THE GALINDO-LIM THUMBMETACARPOPHALANGEAL JOINTSTABILIZATION SPLINT

Aida Galindo, OTR, CHTOccupational Therapy Clinical CoordinatorTexas Orthopedic HospitalHouston, Texas

Suet Lim, MA, OTROccupational Therapist Texas Orthopedic Hospital

When a patient is referred to our therapy clinic fora splint to stabilize the metacarpophalangeal (MCP)joint of the thumb, we typically provide a custom-made short opponens splint.1 However, one of ourreferring physicians requested a “figure 8” splint.After careful consideration, we developed theGalindo-Lim thumb MCP joint stabilization splint.The splint is designed to maintain the thumb in a sta-ble position, minimize compression over the dorsalsurface of the MCP joint, and enhance overall func-tion of the hand (Figures 1 and 2).

Purpose

The purpose of the splint is to prevent hyperexten-sion of the MCP joint due to volar plate laxity. Fess etal.2 assert that slight rotation of the thumb into anopposing position is a requirement of almost anyhand motion, whether it is strong grasp or delicatepinch. Therefore, our goal is to stabilize the thumbMCP joint in approximately 15° to 20° of flexion withslight opposition. Traditional thumb splints typically

enclose the MCP joint of the thumb. Our open designhelps eliminate the increased risks of dorsal thumbMCP joint pressure traditionally associated with atypical thumb spica and short opponens splint.3

Materials and Fabrication

You will need the following materials:

■ A thermoplastic material, such as Polyflex II(Smith & Nephew Rehabilitation, Germantown,Wisconsin) or NCM Clinic (North Coast Medical,Morgan Hill, California). These products offerminimal resistance to stretch but provide maximalrigidity.

The metacarpophalangeal joint is, by design, inherently susceptible to strong physical forces. The dorsal surface of the jointis stressed by the pull of the intrinsics. This is particularly evident in the performance of pinching tasks. Over time, thisstress may cause the joint to deteriorate, causing the first metacarpal to sublux dorsally, which not only can affect functionbut can be painful. The authors of this issue’s Practice Forum have designed an easily fabricated splint to help stabilize themetacarpophalangeal joint.—PEGGY FILLION, OTR, CHT, Practice Forum Editor

A Metacarpophalangeal Joint Stabilization Splint

January–March 2002 83

Correspondence and reprint requests to Aida Galindo, OTR, CHT,Occupational Therapy Clinical Director, Occupational TherapyDepartment, Texas Orthopedic Hospital, 7401 S. Main Street,Houston, TX 77030.

PRACTICE FORUM

FIGURE 1. View of left thumb with hyperextension.

FIGURE 2. The Galindo-Lim thumb metacarpophalangeal jointstabilization splint.

■ Two pieces of 1-inch-wide adhesive hook Velcrotape, each cut approximately 1 inch in length.

■ One piece of 1-inch-wide Velcro loop nonadhe-sive tape approximately 3 inches in length.

The splint pattern is shown in Figure 3.

To make the splint:

1. Heat the thermoplastic material and apply it tothe patient’s hand, with the thumb positioned fortip pinch to the index finger.

2. Mold the splint around the thumb’s proximalphalanx and contour it along the thenar eminenceand dorsal hand (Figure 4).

3. Secure the two 1-inch Velcro hook pieces to themid-point along the splint’s thenar border, andsecure them to the dorsal splint component.

4. Fasten the Velcro loop strap to the splint, makingsure not to compromise the sensory input to thehand’s ulnar border.

Summary

Creation of a splint should allow for maximal func-tional use of the hand as well as comfort. The designof the Galindo-Lim splint enhances functional use ofthe hand not only because it stabilizes the MCP jointbut also because it does not cross the wrist crease,thus allowing full wrist motion. Independence in theperformance of daily activities is easily achieved withthe Galindo-Lim splint (Figure 5). The splint isappropriate for patients with a variety of diagnoses,including MCP joint volar plate injuries, collateralligament injuries, joint hypermobility, and arthriticconditions.

Acknowledgments

The authors thank Carrie Thomas, OTR, for skillful editingof this manuscript.

REFERENCES

1. The Hand Rehabilitation Center of Indiana. Diagnosis andTreatment Manual for Physicians and Therapists. 3rd ed.Indianapolis, Ind.: The Hand Rehabilitation Center, 1991.

2. Fess EE, Gettle KS, Strickland JW. Hand Splinting: Principlesand Methods: St Louis, Mo.: Mosby, 1981:33.

3. Fess EE. Splints: mechanics versus convention. J Hand Ther.1995;.4:124–30.

84 JOURNAL OF HAND THERAPY

FIGURE 4. Application of the Galindo-Lim thumb metacar-pophalangeal joint stabilization splint. Top, dorsal view.Bottom, palmar view.

FIGURE 3. The splint pattern. A, proximal phalanx. B, thenareminence. C, first metacarpal. D, strap.

FIGURE 5. The finished splint. Notice that the splint main-tains the thumb in a functional position.