This article will take you through a step-by-step process of how to fabricate a pulley protection splint for a rock climber with a grade II or III pulley sprain. The purpose of the article is to educate the climber as well as the medical practitioner on the details of constructing the splint.
This article would not have been possible without the guidance, expertise and recommendations from highly respected researchers, medical doctors and surgeons who specialize in climbing injuries. The techniques described below were modified from the research study by Micha Schneeberger B.S. and Dr. Andreas Schweizer M.D. titled “Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment With the Pulley-Protection Splint-A Series of 47 Cases.” Expert opinion from discussions with Dr. Volker Schöffl M.D. further shaped the technique and procedures to make a Pulley Protection Splint (PPS) that are described in this article. Additional thanks to Dr. Liz Souza DPT, CHT for her guidance.
The complete video of how to make a pulley protection splint is below. It is approximately 22 minutes. You can view the video in its entirety, or reference the clips within the article that are associated with each step of the process.
Pulley Sprain Introduction:
Dr. Jared Vagy DPT, author of the best selling book Climb Injury-Free and Dr. Matt DeStefano DPT teamed up to teach medical practitioners how to make pulley protection splints with the help of three time youth national champion Ross Fulkerson. A PPS is an effective treatment for acute grade II or III pulley ruptures since it approximates the flexor tendons to the bone, as in holds them closer, to take stress off the injured pulley. A study by Dr. Andreas Schweizer and Micha Schneeberger, published in the Journal of Wilderness and Environmental Medicine, evaluated the effectiveness of using a PPS after grade III complete pulley ruptures in rock climbers. The results showed almost 90 percent of the climbers who wore the splint returned to their previous climbing level after approximately eight months.
While you’re likely familiar with taping, a PPS differs in design and function. With tape, it’s difficult to achieve enough force to significantly change bone-tendon distance because it would cut off your circulation, especially if you wear it all day. The PPS, however, includes collateral bulges on the sides of the ring. These allow strong compression of the finger while giving adequate space to protect the nerves, arteries, and veins from being compressed. Additionally, it’s made from moldable plastic, which is more rigid than tape. Thus, it can be applied for longer durations with better compression. Medical experts recommend you wear this splint throughout the day (23-plus hours) for six to eight weeks to take stress off the injured pulley and allow it to adequately heal.
Below is a list of all items needed. Some are recommended, some are mandatory. Mandatory items are notated with an asterix. If you would like to receive professional discounted prices on the splinting materials, you will need to create an account with North Coast Medical. You can do so at their webpage by clicking “Register” on the top right of the screen and registering for a professional account. https://www.ncmedical.com/
You can get by with a dirtbag setup for under $100 or get the full setup for under $400. Having the specialized materials makes it easier and quicker to fabricate the splints, but the most important thing is that you practice as often as possible. We recommend making at least 25 practice splints before you begin molding splints for your rock climbing patients.
This article demonstrates how to fabricate a pulley protection splint for the A2 pulley using 1/8’’ or 3.2 mm thermoplastic material. If you would like to fabricate a splint for the A4 pulley with similar materials used in Schweizer’s study, it is recommended that you use 3/32’’ or 2.4mm thermoplastic material.
Make the Mandrel, Make the Thermoplastic Cut Out, Prep the Pan and Heat the Water
Below if the step-by-step instructions on how to make the modified mandrel, cut out the thermoplastic material, prep the splint pan and heat the water so that you can fabricate a pulley protection splint.
Heat the Material for the Second Time
After you’ve cut the thermoplastic to be custom sized, put it back in the heating pan for approx 45-60 more sec.
- Pull out the thermoplastic strip and place it around the mandrel at the level you marked earlier. Wrap around just like you wrapped the paper towel template, until the ends of the plastic strip are separated only by the plastic side bar.
- Gently mold the thermoplastic strip around the mandrel taking care to form the splint over the plastic side bars on the mandrel. Don’t press too hard, or the thermoplastic may stick to the mandrel.
- Let the plastic harden on the mandrel for approx 60-120 sec, and then gently prise it off taking care not to deform the ring too much. Once there is minimal space between the thermoplastic and the mandrel, you can slide it off instead of opening the ring like a book.
Heat the Material for the Fourth Time
Now you have a PPS in your hand, but you need to smooth the edges of the plastic. Otherwise there will be sharp edges that can damage the patient’s skin.
- Use the stationary heat gun in the vice to warm the edges of the PPS. (CAUTION: do not hold the splint too close or it will burn/melt. Also gently use pliers to hold the splint to avoid burning your fingers.)
- Gently smooth all edges and corners of the PPS using your finger tips. Repeat this step until all rough edges are smooth.
- Test the sizing of the splint on the patient’s finger. Place PPS on the distal-most aspect of the proximal phalanx (for A2 pulley injury.)
Securing the PPS Closed
This is the most important step for proper use of the PPS. If the splint is made perfectly, but the patient does not secure the splint tight enough, then the PPS is not doing its job it was made to do.
- Place PPS on the distal-most aspect of the proximal phalanx (for A2 pulley injury) right up against the joint line. When sizing and adjusting, ensure that the PPS does not drift proximally with movement.
- Use leukotape to secure the PPS closed. You must use leukotape because other tapes lack the tensile strength. The tape should be reapplied at least once per day, but at least recheck to make sure the tape and closure is tight. Tape does stretch over time.
- To close the splint, place a strip of leukotape tape on the palmar side of the splint. Starting the tape from the palmar side and pulling upward ensures an upward directed force mimicking the pulley.
- Taping Steps:
- Stabilize with ipsilateral thumb
- Stabilize the dorsal side of the splint with middle finger while pulling tape taut with contralateral thumb/index, and increase closure with contralateral ring finger.
- Seal the splint closed. Ensure that the dorsal/palmar lips are indeed closed tight when you seal the tape. REMEMBER: This is the most important step.
- When fasting the pulley protection splint to the finger, make sure that you fully educate the climber on how tight to fasten so that it does not occlude blood flow. If the finger has a capillary refill of less than 2 seconds, looses circulation or has temperature changes, immediately remove the splint and reapply with less tension once blood flow, temperature and sensation return to the finger.