“It fits into patients’ everyday lives”

Dr. med. Björn Matthies has many years’ experience with hand orthoses from the ManuLoc family. The Specialist in Surgery and Accident Insurance Consultant at Lübbenau Medical Center in the Spreewald, Germany, relies on them – both for non-surgical treatment and for post-operative care.

life: What experiences have you had with ManuLoc orthoses over the years?

Dr. Matthies: Patients are very happy with them. I like to use these orthoses for a range of problems because I have had excellent experiences with them.
We used to immobilize the hand for six weeks, resulting in stiffness, which meant you had to start from scratch. When patients wear an orthosis, however, they can start using their hand much earlier.
I’m quite aggressive during the follow-up treatment …

What do you mean by that?

Dr. Matthies: … It means I switch from a plaster cast quite early. Many patients also come to me after just one week and ask if they can get rid of the plaster cast. And if the patient shows good compliance, I switch from a forearm plaster cast to an orthosis as soon as possible.

How do patients benefit from switching to an orthosis early?

Dr. Matthies: The patient notices the progress in treatment immediately. The plaster cast is coming off, so something is happening. It’s easy for the patient to slide into the ManuLoc because it’s an open orthosis, even if the hand is still a little swollen. The orthosis can be put on and taken off with one hand, for personal hygiene, for example. Patients are able to use their hand earlier and move their fingers more freely. From what I have observed, patients regain regular functioning to perform everyday activity more quickly.

For which indications do you prescribe ManuLoc orthoses?

Dr. Matthies: During post-operative care to secure the result of surgery, for partial immobilization in cases of fractures and for the non-surgical treatment of fractures.
I also prescribe them for immobilization in cases of inflammation, for osteoarthritis, arthroscopy in the wrist or for injuries to the wrist where you want the fingers to remain mobile. I estimate that 20 percent of all my patients qualify for an orthosis.
80 or 90-year-olds also get an orthosis if the injury allows it. These patients are really happy when they no longer have to wear the heavy plaster cast.

And in which cases are they not suitable?

Dr. Matthies: If the discharge papers explicitly recommend several weeks of immobilization. For complex injuries, this could be four to six weeks. In these cases, I will follow the surgeon’s suggestion. Another criterion not to prescribe an orthosis could also be non-compliance, i.e. the patient doesn’t that they still need to be careful despite wearing an orthosis.

At which exact stage in your treatment plan do you use a hand orthosis?

Dr. Matthies: For patients with inflamma­tion, with osteoarthritis, who need non-surgical, regular immobilization, I would recommend the orthosis on the day I examine the patient. I also prescribe them straight away for injuries, but that depends on the nature of the injury. And also after four to five days during post-operative care, if the surgeon’s recommendation allows it. In other cases, it might be after ten to twelve days, also depending on the recommendation. This is usually the time when the sutures are removed.

Is there a ManuLoc model that you prefer?

Dr. Matthies: In 90 percent of the cases, I prescribe the ManuLoc. It’s important to me that the fingers are mobile. They need to be actively used, otherwise they quickly become stiff. ManuLoc makes this possible. I use the long version, ManuLoc long, if the injury is more distal.

What is your therapeutic goal when creating a treatment plan?

Dr. Matthies: Starting functional treatment of the injured structure early to ensure the patient can regain functionality as quickly as possible in their personal and professional lives. For me, this includes several aspects: little immobilization, avoiding complications such as CRPS (Complex Regional Pain Syndrome) or Sudeck’s atrophy, reducing the burdensome feeling of illness for the patient.

How do you check on the patient’s progress after prescribing a ManuLoc orthosis?

Dr. Matthies: I do that regularly during scheduled follow-up appointments, based on my clinical assessment and the diagnosis. What does the hand look like, has the swelling reduced? Are there restrictions in functionality? How has the pain changed on the visual analog scale? An X-ray can also provide objective findings. Patient satisfaction is also important: how are patients getting on, are they gradually able to do more? How do they describe their problems, are they happy, do they take pain medication? I don’t only look at the hand but also assess the following: what is my overall impression, what are the patients’ facial expressions, what do they look like when enter my office? You can learn a lot from that.

In your opinion, which aspects set the ManuLoc apart?

Dr. Matthies: It fits into patients’ everyday lives. The orthosis is lightweight, and it’s great that it’s open and can be opened widely. For my younger patients, it’s important that they can use their hands again quickly – for older patients that they don’t feel too restricted. From a physician’s perspective, it’s handy that the wound can be checked on easily. And when it comes to ease of use, the Velcro fastening is a crucial detail, and the stoppers are cleverly thought out. It’s very easy to use for elderly patients in particular. I’m giving it ten out of ten points!

Images: Thomas Lebie (2), Bauerfeind (2)