Splint in the Spotlight – Anti-Swan Neck Orthosis

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Our Orfit blog shares information and instructions in matching our thermoplastic materials to orthotic designs.
Please check back frequently to gain inspiration and ideas in orthotic fabrication for all of your 
patient’s needs.

Splint Design:  Anti-Swan Neck Orthosis

Here is another example of how a simply designed orthosis can have an incredible impact on improved functionality for the patient with a hyperextension deformity of the PIP joint, known as a swan neck deformity. The typical posture of this deformity is PIP hyperextension and DIP flexion. This deformity might develop with pathology at the MCP, PIP and/ or DIP joint levels.

Anti-swan neck orthosis

Pathologies:

  1. MCP Joint:
    Intrinsic tightness and central tendon tightness can lead to MCP joint subluxation. The resultant MCP flexion deformity can cause a secondary PIP hyperextension deformity as a result of the imbalance of tendons and ligaments.
  2. PIP Joint:
    Synovitis and/ or inflammation of the PIP joint capsule (Rheumatoid Arthritis) can cause overstretching of the volar plate, leading to PIP joint hyperextension. In addition, injury to the FDS at this level can also lead to hyperextension at the PIP joint as there is loss of the dynamic stabilization of the joint.
  3. DIP Joint:
    A mallet injury at the DIP joint can also lead to an imbalance of tendons and ligaments. The injury to the terminal extensor tendon also affects other soft tissue ligaments at their distal insertion. The droop into DIP flexion results in more force across the dorsal PIP joint pulling into hyperextension.
  4. Laxity of the Joints:
    Some people are born with extreme laxity of the joints capsules, allowing for a tendency to hyperextend at the PIP joint.  While this may not elicit a problem in most individuals because they can move in and out of the posture, in severe cases the resultant hyper laxity can cause functional deficits and lead to contractures.  Individuals with Ehlers-Danlos Syndrome in particular are at risk for developing significant functional deficits due to joint laxity.

Splinting Solution:

There is an easy splinting solution to the PIP hyperextension deformity: blocking the PIP joint in slight flexion!

The anti-swan neck orthosis is a simple splint that positions the PIP joint in slight flexion while limiting full PIP joint extension, but also allowing for full PIP flexion and full DIP ROM.

The orthosis itself consists of a thin strip of thermoplastic material placed dorsally over the proximal and middle phalanges of the affected finger, in an oval shape. Another strip runs volarly at the level of the PIP joint. The material should be thin enough not to interfere with motion and holding onto objects in the palm.

Orfit Industries’ new Orfit Strips in 2.0 mm/ 1/12” thickness are perfect for this particular orthosis! Orfit Strips are available in two excellent colors; Gold and Sonic Silver. The edges are cut smooth by machine. Only one third or half of a strip is needed for most patients. After activating in hot water or dry heat, place the central portion of the Orfit Strip over the dorsum of the proximal phalanx and forming an oval, attach to itself over the dorsum of the middle phalanx. Try to utilize the entire length of the proximal and middle phalanges for control of the joint position. Make sure to hold the affected finger in maximum flexion while forming the orthosis! Activate another short piece of Orfit strip and place directly under the flexed PIP joint, attaching to the oval on both sides of the joint. As the Orfit Strips are made from material that is coated, this might not adhere firmly until dry heated. But it will leave an indent where it should be attached. Carefully remove from the finger and trim the edges. Use dry heat to adhere all pieces together. Run under cold water before refitting to the finger! This is important as the material will stretch out significantly if placed back on the finger while warm.

Orficast thermoplastic tape, rolled thin, will also work very well for this orthotic design. The advantages of using Orfit Strips or Orficast is that the material already has smooth edges.

Wearing schedule:

This anti- swan neck orthosis is a functional orthosis and therefore daily wear is recommended during all activities. Night time wear is also recommended to maintain positioning of the PIP joint, or a finger orthosis might be prescribed to ensure proper positioning of the finger for healing.

Often, patients with Rheumatoid Arthritis or Ehlers-Danlos Syndrome may develop deformities in multiple fingers. The Orfit Strips are thin enough to allow for multiple finger splints without interfering with function.

Anti-swan neck orthosis 2

Sometimes, an orthosis that takes care of both the mallet and resultant swan neck deformity is required as well.

Anti-swan neck orthosis 3

Questions?

If you have a question or comment, please post it in the Orfit Splinting & Rehabilitation Group on Facebook, or send an email to welcome@orfit.com.

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