by simulating
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a relative motion flexion split in the operating room
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and the patient can see that his p. i. p. extension is
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much better so three days after surgery we put him
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in a relative motion flexion sport and that drives the extension to the p. i. p. joint
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he where's the night splint in extension he goes home
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he behaves and feeds his wife who has alzheimer's we know all this because we talked to
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him during the surgery to find out what he was doing for the next two weeks
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and you can see that the two and a half weeks after surgery his p. i. p. extension
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is way better than it was during the surgery
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because we've control b. m. p. hyper extension
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and here he is at a year after surgery in my office so he
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was able to maintain it so we're getting better results with good near
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better results with do patrons by controlling m. p. hyper extension and
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driving the extension forced to the p. i. p. joint
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uh here's another case of surgery this is three days
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after surgery up to patrons and you can
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see the p. i. p. is not extended as well as when you flex the empty joint
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and here he is it nine days after surgery with six days in the
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relative motion flexion split the p. i. p. extension is already better
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this is for especially do patrons with more p. i. p. a contractor
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and the same goes after is i flex there's with the pencil
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test showing right after i've ruptured the chords messiah flex
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now we take out the pencil and watch you lose the
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p. i. p. extension and gain m. p. hyper extension
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and p. hyper extension is the enemy
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this patient yeah had a brain injury with left him
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with speech and hand problems he had specificity
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in the hands which had great muscle imbalance and
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so what we did for this patient is
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we um did him wide awake of course and we saw that this agile band
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on the radio side was destroyed so we took approximately
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based strip of expense or tendon cut that
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and suture that on the radio side but actively we could still
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see that the juncture a tent in a we're pulling
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and snapping the finger so we cut the juncture a ten
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day to see what that would do for his extension
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and as soon as we did that it took that's passed take force off of the long extent sir and
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then we sue cheered the stripped down and six s.
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and the patient now thanks us 'cause he's awake
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if we can hear the sound great you like to write
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the only ah we both like a zoom
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little who who yeah oh you will
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you can hear the brain injury there so the expense or tendon glides
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ten millimetres with the splint and sixteen millimetres without the split
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so there's not only last tension there's less collide but there's enough
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glide but it doesn't get stuck the whole thing is
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don't let the darn thing gets stuck let it rest well
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everything heals whether it's an expense or tendon laceration
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or settle band repair as in this case so in this case we did
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four weeks of full time rest and finger extension because of the specificity
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and then four weeks of relative motion a splintering and because i
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knew i was going to go ahead and flexed understand planes
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yeah when it goes great no probable ole huh no more snapping
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uh_huh and how long is it now to your right uh_huh uh_huh more than a year
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members now since no great so i've been using
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relative motion uh extensions planning for extensive
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repairs for over twenty years and i still have not had a rupture many
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of them without a wrist splint but i decide on whether or not i want
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the rest split by what i see with a surgery because they're all awake
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this patient had a two month old extends or tendon injury
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um and he came and said i don't know if i want it fixed 'cause it's not so bad
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and i said well try working with the relative motion extensions point and see if you can work with
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and so he went to work with this roller motion extensions but certainly i can work with that
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so i he said okay now i want the surgery 'cause i can work with my split
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so we respected this car repaired the tendon and a look that what it
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looked like during the surgery and because he has a very heavy job
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and uh what it looked like during our real days after of
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you can require three days edison high school michael who
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i don't know who and what we asked and you know i have almost how sorry can you put your just like that
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and you know just just oh sideways like that that's good i don't bend your rest especially don't uh
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just do a little that would go there
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does that hurt now as long as it doesn't hurt you who a
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little movement but this one for the member's gonna delve a
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little we've got a wrist when we when we can just flux you things form a little bit was it doesn't hurt
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right now he was okay yeah has not heard and not so much no yeah right there
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are some are over so yeah so you only never take it past okay yeah
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and the key is pain guided healing with all early protected movement whether it's finger fractures
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like certain repairs expense or ten repairs anyway he went back to work at ten days
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um and uh he did just fine and there he is at the end of that
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uh this is the last case this is the fellow who cut his
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hand with an axe you went through his extends or tendon
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and he went through the bones of the base of the proximal phalanx and the matter carpal head
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so a pretty significant injuries so weak a wired him wide awake in the clinic
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uh with augmented field sterility this is how we do all of our uh trauma that's like this
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we simulate a relative motion extension split with the toned oppressor
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repair the yeah yeah yeah yeah and i don't like i. r. well do our
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okay oh hell or if there are so many just ask you what's the most important rule about you know
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but you can't you think however he amazing thing yes well haven't fly
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which is absolutely amazing and straight men right can so in order
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to hell am clean down just a little more and more
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ah p. i. or more extended commandos over there of cooking
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you know of motion inflections what uh for the next
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yeah but that's gonna do is it's gonna transmit the courses organised answer across
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through the score and on to the p. l. p. joint 'cause right now is just extending yeah yeah
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so when she puts off the on those two things go ahead
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of lex yeah it forces the other p. down yeah
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with a long finger and secondly it transmits a extensive force
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to the p. i. p. joy across yeah he enjoyed
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so in his case we use both and we see this all the time after fracture you constantly see
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these patients who come in with extends or like it's a common problem it has a simple solution
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we simulate the relative motion flexion split with the pencil
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it takes the pain away for a lot of
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patience and if it takes the pain away that means that the body is going to heal
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your body hurts when you're doing things to that that are slowing
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healing so for the pencil test takes the pain away
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if you build a split that they can exercise and live with it will allow that
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structure to heal the three months ago we had a crush
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injury of the distal phalanx of this finger and the
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i saw the patient a month after or two months after that and she couldn't extend
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or show me in your other hand how much you could extend his like that was
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like that can extend any more than that that's mine at her home often or
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and so we put her in this relative motion inflections one which forced extension
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oh really that p. i. p. joint problem was that for two months
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she was walking around my best ignoring finger and then couldn't extend that
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because of hyper extension yeah he joined in harness so does
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forced her to use the finger again to extend
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and she's been wearing it twenty four seven for one thing the other thing
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you just told me is that within two hours according this one time
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your finger pocket and swelling was better and noisy that half ass
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yeah so what just two hours and no no swelling colonel there yeah right so take yours went
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off now please and show me a your full extension so you got all your extension back
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so that's how we handle uh this problem so for
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a lot of these by hand problems try the
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pencil test um this patient had in it or ah c. s. tear yeah yeah yeah yeah yeah
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three
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turn sideways
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so just tell me uh like you just the the well what this one stone wall yeah
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that's what
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yeah yeah right
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yeah right yeah only had it for a week one before that we body tape too
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i want to know what that do or yeah yeah yeah
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okay alright many of you been frustrated by l. buddy taping does not work
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terribly well for interest his tears but relative motion flexion splitting really does
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i'm gonna scan harry these next couple of years to yeah the and
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um there uh out there are a number of videos that are available
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for all of you it's free this is a open access
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and all you need to do is google a lot on and pencil test and they'll be awful
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large number of other examples of how people who come in with simple hand pain problems
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you can fax with relative motion splitting in a fairly easy manner so
Conference Program
A-1181 Active extensor tendon rehabilitation for zones 3-7; short arc motion and relative motion – two different approaches
Gwendolyn van Strien, The Netherlands
June 15, 2018 · 2:05 p.m.
1240 views
A-1182 Solving boutonniere, PIP joint extensor lag and hand pain problems with relative motion splinting
Donald Lalonde, Canada
June 15, 2018 · 2:32 p.m.
600 views
