Research shows typical results of 40⁰-50⁰ gain in rotation following wrist or elbow fractures with splints despite therapy plateau, hard end-feel, chronicity. While individual results depend on bony integrity and joint congruence, many studies have demonstrated significant improvements despite severity of injury, stiffness or malunion. The reason for this is that while typical stretching won’t work in cases of significant stiffness, the dose of the stretch is increased significantly by such a splint. For example, a diligent patient may get minutes to an hour a day to stretch. If they apply a splint, they get hours of stretch. This allows the soft tissue constraints which cause stiffness to lengthen for a stretch which lasts. A splint which holds a patient at their end-of-range (as far as they could hold themselves passively); and the splint does this for 4-8 hours a day will more than quadruple a patient’s stretching regime.
Splinting for stiffness is tried and tested and works for many joints. In the case of rotation in either supination or pronation, results are impressive; even for people who aren’t progressing with therapy or where clinical reasoning suggests unlikely to improve. We also know that despite “functional range” being considered 100˚ (50 supination & 50 pronation), gains within and beyond this result in significant improvements in function.
Have a read of these articles to see the impressive results splints can have on rotation of the forearm. We find we get similar results with splints such as the Colello and Pronosupinator, but have not had such luck with the van Lede design (wrist splint + elbow splint with rotation strap). Of course, we wouldn’t recommend a neoprene TAP splint as it never holds a patient at end-of-range and isn’t designed to treat stiffness. How do your patient outcomes compare?
Lee, M. J., & LaStayo, P. C. (2003). A Supination Splint Worn Distal to the Elbow: A Radiographic, Electromyographic, and Retrospective Report. Journal of Hand Therapy, 16(3), 190-198.
Lucado, A. M., Li, Z., Russell, G. B., Papadonikolakis, A., & Ruch, D.S. (2008). Changes in impairment and function after static progressive splinting for stiffness after distal radius fracture. Journal of Hand Therapy, 21(4), 319-325.
McGrath, M. S., Ulrich, S. D., Bonutti, P. M., Marker, D. R., Johanssen, H. R., & Mont, M. A. (2009). Static progressive splinting for restoration of rotational motion of the forearm. Journal of Hand Therapy, 22(1), 3-9.
Parent-Weiss, N. M., & King, J. C. (2006). Static progressive forearm rotation contracture management orthosis design: a study of 28 patients. JPO: Journal of Prosthetics and Orthotics, 18(3), 63-67.
Shah, M. A., Lopez, J. K., Escalante, A. S., & Green, D. P. (2002). Dynamic splinting of forearm rotational contracture after distal radius fracture. The Journal of hand surgery, 27(3), 456-463.
Please note: We are unable to supply the full text articles, but would encourage you to do a literature search of your own as getting the following articles from your academic library. Upper Limb Co are supportive of any research in this area.