Referral Guide

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CONDITIONWHEN TO REFERSPLINTGENERAL TREATMENT PLAN
Mallet finger As soon as possible but can refer up to 6 weeks post injuryCustom thermoplastic extension splint for the DIP joint onlyBony mallet – 6 week full time splinting
Tendinous mallet – 8 weeks full time splinting
DeQuervain’s TendinopathyAs soon as symptoms arise but can be referred several months post initial onset on painCustom-made forearm based wrist and thumb splint.

Neoprene splinting can be offered based on symptoms and patient circumstances.
Full time splinting for 4-6 weeks
Followed by a graduated therapy program
Other treatment techniques may include:
• Soft tissue therapy
• Taping
• InterX
• Advice on activity modification
Carpal tunnel syndromeAt the onset of symptomsCustom made thermoplastic wrist splint
Soft splinting may be an option depended on patient and assessment by a therapist
Night splinting until resolution of symptoms ~ 6 weeks
Partial daywear depending on severity of symptoms.
Other treatment techniques may include:
• Advice on activity modification
• Exercise program
Tennis elbow (lateral epicondylitis)At onset of symptomsWrist splinting and/or counter force bracing may be required
Rehabilitation program to include:
• Soft tissue therapy
• Graduated strengthening
• Taping
• InterX
• Advice on activity modification
Cubital tunnel syndromeAt onset of symptomsNight elbow extension splinting – thermoplastic or prefabricated soft splinting Splinting for up to 6 weeks or until symptoms resolve.
Advice on activity modification is key.
Home exercise program.
Distal radius fractureConservative management – as soon as possible or directly after POP removal
Surgical management – 1 to 4 days post operatively
Custom made thermoplastic wrist splintSplint for 4-6 weeks depending on age and fracture type.
Individualised home and in therapy exercise program
Scar and oedema management as required
Metacarpal fractureConservative management – as soon as possible or directly after POP removal
Surgical management – 1 to 4 days post operatively
Custom made thermoplastic hand or wrist based splint depending on fracture location / position/ surgeon preferenceSplint for 4-6 weeks depending on fracture type.
Individualised home and in therapy exercise program is key for regaining functional movement
Scar and oedema management as required
Finger fractures
• Proximal phalanx
• Middle phalanx
• distal phalanx
Conservative management – as soon as possible or directly after POP removal
Surgical management – 1 to 4 days post operatively
Custom made thermoplastic splinting – finger, hand or forearm based depending on fracture location and doctor preferenceSplint for 4-6 weeks depending on fracture type.
Individualised home and in therapy exercise program is key for regaining functional movement.
Scar and oedema management as required
PIP joint dislocations
• Dorsal – possible volar plate involvement
• Volar – possible central slip involvement
As early as possible – ideally 1-3 days post injuryDorsal dislocation – custom made finger based dorsal blocking splint with the PIPj in 30 of flexion.
Volar dislocation – custom made finger based barrel splint with the PIP held in full extension.
Less severe injuries may be treated with buddy splinting or taping.
Splints are worn for 4-6 weeks and modified regularly as the injury progresses.
Dorsal Dislocation – early active ROM is key.
Volar dislocation – immobilisation to protect the tendon if necessary.
Scar and oedema management as required
Scaphoid FractureConservative management – as soon as possible or directly after POP removal
Surgical management – 1 to 4 days post operatively
Custom made thermoplastic wrist splint
Thumb included at Doctor request.
Full time splinting until fracture has healed – can be 6-12 weeks.
Individualised home and in therapy exercise program once fracture is stable
Scar and oedema management as required