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To splint or not to splint?
Hi everyone,
I have a patient who is most likely in stage 4 of the neuro lesion. I was allready seeing her before I did the course. At the time I made a resting splint for the night, because otherwise she couldn't sleep.
But now we are going to start with the somatosensory rehabilitation. I know that she cannnot touch the area but she has to sleep.
What would you do? Let her wear the splint at night or not?
Thank you allready.
Greetings Ellen
Comments
Dear Ellen, we need to know more about the somestesique/neuropathique condition of your patient to answer.
Recently, with a consequent allodynia of the palmar branch of the ulnar nerve, a splint on the radial side of the wrist help in reduising pain during the day ( the ulnar nerve was moving less in the joint ) During the night I add a kind of cover on the Ulnar side that do’t touch the allodynie but jump over. It did help a lot.
Laure Haggenjos
Switzerland
Thank you for your answer.
The region that the allodynia is in is " common and proper palmar digital nerves en dorsal branches of the median nerve".
The allodynia is mostly in dig 3.
So maybe it is possible to make a splint on the ulnar side?
Hi Ellen
If the goal of the splint/orthosis is not to immobilize, but to reduce evoked/intermittent stimuli, then alternate strategies are to cover the area with something that provides a consistent stimulus (ie gentle compression bandage, neoprene sleeve). But if movement is also evocative, then an orthosis which also limits movement may be more useful. I have had patients who realize the evoked pain at night is related to movement of the sheets from their partner and their own movement of the sheets from moving other body parts, so using something like a very soft furry baby blanket (we call it minky here in North America!) to lightly wrap the painful limb can also be very helpful as it provides a consistent, relatively comfortable stimulus and maintains limb temperature. Sleep is so important to address the overall pain syndrome, I think we need to navigate this carefully. Bottom line: if not possible to avoid all stimuli, then be creative in ways to provide a constant stimulus rather than exposure to intermittent stimuli, or to minimize/make consistent as many forms of stimuli as possible.
I had a client who came to me with Rainbow Scale Blue allodynia over the incision for her wrist fusion from many months earlier. Her surgeon was upset that she refused to stop wearing the splint, and thought she had a psychological dependence on it. In reality, she was also using the splint over the allodynia to minimize the evoked stimuli (and yes, had an elbow contracture from continued guarding behaviour). I gave her permission to use the splint when she wanted for the short term (crowds, riding the bus, at night), but started on distant vibrotactile stimulation, and promised her she would not want to wear the splint forever. Within 8 weeks, she had completely weaned from the splint and we were able to treat and resolve her elbow contracture and limited finger ROM after the allodynia had resolved.
Tara
Thank's a lot. It help me
Thank you.