Use of special wedge with crepe elastic bandage for finger extension passive stretching

Karen Feng-Yi HSIAO, Senior Rehabilitation Supervisor

Sunshine Social Welfare Foundation

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In our previous article Use of a Crepe Elastic Bandage for Passive Wrist Extension Stretching, we explained how using a triangular wedge to wrap the wrist and hand with crepe elastic bandage can promote the simultaneous extension stretching of multiple joints of the wrist and hand. In this article, we will also focus on using crepe elastic bandage to achieve simultaneous finger extension stretching, but we will introduce the use of a special triangular wedge. The wedge has added wooden strips both horizontally and vertically, creating anchor points for the elastic bandage. You can also check out our Youtube video demonstrating how to use the wedge.

What is the special wedge?

In previous articles and videos, we explained and demonstrated how to use a triangular wedge to secure the hand and wrist to achieve passive stretching effect. The sloped padded surface (blue cushion) mounted on a sturdy wooden base is used to position the forearm and wrist, with the forearm secured in place with Velcro straps, and the elastic bandage securing the hand and wrist in the desired stretching position. We can achieve combined wrist and hand flexion, or combined wrist and hand extension.

However, sometimes we want to control the stretching direction of individual fingers. This can be achieved with the special wedge. What makes the special wedge different are the wooden strips placed horizontally and vertically along the base. These strips serve as anchor points for elastic bandages to secure the hand and fingers during passive stretching exercises, allowing individual control and targeted stretching of the four fingers, specifically extension for the metacarpophalangeal (MP) and interphalangeal (IP) joints, as well as thumb abduction and extension (targeting the CMC joint).

How to use the special wedge for finger extension passive stretching?

Step 1: Positioning the Forearm and Wrist

Place the forearm on the triangular wedge. To achieve MP and IP joint extension, ensure the MP joints slightly overhang the edge of the wedge. Use one Velcro strap to secure the proximal forearm and another to secure the wrist. The wide Velcro strap can sometimes be difficult to secure if placed too close to the wrist. When applying the Velcro straps, ensure the hook side faces upwards to prevent it from snagging on pressure garments or irritating the skin.

Tip: Prevent wrist extension while stretching the MP joints. When force is applied to extend the MP joints, wrist extension may occur, causing the hand to lift off the wedge. To address this, secure the wrist with a Velcro strap. Avoid positioning the strap too close to the palm, as it may interfere with thumb abduction and extension.

Step 2: First Elastic Bandage Application to Secure Metacarpal Area and Stretch Thumb

Force applied to the fingers can cause the hand to lift off the wedge, so it is recommended to secure the palm at the metacarpal level using the bandage. This keeps the hand flat on the wedge. It’s also possible to secure the elastic bandage from the wrist to the palm area to prevent wrist extension.

Next, wrap the thumb and anchor it to the wooden strip on the side. The wrap should be close to the palm to stretch the carpometacarpal (CMC) joint into abduction. The small area available for securing the thumb’s CMC abduction makes it challenging to find the right anchor point. It is very important to avoid excessive outward wrapping beyond the MP joint, as this can easily lead to MP hyperextension.

Tip: Ensure the forearm’s radial side is close enough to the wedge. If the forearm is too far from the edge, it may be difficult to properly secure the thumb.

Step 3: Second Elastic Bandage Application to Wrap Fingers

When wrapping the fingers, it does not matter whether the starting point of the bandage is underneath or on top of the hand. Placing a rolled towel or a roll of elastic bandage under the wedge's front edge elevates it, making it easier to anchor the bandage to the wooden strips. The wedge design allows each finger to be individually wrapped and secured. A 2-inch bandage width is ideal. If one wrap provides sufficient tension, additional wraps are unnecessary. The shorter length of the little finger limits the wrapping area, so fold the bandage slightly. Be cautious of overlapping the bandage too much, as it may create excessive pressure.

A fully unfolded bandage will also cover the PIP joint and thus create a gentle pull to extend the PIP joint. A folded bandage will solely target MP extension by anchoring at the proximal phalanx, avoiding tension on the PIP. However, it’s important to remember that we must avoid applying force with the bandage directly over the distal phalanx, as it could cause DIP hyperextension.

Troubleshooting to Avoid MP Hyperextension

When the elastic bandage stretching the thumb is too far over the thumb, MP hyperextension can occur. To avoid this, first adjust the position of the forearm closer to the edge of the wedge and re-secure it with the elastic bandage by making sure that the bandage is closer to the palm and the base of the thumb, between the CMC and MP joints.

Considerations for Use with Limited Hand Range of Motion

For a hand with a relatively normal range of motion, the bandage may slip off due to sufficient joint extension range of motion. However, when used on a hand with restricted range of motion, the bandage remains in place. Excess bandage can simply be tucked in.

For patients with intrinsic tightness, the hand may display thumb adduction, MP joint flexion in the index finger, and a narrowed thumb web space. Thumb stretching directions are CMC abduction and MP extension. Ensure the bandage is anchored between the thumb MP and CMC joints to target the CMC without causing MP hyperextension. Fix all four fingers in MP extension alongside the thumb. Stretching only the thumb without securing the other fingers reduces the overall effectiveness.

Conclusion

The special triangular wedge, in combination with elastic bandages, is a valuable tool for burn rehabilitation therapists to achieve precise and controlled passive stretching of the wrist and fingers. Its thoughtful design—featuring anchor points for targeted fixation and a stable, sloped surface—allows for customized adjustments to address specific joint limitations, including MP and IP joint extension, as well as thumb CMC abduction.

By carefully securing the forearm, wrist, and fingers using the described techniques, therapists can effectively achieve therapeutic outcomes, while avoiding unwanted and incorrect effects, such as wrist hyperextension or thumb MP hyperextension. outcomes. This approach not only enhances the stretching process but also ensures greater comfort and safety for patients, ultimately contributing to improved hand function and mobility.

Incorporating this tool into burn rehabilitation protocols provides therapists with a reliable, efficient method to address hand contractures, promoting better recovery and quality of life for their patients.