Proliance Hand, Wrist and Elbow Physicians and occupational therapists follow several well-established hand therapy splinting guidelines to treat a wide variety of conditions. The metaphor that best describes recovery from many hand conditions and surgeries is the picture of a three-legged stool. One leg describes the role of a surgeon, one leg is the patient themselves, and the last leg is your occupational therapist. Each leg of the stool plays a unique part in keeping the stool upright and only together can this team produce the best outcomes for your hand. Hand Therapy Week is celebrated June 7th – 11th this year. To highlight the importance of your hand therapist in your recovery, PHWE is addressing a particular hand therapy splinting guideline and the complexity of knowledge and skill your therapist retains in order to optimize your recovery.

What are Hand Therapy Splinting Guidelines? 

Occupational therapists have formal training in the rehabilitation many different conditions. For our purposes, they are hand recovery specialists. They, along with your Proliance Hand, Wrist and Elbow Physician, design and implement a recovery plan using well established techniques or hand therapy splinting guidelines. Our therapists design programs specifically for each patient so every patient gets a unique, tailored plan to optimize your successful recovery. As part of a formal hand therapy splinting guideline, relative motion splinting is one option that can help treat a number of hand conditions. 

What even is relative motion splinting?

Relative motion splinting is a method of splinting used by hand surgeons and therapists alike that utilizes the hand’s own anatomy to focus muscle pull toward or away from certain tendons, joints or surgical sites. Simply put, each finger has three joints that work in conjunction with tendons to produce a full grip around a baseball bat (flexion) or a flat palm for a high five (extension). There are a number of muscles/tendons that work in conjunction to produce the intricate motions for our daily lives but this type of splinting focuses on one main tendon per digit. To form a grip, the flexor digitorum profundus is the main muscle/tendon unit and to fully extend each digit, the extensor digitorum communis is the counterforce. As it turns out, the flexor digitorum profundus starts as a shared muscle around the elbow and separates into four tendons as it travels down the arm into each finger. There is a similar anatomy on the back of the forearm/hand for the extensor digitorum communis. It is this particular quirk of anatomy, the common muscle with division to four tendons, that allows for relative motion splinting to work.

Wait, how does it really work?

A common analogy that is used to explain how relative motion splinting works involves a chariot being pulled by four individual horses. In the first example, the four ropes to each horse are of equal length and so each horse pulls equally. But imagine a situation where one horse has a slightly longer rope than his three fellow horses. What happens is the other horses end up pulling the entire chariot load before the horse with the longer rope has to pull any weight. The opposite situation involves a single horse with a shorter rope relative to his horse mates and so that single horse pulls the entire chariot by itself while the other horses’ ropes are completely slack. It is this changing of relative rope length that underlies the theory of relative motion splinting.

What conditions might be treated with this particular hand therapy splinting guideline?

Clinicians all over the world have been working on this exact question for over 20 years now. The first cadaveric proof of concept was performed in the 1970s according to Wyndell H. Merritt MD, a plastic surgeon who has been writing about this topic for many years. The idea is now well established if not widespread in hand therapy splinting guidelines for extensor tendon injuries as well as sagittal band ruptures. The goal of a hand therapy splinting guideline after extensor tendon repair is to protect the surgical repair while the body heals. Relative motion splinting with the injured digit in an extended position focuses the muscle force away from the repair in a dynamic way so the patient can continue to move the finger, which avoids stiffness, prolonged recovery, and a delayed return to work.  More recent cadaver research has presented a proof of concept in the rehabilitation of flexor tendon lacerations as well with some very early promising results. A comprehensive review of possible conditions that could be addressed by relative motion splinting as part of complete hand therapy splinting guideline with an occupational therapist was published in 2016.

How Can Proliance Hand, Wrist and Elbow Physicians Help?

A consultation with Proliance Hand, Wrist and Elbow Physicians can help determine if your hand may benefit from a comprehensive hand therapy splinting guideline along with a formal occupation therapy program where relative motion splinting is one component. Our highly trained occupational therapists are onsite at our Kirkland and Bellevue offices for your convenience to see your hand surgeon and therapist conveniently and quickly. To make an appointment please contact our staff at any of our five convenient Eastside locations.




About the Author:

Samuel E. Galle, M.D. is a board-certified orthopedic surgeon with subspecialty fellowship training in conditions of the hand and upper extremity. He has published numerous peer-reviewed articles and surgical technique videos. He lives in Kirkland, WA with his wife, two kids and one especially spoiled Cavalier King Charles Spaniel.