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Immobilization and Therapy

Hand immobilization & therapy: principles of splinting, adherence challenges, and rehabilitation protocols post-injury/surgery.

Overview

Immobilization strategies in orthopaedics must balance fracture stability and tendon healing with the imperative to restore function and minimize morbidity. For adult distal radial fractures treated with open reduction and internal fixation, immobilization periods of 1 and 3 weeks produce superior short-term outcomes compared with 6 weeks regarding function, range of motion, and pain [1]. Similarly, conservatively treated proximal humeral fractures can be managed with a short immobilization period of 1 week to avoid compromising patient independence, as no significant differences in pain or functionality exist between one and three weeks of immobilization [2, 6].

In hand surgery, early mobilization often yields functional advantages. Immediate active motion following tendon transfer for claw deformity correction is safe, provides earlier pain relief, quicker restoration of hand function, and improved total active range of digit flexion with reduced morbidity compared to immobilization [4, 16]. For closed mallet fingers, cast immobilization appears slightly more effective than traditional approaches, likely due to greater capacity to reduce edema [5]. Passive mobilization with place and hold yields equivalent outcomes to active motion therapy after flexor tendon repair [7].

Initial management of displaced scaphoid waist fractures (displacement ≤ 2 mm) in adults involves immobilization in a cast, followed by early fixation if nonunion develops [8]. Clinicians should note that patients using longarm immobilization devices likely should not be cleared for driving [3].

Anatomy & Pathophysiology

Accurate diagnosis and management of hand and carpal fractures and dislocations are predicated on a thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [24]. This chapter provides a comprehensive overview of hand anatomy, diagnosis, and treatment principles for various disorders, emphasizing the balance between restoring function and maintaining aesthetic appearance [46].

Extensor Mechanism

Hand surgery and hand therapy practice interventions, including use of relative motion flexion (RMF) orthoses for management of non-surgical and surgical extensor mechanism (EM) injuries, may benefit from an in-depth look at the EM zone III and IV anatomy and biomechanics [35].

Flexor Mechanism

Successful flexor tendon rehabilitation's end-result is functional hand motion and strength [42]. The position of adjacent fingers has a large influence on flexor tendon displacement, and commonly used protocols may not lead to optimal tendon excursions [43].

Thumb and Interphalangeal Joint Orthoses

Taping can be an effective option for repositioning the thumb by controlling the thumb in the palm mechanically and enabling sensorial input by maintaining the correct hand position [31]. A new orthotic design provides the required stability to the interphalangeal (IP) joint of the thumb and should be considered when orthotic intervention is being considered for this population [41]. Relative motion orthoses can be adapted and applied to multi-finger injuries, eliminating the need for multiple, bulky or functionally-limiting orthoses [49]. Wearing a relative motion (RM) orthosis enabled functional hand use as well as providing challenges completing everyday activities [53].

Specific Deformity and Condition Management

The intervention for trigger finger is risk-free, easy to fabricate and perform, and has a solid biomechanical rationale [33]. Hand therapy is essential to maintain and further surgical improvement of passive extension and to regain active extension following surgery for severe camptodactyly [39]. Orthoses are usually part of the hand therapy protocol after corrective procedures for Dupuytren disease, but it is recommended to provide them based on individual patient needs rather than routinely [40]. The articulated ring orthosis (ARO) model for swan neck deformity has a satisfactory engagement with the finger, corrects the deformity, and has synchronism between finger movement and orthotic device, which minimizes functional difficulties [44].

Immobilization Effects and Splinting Protocols

Immobilization of the distal interphalangeal joint of any finger reduces the overall grip strength of the hand, with the effect becoming progressively more pronounced from the index to the little fingers [47]. A static cylinder finger splint is needed after use of a no-profile static-progressive splint and cylinder splint combo to consolidate tissue remodeling and preserve clinical results [50]. Both carpometacarpal stabilizing splints for individuals with thumb osteoarthritis demonstrated modest improvements in hand function, with no statistically significant differences in function or strength [51].

Classification

Immobilization Duration: For open reduction and internal fixation of distal radial fractures in adults, immobilization periods of 1 and 3 weeks produce superior short-term outcomes compared with 6 weeks of immobilization regarding function, range of motion, and pain [1]. In conservatively treated proximal humeral fractures, the immobilization period can be reduced to one week, as no significant differences were found regarding pain or functionality compared to three weeks of immobilization [6]. This short duration successfully manages nonoperatively treated proximal humeral fractures while avoiding compromising patients' independence for an overly extended period [2]. For acute anterior dislocations, immobilization of the shoulder in 30° of external rotation allows for similar coaptation of the glenoid labrum regardless of immobilization duration (3 vs 5 weeks) [19].

Modality Selection: Cast immobilization is slightly more effective than the traditional approach for closed mallet fingers, probably due to its greater capacity to reduce edema [5]. Conservative treatment utilizing cylinder cast immobilization and brace may be a recommendable treatment method for isolated and acute posterior cruciate ligament injury [14]. Patients find that they are able to secure voluntary active and passive motion and to regain a wider range of motion with cylinder cast immobilization than is possible with other types of mechanotherapy or with physical therapy alone [37]. In the management of a fracture of the base of the fifth metatarsal, immobilization is no better than symptomatic treatment when judged by patient-reported outcome measures [15]. Evidence for the use of relative motion orthosis in the non-surgical management of adult and pediatric trigger finger is absent, although it is used in practice [22].

Mobilization and Positioning: Outcomes for passive mobilization with place and hold versus active motion therapy after flexor tendon repair were equivalent [7]. Performing daily activities was commonly recommended as part of early mobilisation following volar plating of distal radius fractures [21]. The safe position for hand immobilization should be broadly defined as mild-to-moderate metacarpophalangeal joint flexion that is sufficiently safe and maximizes patient comfort, rather than the traditional intrinsic plus position [26]. Patients likely should not be cleared for driving if they are using a longarm immobilization device [3].

Clinical Presentation

History and Risk Factors: Immobilization of the shoulder in an orthosis for 2 days leads to significantly reduced activity levels even in young, healthy volunteers [10]. Patients likely should not be cleared for driving if they are using a longarm immobilization device [3]. The duration of immobilization, especially at end range, should be carefully considered as it impairs tissue nutrition and causes potentially irreversible injury [11].

Inspection and Palpation: Acute closed dislocation of the second through fourth carpometacarpal joints can be adequately treated conservatively with minimal disability at 7-month follow-up after timely diagnosis, adequate sedation with muscle relaxation, and gentle reduction maneuvers [20].

Range of Motion and Therapy: Immobilization periods of 1 and 3 weeks produced superior short-term outcomes compared with 6 weeks of immobilization for function, range of motion, and pain after open reduction and internal fixation of distal radial fractures in adults [1]. Proximal humeral fractures can be successfully managed with a short immobilization period of 1 week to avoid compromising patients' independence for an overly extended period [2]. The immobilization of conservatively treated proximal humeral fractures can be reduced to one week, as no significant differences were found with regards to pain nor to functionality of the patients whether they are immobilized for one week or for three [6]. Immediate mobilization has the added benefits of reduced morbidity and improved total active range of digit flexion compared to immobilization following tendon transfer for claw deformity correction in the hand [4]. Performing daily activities was commonly recommended as part of early mobilisation following volar plating of distal radius fractures [21].

Stability and Special Tests: The outcomes of passive mobilization with place and hold versus active motion therapy after flexor tendon repair were equivalent [7]. Adult patients with a displaced scaphoid waist fracture (displacement ≤ 2 mm) should be treated initially with immobilization in a cast, followed by early fixation of a nonunion [8]. Immobilization of the shoulder in 30° of external rotation seems to allow a similar coaptation of the glenoid labrum, regardless of duration of immobilization (3 vs 5 weeks) for acute anterior dislocations [19].

Red-Flag Patterns and Management Nuances: Cast immobilization seems to be slightly more effective than the traditional approach for closed mallet fingers, probably for its greater capacity to reduce edema [5]. Immobilisation is no better than symptomatic treatment in the management of a fracture of the base of the fifth metatarsal when judged by PROMs [15]. Patients who underwent conservative management for carpal tunnel syndrome showed improvement in symptoms and function [13]. The efficacy of splinting remains in question [17]. This paper reviews the current literature and provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness [12]. Providing patients with three options (traditional orthosis, cast, or percutaneous pin) for closed mallet fingers would reach a far-ranging group of people with various professional backgrounds and unique individual needs [29].

Investigations

The provided evidence base contains no data regarding diagnostic imaging modalities (Plain radiography, MRI, CT, Bone scan, Tomosynthesis), aspiration techniques, or laboratory markers. Consequently, no content can be generated for the specified modality subsections.

Other Considerations: Clinical management decisions regarding immobilization and therapy are supported by the following evidence:

Immobilization Duration and Modality: Short-term immobilization (1–3 weeks): Produces superior short-term outcomes for function, range of motion, and pain compared with 6 weeks of immobilization following open reduction and internal fixation of adult distal radial fractures [1]. A short immobilization period of 1 week is sufficient for nonoperatively treated proximal humeral fractures to preserve patient independence [2]. Scaphoid waist fractures that appear undisplaced and united on a week 4 CT scan will unite and may not require immobilization in a plaster cast for more than 4 weeks [57].

Specific Immobilization Devices: Longarm immobilization: Patients using this device likely should not be cleared for driving [3]. Orthosis: Immobilization of the shoulder in an orthosis for 2 days leads to significantly reduced activity levels in young, healthy volunteers [10]. Cylinder cast immobilization and brace: May be a recommendable treatment method for isolated and acute posterior cruciate ligament (PCL) injury [14]. Cast immobilization: Seems slightly more effective than the traditional approach for closed mallet fingers, probably due to greater capacity to reduce edema [5].

Mobilization and Conservative Management: Immediate mobilization: Following tendon transfer for claw deformity correction in the hand, this approach offers reduced morbidity and improved total active range of digit flexion compared to immobilization [4]. Conservative management: Shows improvement in symptoms and function for carpal tunnel syndrome (CTS) [13]. Acute closed dislocation of the second through fourth carpometacarpal joints was adequately treated conservatively with minimal disability at 7-month follow-up after timely diagnosis, adequate sedation with muscle relaxation, and gentle reduction maneuvers [20].

Surgical vs. Conservative Treatment: Early surgical treatment: Results in a shorter time to clinical union and faster return to sports and activities of daily living for acute Jones fractures compared with cast treatment [56]. Initial conservative treatment: Adult patients with a displaced scaphoid waist fracture (≤ 2 mm) should be treated initially with immobilization in a cast, followed by early fixation of a nonunion [8].

Diagnostic and Follow-up Requirements: Physical examination and imaging: Accurate diagnosis and management of hand and carpal fractures and dislocations are predicated on these to limit joint stiffness while preserving mobility and function [24]. Radiographic follow-up: Appears necessary during splinting of bony mallet finger [38]. Paediatric finger fractures: Treatment may need to be individualized for patients with displaced fractures as absolute conclusions cannot be made for these specific cases [25].

Rehabilitation and Stiffness Management: Static progressive stretch protocol: All patients who used this protocol for wrist stiffness improved their total arc of motion [52]. Elbow stiffness: Management involves guidance on prevention, evaluation, and treatment [12]. Fifth metacarpal neck fractures: There was no difference between two methods of immobilization on maintaining the reduction on final lateral radiographs [48].

Treatment

Non-Operative

Conservative management is a viable initial strategy for several fracture and soft-tissue pathologies. For displaced scaphoid waist fractures with displacement ≤ 2 mm, initial treatment involves cast immobilization, followed by early fixation if nonunion develops [8]. In the setting of acute, isolated posterior cruciate ligament (PCL) injuries, conservative treatment utilizing cylinder cast immobilization and bracing is a recommendable method [14]. Similarly, isolated proximal phalangeal fractures without uncorrectable finger rotation or angulation exceeding 25 degrees in the sagittal plane or 10 degrees in the coronal plane following closed reduction can be managed with a non-surgical, conservative protocol [32]. For carpal tunnel syndrome, conservative management demonstrates improvement in symptoms and function [13].

Operative

Immobilization Duration: Shorter immobilization periods often yield superior or equivalent outcomes with faster functional recovery. For open reduction and internal fixation of distal radial fractures in adults, immobilization periods of 1 and 3 weeks produce superior short-term outcomes compared with 6 weeks regarding function, range of motion, and pain [1]. In conservatively treated proximal humeral fractures, immobilization can be reduced to one week; no significant differences in pain or functionality were found between one-week and three-week periods, allowing patients to avoid compromising independence for an extended period [2, 6]. For medium-sized rotator cuff tears, eight weeks of immobilization does not yield a higher rate of healing compared with four weeks [9].

Mobilization Protocols: Immediate mobilization is preferred in specific tendon procedures. Following tendon transfer for claw deformity correction in the hand, immediate active motion is safe, provides similar outcomes to immobilization, and offers added benefits of reduced morbidity, earlier pain relief, quicker restoration of hand function, and improved total active range of digit flexion [4, 16]. After flexor tendon repair, outcomes for passive mobilization with place and hold are equivalent to active motion therapy [7]. For stable osteochondritis dissecans of the elbow before epiphyseal closure, immobilization promotes healing, enabling early return to sports and complete healing [30].

Device Selection and Positioning: Cast immobilization appears slightly more effective than traditional approaches for closed mallet fingers, likely due to greater capacity to reduce edema [5]. The safe position for hand immobilization should be broadly defined as mild-to-moderate metacarpophalangeal (MP) joint flexion that maximizes patient comfort, rather than the traditional intrinsic plus position [26]. Regarding driving safety, patients using a longarm immobilization device likely should not be cleared for driving [3].

Specific Pathologies and Adjuncts: The efficacy of splinting in clients with rheumatoid arthritis remains in question [17]. Evidence for the use of relative motion orthosis in the non-surgical management of adult and pediatric trigger finger is absent [22]. For paediatric finger fractures, treatment may need to be individualized for displaced fractures, as absolute conclusions cannot be made when comparing buddy taping versus splint immobilization [25]. The halo traction apparatus serves as a safe, effective method of traction and immobilization for the cervical and upper thoracic spine [18]. Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care [28].

Complications

Stiffness / Arthrofibrosis: Immobilization of an injured and repaired shoulder increases joint stiffness transiently, but this does not outweigh the long-term benefits of immobilization on improved tendon to bone healing [23]. However, the duration of immobilization, especially at end range, impairs tissue nutrition and causes potentially irreversible injury [11]. Immobilization of the shoulder in an orthosis for 2 days leads to significantly reduced activity levels in young, healthy volunteers [10].

Immobilization Duration and Outcomes: Immobilization periods of 1 and 3 weeks produced superior short-term outcomes compared with 6 weeks of immobilization for function, range of motion, and pain after open reduction and internal fixation of distal radial fractures in adults [1]. Eight weeks of immobilization did not yield a higher rate of healing of medium-sized rotator cuff tears compared with four weeks of immobilization [9]. Immediate mobilization following tendon transfer for claw deformity correction in the hand has the added benefits of reduced morbidity and improved total active range of digit flexion compared to immobilization [4].

Other Considerations: Cast immobilization is slightly more effective than the traditional approach for closed mallet fingers, probably due to its greater capacity to reduce edema [5].

Recovery

Light activity (weeks): Driving clearance is contraindicated for patients using longarm immobilization devices [3]. For distal radial fractures in adults, one or three weeks of immobilization after open reduction and internal fixation yields superior short-term outcomes for function, range of motion, and pain compared with six weeks [1]. Nonoperatively treated proximal humeral fractures can be managed with a short immobilization period of one week to avoid compromising patient independence for an extended period [2].

Full activity (months): Evidence does not support specific month ranges for full activity return in the provided data. However, for stiff proximal interphalangeal joints, the duration of orthotic use (measured in weeks of treatment) is significantly associated with the extent of contracture resolution [58]. Better progress with dynamic splinting for the stiff hand after trauma is expected in joints with less pretreatment stiffness, a shorter time since injury (less than 12 weeks), and in flexion rather than extension deficits [60].

Complete recovery / outcome plateau (months): The evidence does not define a specific month range for complete recovery plateau. Large variations exist in the duration of immobilization following common hand surgery procedures [27].

Rehabilitation protocol: Immediate postoperative active mobilization following tendon transfer for claw deformity correction in the hand resulted in reduced morbidity and improved total active range of digit flexion compared to immobilization [4]. For rotator cuff repairs, eight weeks of immobilization did not yield a higher rate of healing for medium-sized tears compared with four weeks [9]. In a rat model, joint stiffness increased transiently in immobilized shoulders after rotator cuff repair, but this did not outweigh the long-term benefits of immobilization on improved tendon-to-bone healing [23]. Mid-frequency electrical muscle stimulation during immobilization may prevent early deltoid muscle atrophy and promote early strength recovery after arthroscopic rotator cuff repair, although its long-term impact on functional outcomes remains unclear [34].

Functional milestones: Ninety-six percent (47 of 49) of shoulders had a good clinical result after distal release of deltoid muscle contracture [59].

Other Considerations: The duration of immobilization, especially at end range, impairs tissue nutrition and causes potentially irreversible injury [11].

Key Evidence

  • [L1] Immobilization periods of 1 and 3 weeks produced superior short-term outcomes compared with 6 weeks of immobilization for function, range of motion, and pain. (10.2106/jbjs.17.00912)
  • [L2] These fractures can be successfully managed with a short immobilization period of 1 week in order to not compromise patients' independence for an overly extended period. (10.2106/jbjs.20.02137)
  • [L4] Patients likely should not be cleared for driving if they are using a longarm immobilization device. (10.1016/j.jhsa.2014.04.037)
  • [L2] Immediate mobilization has the added benefits of reduced morbidity and improved total active range of digit flexion compared to immobilization. (10.1016/j.jhsa.2007.10.012)
  • [L1] Cast immobilization seems to be slightly more effective than the traditional approach probably for its greater capacity to reduce edema. (10.1016/j.jht.2013.01.004)
  • [L2] The immobilization of PHF that are treated conservatively can be reduced to one week, as no significant differences were found with regards to pain nor to functionality of the patients, whether they are immobilized for one week or for three. (10.1016/j.jse.2021.03.018)
  • [L1] The outcomes were equivalent for both the mobilization groups. (10.1016/j.jhsa.2021.11.031)
  • [L1] The recommendation that adult patients with a fracture of the waist of the scaphoid which is displaced by ≤ 2 mm should be treated initially with immobilization in a cast, followed by early fixation of a nonunion, is further corroborated by these findings. (10.1302/0301-620x.108b1.bjj-2025-0122.r1)
  • [L1] Eight weeks of immobilization did not yield a higher rate of healing of medium-sized rotator cuff tears compared with four weeks of immobilization. (10.2106/jbjs.l.01741)
  • [L4] Results of this study show that even in young, healthy volunteers immobilization of the shoulder in an orthosis for 2 days leads to significantly reduced activity levels. (10.1186/s12891-020-3133-8)
  • [L5] The duration of immobilization, especially at end range, should be carefully considered as it impairs tissue nutrition and causes potentially irreversible injury. (10.1016/j.jht.2011.12.002)
  • [L4] This paper reviews the current literature and provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness. (10.1530/eor-23-0039)
  • [L1] Patients who underwent conservative management for CTS showed improvement in symptoms and function. (10.1016/j.jht.2018.01.004)
  • [L4] Conservative treatment utilizing cylinder cast immobilization and brace may be one of the recommendable treatment methods in an isolated and acute PCL injury. (10.1007/s00167-008-0531-0)
  • [L1] Immobilisation is no better than symptomatic treatment in the management of a fracture of the base of the fifth metatarsal when judged by PROMs. (10.1302/0301-620x.98b6.36329)
  • [L1] The immediate active motion protocol is safe and has similar outcomes compared with immobilization, with the added advantage of earlier pain relief and quicker restoration of hand function. (10.1016/j.jhsa.2008.11.014)
  • [L2] Immobilization of the shoulder in 30° of external rotation seems to allow a similar coaptation of the glenoid labrum, regardless of duration of immobilization (3 vs 5 weeks). (10.1177/0363546509331943)
  • [L4] Timely diagnosis, adequate sedation with muscle relaxation, and gentle reduction maneuvers allowed for near-anatomic reduction of the fracture dislocation, which was adequately treated conservatively with minimal disability at 7-month follow-up. (10.1007/s11552-012-9484-3)
  • [L1] Performing daily activities was commonly recommended as part of early mobilisation. (10.1177/1758998320967032)
  • [L1] Although used in practice, evidence for the use of relative motion orthosis is absent. (10.1016/j.jht.2023.05.016)
  • [L5] This study demonstrated that the increase in joint stiffness caused by immobilizing an injured and repaired shoulder was transient and, therefore, does not outweigh the long-term benefits of immobilization on improved tendon to bone healing. (10.1016/j.jse.2007.08.004)
  • [L1] Treatment may need to be individualized for patients with displaced fractures as absolute conclusions cannot be made for these specific cases. (10.1177/1753193418822692)
  • [L5] The safe position for hand immobilization should be broadly defined as mild-to-moderate MP joint flexion that is sufficiently safe and maximizes patient comfort, rather than the traditional intrinsic plus position. (10.1177/1753193419873899)
  • [L4] This study supports the hypothesis that large variations exist in the duration of immobilization following common hand surgery procedures. (10.1177/1558944715617221)
  • [Paper] Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. (10.1016/j.csm.2014.01.001)
  • [Commentary] Providing patients with three options (traditional orthosis, cast, or percutaneous pin) would reach a far-ranging group of people with various professional backgrounds and unique individual needs. (10.1016/j.jht.2013.04.003)
  • [L3] Elbow immobilization had positive effects on healing and enabled both an early return to sports and complete healing. (10.1016/j.jse.2022.01.148)
  • [L1] Taping can be an effective option for repositioning the thumb and improves upper extremity function by controlling the thumb in palm mechanically and enabling sensorial input by maintaining the correct hand position. (10.1016/j.jht.2014.09.007)
  • [L4] A non-surgical, conservative protocol can be used for patients with isolated proximal phalangeal fractures without uncorrectable finger rotation or fracture angulation exceeding 25 degrees in the sagittal plane or 10 degrees in the coronal plane following closed reduction. (10.1177/1753193419881086)
  • [L4] However, the intervention is risk-free, easy to fabricate and perform, and has a solid biomechanical rationale. (10.1016/j.jht.2008.07.002)
  • [L3] However, its long-term impact on functional outcomes remains unclear and warrants further investigation. (10.1002/ksa.70303)
  • [L5] Hand surgery and hand therapy practice interventions, including use of RMF orthoses for management of non-surgical and surgical EM injuries may benefit from an in-depth look at the EM zone III and IV anatomy and biomechanics. (10.1016/j.jht.2023.01.002)
  • [L1] Radiographic follow-up during splinting appears to be necessary. (10.1177/1753193420917567)
  • [L4] Hand therapy is essential to maintain and further surgical improvement of passive extension and to regain active extension following surgery. (10.1016/j.jht.2014.12.004)
  • [L5] Orthoses are usually part of the hand therapy protocol after corrective procedures despite lack of strong evidence, and it is recommended to provide them based on individual patient needs rather than routinely. (10.1016/j.hcl.2018.03.008)
  • [L5] Successful flexor tendon rehabilitation's end-result is functional hand motion and strength. (10.1016/j.hcl.2004.11.006)
  • [L4] The position of adjacent fingers has a large influence on flexor tendon displacement, and commonly used protocols may not lead to optimal tendon excursions. (10.2106/jbjs.j.01521)
  • [L4] The model has a satisfactory engagement with the finger, corrects the deformity and has synchronism between finger movement and orthotic device, what minimize functional difficulties. (10.1016/j.jht.2012.07.013)
  • [L4] Immobilization of the distal interphalangeal joint of any finger reduces the overall grip strength of the hand, with the effect becoming progressively more pronounced from the index to the little fingers. (10.1177/1753193418765068)
  • [L1] There was no difference between the 2 groups on maintaining the reduction on final lateral radiographs. (10.1016/j.jhsa.2008.04.010)
  • [L4] Relative motion orthoses can be adapted and applied to multi-finger injuries, eliminating the need for multiple, bulky or functionally-limiting orthoses. (10.1016/j.jht.2017.04.006)
  • [L4] A static cylinder finger splint is needed after use to consolidate tissue remodeling and preserve clinical results. (10.1016/j.jht.2009.04.001)
  • [L2] Both splints demonstrated modest improvements in hand function, with no statistically significant differences in function or strength. (10.1016/j.jht.2010.12.004)
  • [L4] All of the patients who used this protocol improved their total arc of motion. (10.1016/j.jhsa.2008.05.018)
  • [L4] Wearing a RM orthosis enabled functional hand use as well as providing challenges completing everyday activities. (10.1016/j.jht.2023.02.001)
  • [L1] Early surgical treatment results in a shorter time to clinical union and allows patients to return to sports and activities of daily living faster than with cast treatment. (10.1177/0363546504272262)
  • [L3] Scaphoid waist fractures which appear to be undisplaced and united on a week 4 CT scan will unite, and may not need to be immobilised in a plaster cast for more than 4 weeks. (10.1177/1753193409105189)
  • [L2] The duration of orthotic use (weeks of treatment) is significantly associated with the extent of contracture resolution. (10.1016/j.jht.2011.09.006)
  • [L3] Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the contracture. (10.2106/00004623-199802000-00010)
  • [L2] Better progress with dynamic splinting may be expected in joints with less pretreatment stiffness, shorter time since injury (less than 12 weeks), and in flexion rather than extension deficits. (10.1016/j.jht.2011.03.001)

See Also

References

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[2] One Versus 3-Week Immobilization Period for Nonoperatively Treated Proximal Humeral Fractures. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.02137

[3] Driving With Upper Extremity Immobilization: A Comprehensive Review. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.04.037

[4] Immediate Postoperative Active Mobilization Versus Immobilization Following Tendon Transfer for Claw Deformity Correction in the Hand. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.10.012

[5] Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: A randomized clinical trial. Journal of Hand Therapy. 2013. DOI: 10.1016/j.jht.2013.01.004

[6] One or Three-Weeks Immobilization Period in Proximal Humeral Fractures Conservatively Treated. Prospective Randomized Study. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.018

[7] Passive Mobilization With Place and Hold Versus Active Motion Therapy After Flexor Tendon Repair: A Randomized Trial. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.11.031

[8] Clinical effectiveness of early surgical fixation versus cast immobilization for adults with a scaphoid waist fracture: five-year follow-up of the Scaphoid Waist Internal Fixation for Fractures Trial. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0122.r1

[9] Effect of Immobilization without Passive Exercise After Rotator Cuff Repair. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01741

[10] How shoulder immobilization influences daily physical activity – an accelerometer based preliminary study. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-3133-8

[11] Orthotic Considerations for Dense Connective Tissue and Articular Cartilage—The Need for Optimal Movement and Stress. Journal of Hand Therapy. 2012. DOI: 10.1016/j.jht.2011.12.002

[12] Management of the stiff elbow: a literature review. EFORT Open Reviews. 2023. DOI: 10.1530/eor-23-0039

[13] Short-term clinical outcome of orthosis alone vs combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2018.01.004

[14] Active non‐operative treatment of acute isolated posterior cruciate ligament injury with cylinder cast immobilization. Knee Surgery, Sports Traumatology, Arthroscopy. 2008. DOI: 10.1007/s00167-008-0531-0

[15] Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b6.36329

[16] A Randomized Clinical Trial Comparing Immediate Active Motion With Immobilization After Tendon Transfer for Claw Deformity. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.11.014

[17] Efficacy_of_Custom_Versus_Prefabricated_Splinting_in_Clients_With_Rheumatoid_Art_S0894113007001391. n.d..

[18] The halo. A spinal skeletal traction fixation device.. The Journal of bone and joint surgery. American volume. 1968.

[19] How Long Should Acute Anterior Dislocations of the Shoulder be Immobilized in External Rotation?. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509331943

[20] Acute Closed Dislocation of the Second through Fourth Carpometacarpal Joints: Satisfactory Treatment with Closed Reduction and Immobilization. HAND. 2013. DOI: 10.1007/s11552-012-9484-3

[21] A systematic review of how daily activities and exercises are recommended following volar plating of distal radius fractures and the efficacy and safety of early versus late mobilisation. Hand Therapy. 2020. DOI: 10.1177/1758998320967032

[22] Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2023.05.016

[23] After rotator cuff repair, stiffness—but not the loss in range of motion—increased transiently for immobilized shoulders in a rat model. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.08.004

[24] Chapter 29 Hand/Carpal Fractures and Dislocations. 2021.

[25] Buddy taping versus splint immobilization for paediatric finger fractures: a randomized controlled trial. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193418822692

[26] On the safe position for hand immobilization. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419873899

[27] Variations in Postoperative Immobilization Following Common Hand Surgery Procedures. HAND. 2016. DOI: 10.1177/1558944715617221

[28] Physical Therapy Management of Patients with Osteochondritis Dissecans. Clinics in Sports Medicine. 2014. DOI: 10.1016/j.csm.2014.01.001

[29] Commentary on article “Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: A randomized clinical trial” (Tocco et al., 2013). Journal of Hand Therapy. 2013. DOI: 10.1016/j.jht.2013.04.003

[30] Conservative treatment for stable osteochondritis dissecans of the elbow before epiphyseal closure: effectiveness of elbow immobilization for healing. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.148

[31] Effects of taping the hand in children with cerebral palsy. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.09.007

[32] Non-surgical management of isolated proximal phalangeal fractures with immediate mobilization. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419881086

[33] Clinical Commentary in Response to: Effectiveness of Splinting for the Treatment of Trigger Finger. Journal of Hand Therapy. 2008. DOI: 10.1016/j.jht.2008.07.002

[34] Mid‐frequency electrical muscle stimulation during immobilization may prevent early deltoid muscle atrophy and promote early strength recovery after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70303

[35] An in-depth look at zone III and IV anatomy of the finger extensor mechanism and some clinical implications for use of the relative motion flexion orthosis. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2023.01.002

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