When should you use a Static Progressive Splint in Hand Therapy?

Flowers, K. (2002). A proposed decision hierarchy for splinting the stiff joint, with an emphasis on force application parameters. Journal of Hand Therapy, 15, 158–162.

The Skinny- The article proposes a decision hierarchy to determine when you should apply a static progressive or dynamic orthosis.  The decision hierarchy uses a modified Weeks test (MWT). The modified Weeks test is usually performed after joint stiffness has been determined to be a significant problem.  The following are the key concepts for force application.   

Key concepts for force application 

In The Weeds-

How the test is performed 

These measurements are compared.  Based on this comparison the following recommendations are made.  

a.) if a MWT results in a gain of 20 degrees, a splint is not indicated and to rely on an exercise program instead

b.) If the gain is 15 degrees, this indicates a slightly stiff joint.  Consider using the least stressful end-range splint. A static splint which by definition provides no over-pressure

    c.) if the gain is 10 degrees, this indicates a stiff joint.  This requires a dynamic splint with over pressure. Make sure you respect the patients pain level.  

d.) If the gain is 5 degrees or less, the joint is considered very stiff and requires the most aggressive splinting. This indicates a static progressive orthosis with unremitting overpressure.  

Bringing it Home- Based on the comparison between a “cold reading” and a “preconditioned reading” the following guidelines are recommended. 

PROM Increase Splinting
About 20 degrees No splint
About 15 degrees  Static Splints
About 10 degrees  Dynamic Splint
About 0-5 degrees Static Progressive Splinting 

The authors propose a plan for managing joint stiffness and when the appropriate time for application of a static progressive or dynamic orthosis.  It would be great if there were additional case reports demonstrating the application of the modified Weeks Test to demonstrate its clinical application and the outcomes.  

5 Comments

  1. Amy O’Brien on February 3, 2020 at 8:28 am

    The information is useful and practical. Thank you for your efforts.

  2. Elizabeth Carter on February 3, 2020 at 10:07 am

    Thank you so much for sharing! This is a great way for me to facilitate my splint or not to splint decisions!

  3. Grace on January 25, 2022 at 11:07 am

    thank you! this is so helpful

  4. Miranda Materi on January 28, 2022 at 8:44 am

    We are so glad that it is helpful!

  5. Jeremy T on October 6, 2022 at 10:40 am

    Does this hold true for the elbow as well?

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