Splinting

Question 1

Orthotic

Answer 1

The splint is a device that is applied to a part of the body for the purpose of protecting that part or assisting in the restoration or improvement of function

*Do have to have doctors orders for orthotics

Goals = to protect or support injured, weakened, or
repaired joints and soft tissue
(tendon repairs and arthritis)

          to immobilize or restrict joint ROM
          CTS, cubital tunnel syndrom, dequervain's 
          tenosynovitis

          to correct or prevent joint deformity
          (arthritic ulnar deviation)

          to stabilize for weak and absent muscle fx

          to inhibit abnormal muscle tone
          (stroke)

          to increase ROM
          (static progressive splints)

Question 2

Static splints

Answer 2

A splint that is molded to the hand to maintain the tissue in one position

Has no movable parts

May be used to:

• relieve pain but can help edema and swelling
• position and maintain joint alignment
• prevent adaptive shortening of soft tissue
• correct soft tissue contractors
• immobilize a joint or limb following trauma

Question 3

Types of Static splints

Answer 3

Resting Hand Splint = RA, CTS, fractures, hand burns,
tendonitis, hemiplegia

                                 intrinsic plus splint (modified resting
                                 hand splint for burns (duck position)
                                 to reduce contracture

                                 70-90 degrees MCP flexion
                                 IPs straight for burns

CMC Static splint

Ulnar Gutter Splint = any splint that comes up the ulnar
side is an ulnar gutter splint

AquaForm Zippered Wrist splint (long and short) =
more circumferential = provides more
immobilization

Anti-Spasticity Ball Splint = synergy rigid material

Thumb Hole Wrist Cock-Up Splint = wrist neutral splint

Wrist and Thumb Spica Splint with IP Immobilization
Hand-Based Thumb Spica Splint
Gauntlet Thumb Spica Splint
* Scaphoid fractures or DeQuervain’s

Clamshell Splint = prefab with straps, like my black one
good protection and immobilization

Buddy Straps = phalanx fractures, dislocations, encourages
full flexion

Tennis Elbow Band = prefab

Splint liners = fleecy web, foam lining, Terry foam padding
stockinette

                    absorb sweat, comfort
                    Terry cloth could cause sheering on skin

Question 4

Dynamic Splints

Answer 4

A splint that applies force and movement to a joint

Have 3 parts: base
outrigger
dynamic traction force

Trying to improve motion or function
Substitutes for loss of Mm function
Correct deformity
Minimize adhesions formation

Ex: RA attacks soft tissue (ligaments and sagittal bands) helps to keep fingers tracking properly

Ex: radial n, extends wrist and fingers when nerve is damaged and pt can’t do that for a while so this helps to hold wrist in extension and fingers. Often pt will get it back in 3-4 months

Question 5

Static Progressive Splints

Answer 5

• Similar to dynamic splints, but no movable components
• Applies low-load to joint while maintaining the tissue at its
  max length
• Worn for extended periods of time so that the tissue adapt
  “grow” to its new length
• Serial static splints
• May be used to: increase range of motion
  correct soft tissue contractors
  maintain improvement obtained through
  other forms of tx, such as passive stretch

*** Always about ROM, better than passive stretching b/c
you need more time (low grade stretch for a long period
of time.

MCP Flexion Static-progressive = not elastic, they can’t extend against it, this is why it is not dynamic

Static Progressive Finger Flexion Splint
Static Progressive Finger Extension Splint
*Individual units for flex and ext

Dynamic wrist splint

Phoenix Wrist Hinge

PIP Short Extension Splint = ( still considered dynamic)
b/c of spring

Question 6

Anatomical landmarks

Answer 6

• Clear the creases of mobile joints to allow full movement of the joint

Creases of the Hand:

• DIP crease
• PIP crease
• Palmer digital crease
• Distal palmer crease
• Proximal palmer crease
• Thenar crease
• Median crease
• Ulnar crease
• Wrist crease

Question 7

Arches of the Hand

Answer 7

Custom made splint should maintain the arches of the hand

Arches of the Hand:
* Longitudinal arch = middle finger down to base of palm
* Distal Transverse arch = slightly distal of the distal palmer
crease
* Proximal Transverse arch = proximal of the proximal
palmer crease

The 3 arches of the hand allow the hand to conform to objects being held. This maximizes the amount of surface contact which enhances stability and increases sensory input. Loss of these arches results in severe impairment in the functional use of the hands = therefore you must support the arches

Question 8

Longitudinal Arch

Answer 8

Maintained by activity in the hand’s intrinsic Mm

Flexible arch

Question 9

Proximal Transverse arch

Answer 9

A stable bony arch that forms the posterior border of the carpal tunnel
Rigid arch

At the level of the CMC joint with the keystone being the capitate

Remains arched even when hand is open

Question 10

Distal Transverse arch

Answer 10

Formed by the metacarpal heads
Combination of “radial” stability and “ulnar” mobility
Flexible arch

Level of MCP joints with the keystone being the 2nd and 3rd metacarpals. The 1st, 4th, and 5th metacarpals rotate around the 2nd and 3rd metacarpals to either flatten or increase its arch

Question 11

Anatomical considerations

Answer 11

• Maintain the normal axis of motion
• Try not to splint unaffected joints
• When possible allow contact of palmar surface of palm and digits with the environment to permit greater sensory discrimination

Question 12

Mechanical Principles

Answer 12

Resting Hand Position

• 10-20 degrees wrist extension
• wrist neutral
• flexion and abduction of the thumb
• 15-20 degrees flexion of MCP joints

Splinting principles:
* When flexed, fingers point to scaphoid bone
* Hooks should be attached to the proximal and central
aspect of the nail
* Maintain a perpendicular traction application (90 degrees
not to compress or distract the joint, want angle
straight up and down
* Increase material strength by adding contours
*Distribute forces equally =
Increase the area of force applied on the skin will reduce
the pressure on that area: forearm trough should be
2/3 forearm length

                                           thumb or forearm trough
                                           1/2 circumference * Rolled edges reduce pressure and avoid sharp points * Remember areas of impaired sensation * Use padding over bony prominence BEFORE splinting.     Padding after will increase pressure

Question 13

Pressure Areas

Answer 13

Patient should wear the splint for approximately 20-30 mins, remove the splint and check for redness

Red areas should not last for more than 20 mins after splint removed

Common Pressure Areas:
* Ulnar styloid is biggest followed by 
* Metacarpal joints
* PIPs
* Fingertips
* Theraputty to create a negative space to bubble area
   out and don't have to use padding