Dorsal Carpal Ganglion DCG

The most common soft tissue tumors of the wrist are ganglions that originate from the dorsal scapholunate ligament.3,45,50 Minor sprains to dorsal wrist capsules or repeated manipulations with the wrists in extension may, in time, cause dorsal ganglions to develop. Gymnasts report wrist ganglia associated with other wrist complaints to be major problems.53 Ganglions may originate either extra-articularly or intra-articularly and the cysts generally involve adjacent tendon sheaths and joint...

Wrist Finger Splints

Some splints include both wrist and digital joints as primary joints. These dual primary purpose splints involve immobilization, mobilization, restriction, or torque transmission of primary proximal joints of the fingers and or thumb in addition to the primary focus wrist joint. Because the expanded SCS groups splints Fig. 13-16 A, Wrist ulnar deviation restriction splint, type 0 (1) B, Wrist flexion restriction splint, type 0 (1) C, Wrist circumduction restriction splint, type 0 (1) D, Wrist...

DeQuervains Disease

DeQuervain's disease is a stenosing tenosynovitis of the extensor pollicis brevis and abductor pollicis longus in the first dorsal compartment. Inflammation of the peritenons of the EPB and APL can be quite debilitating because of their role in thumb function.7 Workers, athletes, and musicians may complain of pain occurring with thumb flexion when the wrist is ulnarly deviated and palmarly flexed. Common examples of sports that involve repetitive hand and wrist motion are bowling and golfing...

Step

A thermoplastic wrist splint is made with careful attention to curves in molding the palmar eminence and metacarpal arch, to provide anatomic support and splint strength (Fig. 23-2). The distal thumb and metacarpophalangeal (MP) crease edges can be folded and add to strength with minimal coverage. Tongue extensions (radial and ulnar deviation bars) around the thumb web space and at the ulnar border of the metacarpals add to splint stabilization on the arm during active use of the prosthesis....

Active Exercise

Flexion Block Splint

Active exercise through purposeful activity such as self-care, leisure, work, or sports and individualized exercise routines produces joint motion affected by muscle contraction and resultant tendon excursion. Achievement of a functional level of active motion depends on the presence of adequate muscle strength and passively supple joints (Fig. 15-3). Active range of motion is benefited by correctly implemented passive motion and splinting techniques that are designed to mobilize arthrofibrosed...

Allow for Efficient Construction and

The splint design should also allow for quick, efficient construction. With increasing concern for medical costs, long construction and fit times are, for the most part, inappropriate. Proper design can expedite construction and fit and decrease expense. Because each part that must be bonded or jointed increases the construction time, the incorporation of multiple components into the main body of the splint at the design stage results in improved efficiency. For example, providing contour at...

Allow for Optimum Function of the Extremity

The upper extremity has the unique ability to move freely in a wide range of motions, which allows for the successful accomplishment of a tremendous variety of daily tasks. The segments of the arm and hand function as an open kinematic chain, with each segment of the chain dependent on the segments proximal and distal to it. Compensation by normal segments when injury or disease limits parts of the chain often provides for the continued functional use of the extremity. Because of this adaptive...

American Society for Surgery of the Hand Total Active Motion Total Passive Motion

Total passive motion (TPM) Sum of angles formed by metacarpal (MIP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints in maximum passive flexion minus the sum of angles of deficit from complete extension at each of these three joints (MP + PIP + DIP) - (MP + PIP + DIP) Total flexion - Total extensor lag TPM. 2. Total active motion (TAM) Sum of angles formed by MP, PIP, and DIP joints in maximum active flexion that is, fist position, minus total extension deficit at the...

Analysis of Splints

FINGER MP, PIP, DIP, THUMB CMC, MP SPLINTS FINGER PIP, THUMB CMC, MP SPLINTS WRIST SPLINTS WRIST, THUMB CMC SPLINTS ELBOW SPLINTS that this chapter will initiate, facilitate, and strengthen sound analytical thinking in regard to splint design and fabrication. On the following pages illustrations of improperly constructed splints are presented and analyzed according to the expanded ASHT Splint Classification System purpose of application, clinical problems, solutions to the problems, and design...

And Shoulder

The wonderful abilities of the hand are intimately related to the function of the shoulder, elbow, and forearm. The extrinsic flexor and extensor tendons of the hand and wrist originate from the forearm bones and or the distal humerus. Without the proper function of the shoulder, elbow, and forearm, one's ability to use the hand in activities of daily living may be severely compromised. Proper rehabilitation of the hand must, therefore, include attention to the status of these more proximal...

Articular Splints

In a study by Neeman and Neeman of the effects of orthokinetic cuffs on a hemiparetic upper extremity, one of three cuffs applied to the subject included a proximally placed cuff to enhance shoulder flexion and abduction and elbow extension.50 Although the effects of the orthokinetic cuff on shoulder motion were not evaluated in their pilot study, the authors reported improvement in active shoulder mobility after a longer duration of treatment. Further, researchers studying the effects of other...

Bone and Cartilage Healing

Unlike the healing by the scar formation of soft tissues, bone is capable of limited regeneration. As with the other tissues, the immediate response to injury includes inflammation and edema with associated bleeding in the marrow cavity and surrounding tissues (Fig. 3-2, A). Within a few days the fibroblas-tic phase of soft tissue healing begins and osteogenic cells from the periosteum and endosteum of the bone begin migration and proliferation at the wound site. These cells lay down callus and...

Casts for Severe Contracture

If the finger is too severely flexed for the cast to be easily removed, the cast could cause shear stress at the dorsum of the proximal interphalangeal joint on replacement. A small cut made along the proximal lateral dorsal surface of the cast may be all that is needed (Fig. 22-4, A) or this can be extended in a U-shape and top flap cut or removed from the cast (Fig. 22-4, B). The cut cast can be secured back on the finger with paper tape. It should be noted that the cast is more secure...

Change Method According to Properties of Materials Used

Different materials require the use of diverse approaches to the forming procedure (Fig. 10-43). For example, if a protective stockinette is used during the shaping of a splint constructed of high-temperature Fig. 10-41 Tape may be used to maintain splint position until plastic hardens. Fig. 10-41 Tape may be used to maintain splint position until plastic hardens. Fig. 10-42 Index-small finger extension torque transmission splint, type 1 (13) A slant board assists arm positioning during the...

Clinical Problem

Splint was left in a closed car on a hot day, which resulted in numerous fit problems and overstretching of thermoplastic material. Fig. 20-18 A,B, Index-small finger flexion, thumb CMC palmar abduction immobilization splint, type 3 (16) 1. Start over. Fig. 20-18 A,B, Index-small finger flexion, thumb CMC palmar abduction immobilization splint, type 3 (16) 1. Start over.

Clinical Solutions

Adjust the elastic traction to provide a perpendicular angle of force application to the IP joint axis of rotation. 2. Roll the distal edge of the splint proximally. It should not extend beyond the distal palmar flexion crease. 3. Continue splint material to cover dorsal aspect of thumb for greater stability. Fig. 20-11 D, Thumb IP flexion mobilization splint, type 2 (3) (Courtesy Peggy McLaughlin, OTR, CHT, San Bernardino, Calif.) Fig. 20-11 E, Thumb IP flexion or extension mobilization...

Consider Individual Patient Factors

The individual requirements of each patient are the most influential factors in determining the ultimate size and configuration of a given splint. After the functional requirements of the splinting program are established, additional individual factors must be addressed How much of the pathologic condition and rehabilitation program does the patient understand, and how much of the program can he intelligently accomplish for himself How accessible is the splinting facility, and how often will he...

Consider the Effects of Reciprocal Parallel Forces

As noted earlier, the use of three parallel forces in equilibrium as exemplified by a first-class lever system is basic to splinting of the hand, with the splint acting as the proximal and distal counterforces to the forces of the hand and forearm and a strap at the axis of the splinted segment providing the reciprocal middle force. In an analysis of the interrelationships of forces in a first-class lever system in equilibrium, the combined downward weights must be opposed by an equal upward...

Consider the Length of Time the Splint Is to Be Used

In general, the shorter the anticipated need of a splint, the simpler its design, material type, and construction Fig. 8-2 A, Index-long finger extension mobilization splint, type 1 (7) B, Nonarticular thumb distal phalanx splint C,D, Wrist extension immobilization splint, type 0 (1) A,B, Imagination and humor can entice a child to cooperate in the splinting program. C,D, Glow-in-the-dark splinting material (Reveals Nite-Lite , WFR Corporation, Wyckoff, N.J.) improves splint compliance for...

Considerations and Variations

The splint design final can be fabricated in fiberglass or cast-molded in skin colors by local prosthetic companies. A metal or brace-type appearance is avoided as it is undesirable to many patients. The distal splint can be extended in a platform to support flaccid fingers. A wrist-hinge joint can be included, and the splint made to be dorsal (Fig. 23-8). Unconditional routing of the cable helps some patients. Routing the cable around the medial side of the elbow restores pronation in a...

Construction Principles

STRIVE FOR GOOD COSMETIC EFFECT APPROPRIATELY MATCH MATERIAL TO CONSTRUCTION CIRCUMSTANCES USE EQUIPMENT APPROPRIATE TO MATERIAL USE TYPE OF HEAT AND TEMPERATURE APPROPRIATE USE SAFETY AND ERGONOMIC PRECAUTIONS AND WORK EFFICIENTLY CONSIDER INFORMATION DATA ON MATERIAL SAFETY DATA SHEETS (MSDS) ROUND CORNERS AND SMOOTH EDGES ANALYZE AND INTEGRATE EFFECTIVE MECHANICAL PRINCIPLES STABILIZE JOINED SURFACES ACCORDING TO PURPOSE FIXED BOND OR ARTICULATED LINK PROVIDE VENTILATION AS NECESSARY SECURE...

Control Direction and Maintain Force Magnitude

Once correct tensions are set (Fig. 7-24), corrective splints require careful monitoring and frequent readjusting to maintain their effectiveness (Fig. 7-25). An elastic assist may lose some of its rebound ability, creating excessive length and a concomitant inability to generate mobilizing forces within the desired range. These types of assists may require adjustment or replacement as often as every 2 or 3 days, depending on physical properties and use. The optimum range of forces for a spring...

Correlate Physical Properties of the Mobilization Assist and Interface Material with the Design of the Splint

Splint design also influences the type of mobilization assist that may be used. Because of their physical properties, some materials may not be compatible with certain splint designs. For example, a mobilization assist that requires length to generate appropriate force parameters would probably have limited effectiveness with a hand-based splint design simply because of the relative shortness of the splint. Because of inherent mechanical bias, some splints and assist components are more...

Correlate Physical Properties of the Mobilization Assist with Patient Requirements

Mobilization splinting is dependent upon a series of interrelated variables that describe joint condition, the most important of which include, but are not limited to, time duration, degree of angulation, and end feel. When aligned, these variables form a series of separate but parallel condition continuums, each of which ranges from minor to major level of involvement. Selection of a mobilization assist depends on the amount of joint involvement as it relates to duration of the problem over...

Cubital Tunnel Syndrome

The ulnar nerve is vulnerable to injury at the elbow as it courses under fascia at the medial epicondyle and is tethered by the flexor carpi ulnaris.55 Cubital tunnel syndrome may result from direct trauma, as in being hit on the elbow by a batted ball, or from sustained elbow flexion that compresses the ulnar nerve, as in playing a musical instrument that requires prolonged elbow flexion postures. For musicians, nerve compressions and tendonitis necessitate evaluation of postures, changes in...

Cuff or Strap

Designed to hold the splint in place on the extremity, this splint part (Fig. 4-14) is usually constructed of a softer, more pliable material. Cuffs tend to be wider Expanded Splint Classification System (ESCS) Combinations of Primary and Secondary Joints When a primary joint is linked with its potential secondary joint partners, a predictable linear pattern emerges (see specific examples at bottom of table). For this exercise, only joints proximal to the primary joints are considered. Joints...

D

487f, 489f Deformity biomechanics and, 108-109 boutonniere, 459-460, 460f progressiveness of, 106 in rheumatoid arthritis, 438-439, 445, 447-449, 448f, 449f swan neck, 605 Deltoid muscle, 80, 80f Denis Browne splint, 37-39 Dental acrylic for hand mold, 626-628, 627f Department of Health, Education and Welfare, 22 deQuervain's disease, 466-467, 468f, 469f Design, 210-236 for child's splint, 486-488, 487f evaluation criteria for, 144b general principles of appearance of, 213 ease of application...

Decide Whether to Employ Inelastic or Elastic Mobilization Forces

The kind of traction a mobilization splint uses has major influence on the final design of the splint. Fig. 8-20 A, Index finger IP flexion mobilization splint, type 1 (3) B,C, Long finger IP flexion or extension mobilization splint, type 1 (3) D, Index finger PIP extension mobilization splint, type 1 (2) Mechanical principles are crucial to successful splint designs. Combined dorsal and palmar proximal phalanx components provide excellent stabilization of the metacarpophalangeal joints in...

Determine if the Wrist Forearm andor Elbow Should Be Included

Deciding whether a finger or thumb splint should be hand-based or forearm-based is a major step in the design process. An incorrect choice may needlessly immobilize the wrist or result in a splint that is ineffective in increasing range of motion or providing protection to healing structures. The key question concerns wrist position and whether it alters or affects the motion or stability of more distal structures. If wrist posture does influence articular motion or changes the tension on...

Determine the Surface for Splint Application

The decision as to what surface or surfaces of the hand, forearm, or upper arm a splint is to be applied is the next step in the progression through the hierarchy of design principles. This decision is influenced by the interrelationships of anatomic and mechanical factors. Although pressure is usually tolerated better on the anterior surface of the upper extremity, one must be aware that this side makes the greatest contribution to function and sensation. A finger extension mobilization splint...

Dry Heat

Knowledge of splint material properties is important to improving efficiency. Using dry heat alone, some materials, such as Orthoplast, may be heated to malleable stage in a dry heat pan and held for prolonged periods of time at a constant warm temperature, providing splint material that is immediately ready for cutting and fitting throughout the day (Fig. 9-3). Also, when working in environments where water sources are remote or cumbersome (e.g., hospital bedside or surgery), use of dry heat...

E

Early fit cast prosthesis, 608 Economic factors in assessment, 155 design of splint and, 211 Edema compressive dressing and, 102 in contracture, 91-92 force and, 104-105 range of motion and, 105 Edge, smooth, 243-244, 243f-245f Education client, 144b professional, 26 Efficiency, 273-274 Egyptian splint, early, 5f Elastic assist force maintenance of, 203 length of, 200 Elastic-based thermoplastic, 485 Elastic mobilization force, 229-230 Elastic traction mobilization splinting, 605-606, 606f...

Elbow Forearm Splints Mobilization Splints

Splints that mobilize both the elbow and forearm joints typically are diagnosis-specific in design. These splints may be used preoperatively to substitute for lost active motion, or they may maintain or improve passive joint motion. Postoperatively they protect healing structures and improve joint motion. Type 1. With the elbow and forearm designated as primary joints, type 1 elbow, forearm mobilization splints incorporate either the wrist distally or the shoulder proximally as secondary joints...

Elbow splints

The elbow joint is critical to upper extremity function. Considered a trochoginglymoid joint, the elbow has two articulations, the ulnohumeral joint, a hinge joint, and the radiohumeral and proximal radioulnar joint, an axial rotation joint.26 These two articulations combine to permit two degrees of freedom of motion, flexion-extension and supination-pronation. Without sufficient elbow flexion, the ability to get one's hand to the face and mouth is significantly compromised lack of elbow...

Employ Kinetic Concepts

The actual positioning of specific splint parts will augment or retard muscle action. An extension finger cuff placed on the proximal phalanx assists the long extensor tendons, while interossei and lumbrical forces are reinforced when the cuff is positioned at the middle phalanx. The fitting of a dorsal phalangeal bar to prevent metacarpal hyperextension augments extension of the fingers by maximizing the extrinsic extensor action at the IP joints (Fig. 10-40). Because of the relative lengths...

Exercise and Splinting for Specific Upper Extremity Problems

EXERCISE Passive Exercise Active Exercise Resistive Exercise TORQUE TRANSMISSION SPLINTS TIMING AND TYPE OF EXERCISE COORDINATION OF EXERCISES AND SPLINTING SCHEDULES SPECIAL PROBLEMS ACCORDING TO ANATOMICAL Capsulotomy Capsulectomy Neurovascular Peripheral Nerve Injuries Spinal Cord Nerve Injury Tetraplegia Secondary Procedures Post Tendon Repair Tendon Transfers Soft Tissue Crush, Burn, and Cold Injuries Dupuytren 's Nail Bed Repair Extensive Injuries to Multiple Structures Ray Resection...

Extensive Injuries to Multiple Structures Ray Resection

Splinting post third or fourth digital ray resection without ray transposition is designed to protect the surgical reapproximation of the transverse intermetacarpal ligament of the digits adjacent to the excised metacarpal. Splint buttressing of this ligament reapproximation is accomplished by fitting a nonarticular metacarpal splint (Fig. 15-29) over the site of the ligament and around the remaining metacarpals. Resection of the second or fifth rays generally does not require protective...

Fabrication

Cover working area with disposable drape. Apply a nonsterile surgical glove to the patient's injured hand. Proximal to the glove apply petroleum jelly to prevent adherence of RTV11 silicone rubber to skin and hair followed by prewrap or cotton stockinette (Fig. 17-30). If the foam padding has an adhesive side, remove paper backing. Moleskin is applied to the sticky side of the padding. The adhesive foam padding side will be against the skin and the moleskin side is exposed. The foam-padding...

Finger DIP Splints

Because the DIP joints are also hinge articulations with collateral ligaments and palmar plate stabilization, mechanical principles similar to those of the proximal interphalangeal joints are applicable. From a practical point of view, however, the small area of purchase provided by the distal phalanx makes elaborate mobilization traction techniques less successful in correcting stiffness at this joint. Three-point pressure splints that utilize inelastic traction sometimes prove more effective...

Finger Distal Phalanx Splints

Nonarticular finger distal phalanx splints protect sensitive digital tips, provide pressure to healing nail beds, or reinforce distal phalangeal internal fixation hardware. These splints do not impede DIP joint motion. Pericapsular fibrosis resulting in stiffening of the metacarpophalangeal or interphalangeal joints of the fingers represents the most common disabling problem following hand injury, disease, or surgery. Preventive splints that immobilize or restrict joints in positions least...

Finger Middle Phalanx Splints

Protecting healing structures of finger amputations, nonarticular finger middle phalanx splints (Fig. 11-46) allow early use of remaining finger segments. Fig. 11-45 A, Nonarticular finger proximal phalanx splint. B, Nonarticular index finger proximal phalanx splint A, Two different designs of nonarticular finger proximal phalanx splints protect digital pulley injuries repairs. The splint on the left provides a uniform circumferential pressure around the proximal phalanx, while the splint on...

Finger Mp Pip Dip Thumb Cmc Mp Ip Immobilization

Abduction, flexion, palmar 1 (16) Index-small, thumb abduction, extension Flexion, extension, palmar 1 (16) Index-small, thumb Index-small finger MP flexion and IP extension, thumb CMC palmar abduction 11-38 A-B Index-small finger MP 70 flexion and IP extension, thumb CMC palmar abduction 4-30 A-B Index-small finger flexion, thumb CMC palmar abduction immobilization splint, 8-9 C Index-small finger flexion, thumb CMC palmar abduction immobilization splint, 20-1 2 C Index-small finger flexion,...

Finger PIP Splints

Anatomy of the proximal interphalangeal joint is complex it is important that all those involved in treating PIP joint pathology understand normal and abnormal biomechanics of this joint before embarking on any type of treatment intervention. Although approximately 6 of supination occurs with joint flexion,2 the PIP joint is a hinge joint that allows motion in one plane, extension-flexion. Radial and ulnar collateral ligaments and the palmar plate combine to provide strong articular stability....

Finger Thumb Splints

Finger, thumb splints include the finger MP, PIP, and DIP joints and the thumb CMC, MP, and IP joints as primary joints. The only difference between the splints described in this section and the splints described in the immediately preceding section is the addition of the thumb MP and IP joints to the splints included in this category. All of the concepts discussed above are applicable to splints in this section. Further, splint complexity increases from a minimum total of 13 joints included...

Finger MetacarpalWrist Forearm Shell Dorsal

Positions MP, PIP, and DIP joints of index, long, ring, and small fingers. 2. Supports the transverse metacarpal arch via dorsal metacarpal bar. Splint Index-small finger MP flexion and IP extension immobilization splint, type 1 (13) (Fig. 21-12, B) ANATOMIC LANDMARKS (on paper pattern) ANATOMIC LANDMARKS (on paper pattern) c. Two-thirds distal length of forearm 2. Medial and lateral (Fig. 21-12, C) a. Half thickness second and fifth rays b. Half thickness ulnar and radial wrist c. Half...

Finger MetacarpalWrist Forearm Shell Volar

Positions MP, PIP, and DIP joints of fingers. 2. Positions CMC, MP, and IP joints of thumb. Specific CMC joint ligaments are either taut or relaxed, depending on CMC joint positioning. 3. Supports the transverse metacarpal arch via palmar metacarpal bar. Splint Index-small finger MP flexion and IP extension, thumb CMC palmar abduction and MP-IP extension mobilization splint, type 1 (16) (Fig. 21-13, A) Splint Index-small finger MP flexion and IP extension, thumb CMC radial abduction and MP-IP...

Forearm Splints

Splints may be applied to immobilize, mobilize, restrict, or transmit torque to radioulnar joint motion. Because of the orientation of the rotational axis of the forearm and the problems presented in obtaining a secure mechanical hold from which to base splinting forces, designing and fitting splints to limit or increase supination or pronation range of motion may be a very Fig. 13-21 A,B, Wrist extension index-long finger flexion torque transmission Wrist flexion index-long finger extension...

Forearm Humerus Bar or Trough

This longitudinal splint part (Fig. 4-19) rests proximal to the wrist (for a forearm bar trough) or the elbow Fig. 4-16 Wrist extension, index-small finger MP extension, thumb CMC radial abduction and MP extension mobilization splint, type 0 (7) This splint for radial nerve palsy employs a combination of elastic rubber band and inelastic filament traction. Elastic traction glides proximal to the outrigger while the inelastic component is situated distally. (Courtesy Dominique Thomas, RPT, MCMK,...

I

Identification of items or shapes, 153 Identification system for splints, 2627 Iliac crest, 259 Immobilization contracture and, 92-93 of metacarpophalangeal joint, 11 scar remodeling and, 96 Immobilization mobilization splint, 126 Immobilization restriction splint, 345, 347f Immobilization splint design of, 222-223, 223f elbow, 378, 379f finger DIP, 318, 319f MP, 284, 285f MP, PIP, DIP, 295, 296f thumb, 322-323, 323f thumb CMC, 319-322, 322f forearm, 225, 369, 370f ligaments and, 264 in...

Identify Optimum Force Magnitude Parameters

When discussing mobilization assists and the forces they impart, it is important to understand the funda mental differences between a splint designed to substitute for absent or weak active motion and a splint that corrects passive motion limitations. Both of these splints are classified as mobilization splints, but the mobilizing forces employed by each splint differ. A substitution splint is applied to a passively supple joint, requiring a force that is just sufficient to pull or push the...

Identify Primary Joint Segments

The first step in splint design is to identify which anatomical structures the splint will influence. Splints that do not affect joints, nonarticular splints, concentrate on individual segments of the upper extrem ity open kinematic chain (e.g., humerus, forearm, metacarpal, or phalanx). Nonarticular splints usually employ conforming, two-point coaptation forces to support or reinforce healing tissues splint design is determined by the length and circumference of the segment to which the splint...

Identify Secondary Joints

Maximum mechanical benefit of splinting forces may be obtained by controlling joints proximal and or distal to injured or diseased primary joints. Secondary joints are normal or less involved joints that are included in a splint to focus immobilization, mobilization, restriction, or torque transmission forces to primary joints (Fig. 8-17, A). When secondary joints are controlled, dissipation of desired forces at the more mobile secondary joints is avoided. Secondary joints may also be included...

Increase Material Strength by Providing Contour

The time-honored engineering principle of strength through contour is directly applicable to the design and construction of hand splints and is in many instances a concept that is concomitant with the previous consideration of force dissemination and use of leverage. When a large force is placed on a flat, thin piece of material, the counterforce produced by the material is insufficient, and the material bends. If, however, the Fig. 6-31 In a type 1 PIP extension mobilization splint, the force...

Increase Mechanical Advantage

The design and construction of splints should be adapted to include use of favorable force systems. Many splints fail because of patient discomfort or because of fractured components. These problems may result from inattention to the lever systems at play between the splint and the extremity or between individual splint parts. Mechanically, splints are simple machines, levers, that work in equilibrium. Incorporating forces, axis of rotation, moment arms, and resistances, splints are predictable...

Increase the Area of Force Application

Since splinting materials are, to varying degrees, rigid, their improper application to the extremity may cause damage to the cutaneous surface and underlying soft tissue as a result of excessive pressure. Problems from pressure occur most often in areas where there is minimal subcutaneous tissue to disperse pressure, such as over bony prominences, or in areas where the inherent structure of the splint predisposes to increased pressure of mechanical counterforces. indicates that a force of 25...

Info

Fig. 24-6 To minimize waste of alginate material, choose an appropriate sized plastic matrix (container) that is slightly wider and longer than the hand and forearm to be molded. Plastic containers work well and clean easily and may be adapted as shown to accommodate longer hands and forearms. To fabricate a mold for an award trophy, subject's hand is positioned in the scout sign of the Boy Scouts of America. Fig. 24-6 To minimize waste of alginate material, choose an appropriate sized plastic...

J

Jensen hand function test, 154 Joined surfaces, stabilization of, anatomy of, 48-53, 50f-53f assessment of, 146-147, 147f capsulotomy or capsulectomy of, 406-407, 406f contracture of, 91-95. See also Contracture as design consideration primary, 221-222, 222f secondary, 224-225, 227f digital anatomy of, 21 biomechanics of, 21 ligaments of, 52f distal interphalangeal. See Distal interphalangeal joint excessive stress on, 101 fitting of splint and, 268-271, 269f-273f interphalangeal, 52...

L

Laceration, contracture and, 93 Landmark of humerus, 73f Lateral antebrachial cutaneous nerve, 72 Lateral epicondylitis, 471-472, 471f, 472f Latissimus dorsi, 81f, 82 Lengthener, forearm, 610 Leprosy, 20-21 Letterman General Hospital, 10 Levator scapulae muscle, 78, 79f Lever in construction, 244 mechanical advantage and, 164-165 Leverage, 256-257, 259f Lifecasting, 617 Ligament 264f-268f stress and, 262-263 fracture and, 405-406 of hand, 49 inferior glenohumeral, 79f in joint assessment, 146...

Lessons From Hot Feet A Note on Tissue Remodeling

Few persons have contributed more to our understanding of biomechanics and soft tissue response to stress then Dr. Paul Brand. Historically, enlightened physicians and brace makers have, for centuries, advocated slow, gentle tension to effect change in soft tissue, but their opinions were based on individual trial-and-error observations. This lack of organization and scientific validation made their teachings vulnerable to contradictory, opposing practices that prompted harsh manipulation to...

Mallet Finger

Mallet finger, baseball finger, and drop finger are interchangeable colloquial terminology for the most common closed tendon injury in the athletic patient population.1,2,34,35,48 Disruption of the terminal extensor tendon at its insertion may occur when catching a ball (baseball finger) or whenever an excessive external flexion force is applied to the distal inter-phalangeal joint (DIP) while the joint is extended (mallet finger). This injury is frequently seen in athletes who catch or hit...

Materials and Application

Fabrication of Proximal Interphalangeal Joint Casts Quick-setting specialist plaster Bandage scissors (to cut plaster) Curved scissors, wire cutters, suture removal scissors (for removal and trimming of cast) 1. Cut plaster gauze strips 2.5 cm wide and 18 cm long. 2. Wet plaster gauze and dry excess on a paper towel (if Specialist fast-setting plaster do not dry if gypsona plaster). 3. Fold edge slightly (0.5 cm for the first 2.5 cm) to make a smooth edge for the cast against the skin (Fig....

Mechanical Principles

Fig. 6-12, A-C F x FA R x RA F x 3 0.9 x 2.5 F x 3 2.25 F 0.75 F x 5 0.9 x 2.5 F x 5 2.25 F 0.45 F x 7 0.9 x 2.5 F x 7 2.25 F 0.32 F x 1.5 4(0.5) x 5 F1.5 10 F 6.67 F x 3.75 4(0.5) x 5 F3.75 10 F 2.67 F x 5.75 4 (0.5) x 5 F5.75 10 F 1.74 Fig. 6-21 Torque Force x length T 8 x 1 T 8 inch-ounces Fig. 6-28, A F x 3.5 0.9 x 3 F3.5 2.7 F 0.77 F x FA R x RA F x 9 0.9 x 3 F9 2.7 F 0.3 Patterns for Splinting from Chapters 18 and 21 Articular Nonarticular Joint Segment Shoulder abduction and external...

Metacarpal WristForearm Shell Volar

Supports the transverse metacarpal arch via palmar and dorsal radial metacarpal bars. 3. Provides a base of attachment for finger or thumb phalangeal bars and for outrigger components. d. Two-thirds distal length of forearm 3. Medial and lateral (Fig. 21-9, C,D) Splint Ring-small finger MP flexion mobilization splint, type 1 (3) (Fig. 21-9, B) Fig. 21-9B Example of completed splint Fig. 21-9B Example of completed splint

Mobilization

Index-long finger MP extension mobilization flexion restriction splint, type 1 (3) Index-small finger MP extension, flexion, and ulnar deviation splint, type 0 (4) 11-7 D Long finger MP flexion restriction splint, type 0 (1) 1 7-8 Index-small finger MP flexion restriction splint, type 0 (4) 6-4 B Index-small finger MP flexion and ulnar deviation restriction splint, type 0 (4) 4-15 Index-small finger MP flexion and ulnar deviation restriction splint, type 0 (4) 1 0-4 A Index-small finger MP...

Motion Assessment Instruments

The measurement of motion involves muscle tendon continuity, contractile and gliding capacity, neuro-muscular communication, and voluntary control. Techniques for evaluating upper extremity motion include goniometric measurements and the determination of isolated muscle strength. Goniometric evaluation of the upper extremity is essential to monitoring articular motion and muscu-lotendinous function. Both passive and active motion should be recorded using an appropriate size goniometer with a 0...

Muscle and Tendon

Diminished or absent active motion in the presence of normal passive articular motion may indicate loss of muscle tendon continuity, impaired contractile capacity, or limitation in tendon glide. The effect is observable in the resting hand when the normal cascading posture of the digits is altered, and pathology is assessed through measurement of active motion of those joints spanned by the involved musculo-tendinous units and through manual muscle testing procedures.35 Again, relating...

Muscle Tendon Tendon

Traditionally, extensor tendon repairs have been treated by immobilizing the wrist and digital joints in extension.81 Problems of adhesions between the repair site and the gliding bed are not as limiting to extensor tendons as they are to flexor tendons because of the relatively long fibroosseous canals through which the flexor tendons course. However, with severe extensor tendon injuries in which periosteum, retinaculum, or soft tissues are involved, adhesions can...

P

Appropriate use of, 248-249, 249f cast and, 603, 603f, 604 to decrease pressure, 163 fit and, 255 splint design and, 232 Pain assessment, 153 Palmar aponeurosis, 67 Palmar crease as boundary, 253-254, 255f mechanical advantage and, 165 reciprocal, 173, 173f-177f, 175 Paralysis, 65-66 Paralytic stage of polio, 8 Parry, Wynn, 27 Partial hand splint prosthesis, 608-612, 609f-612f Passive exercise, 397-398, 398f Passive mobility, 170-171, 172f Passive motion, 151 Pathomechanics in rheumatoid...

Pattern and Fabrication Sequence

Cut a strip of neoprene - to 1- inches wide (the width will vary with the size of the hand) at a length that will wrap around the wrist and overlap enough to add a Velcro attachment. Sew Velcro onto the underside of the strap end. The Velcro will be positioned at the ulnar wrist. Cut another strap --to 1 inch wide at a length that will begin at the proximal edge of the wrist strap at the center of the dorsal wrist, wrap through the web space, around the thenar eminence, and end at the proximal...

Patterns

SPLINT PATTERN FABRICATION PATTERN MATERIALS AND EQUIPMENT SPECIFIC PATTERNS Metacarpal Shell Metacarpal Wrist Forearm Shell (Dorsal) Metacarpal Wrist Forearm Shell (Volar) Forearm Elbow Humerus Shell CONTIGUOUS ADAPTATIONS OF BASIC PATTERNS Proximal Phalangeal Metacarpal Wrist Forearm Shell Finger Metacarpal Wrist Forearm Shell (Dorsal) Finger Metacarpal Wrist Forearm Shell (Ventral) The transition from the cognitive design process to the actual construction of tangible splint patterns is...

Plaster Serial Casting for the Remodeling of Soft Tissue Mobilization of Joints and Increased Tendon Excursion

Judith Bell Krotoski, OTR, FAOTA, CHT MOBILIZATION SPLINTING INEVITABILITY OF GRADUALNESS IN THE REMODELING OF SOFT TISSUE CASTING TECHNIQUE Special Considerations Materials and Application Fabrication of Proximal Interphalangeal Joint Casts Lack or Minimal Use of Padding REMOVABLE CASTS Casts for Severe Contracture OTHER JOINTS AND TENDONS CASTING IN TWO DIRECTIONS TWO-STAGE CASTING Boutonniere Deformity Swan Neck Deformity CASTING COMBINED WITH ELASTIC TRACTION In the Splint Classification...

Principles of Using Outriggers and Mobilization Assists

Select Appropriate Design Configuration Select Appropriate Material Establish and Maintain Correct Directional Orientation Platform for Application of Mobilizing Force(s) MOBILIZATION ASSISTS Identify Optimum Force Magnitude Parameters Therapists' Abilities to Select Rubber Band Tensions Appropriate Boundaries Identify Optimum Torque Magnitude Parameters Correlate Physical Properties of the Mobilization Assist with Patient Requirements Correlate Physical Properties of the Mobilization Assist...

Provide for Ease of Application and Removal

Whenever possible, patients should be able to apply and remove their splints independently. Dependence on others for assistance may lead to frustration of both patient and family, resulting in poor wearing habits or discarding of the splint. To allow for ease of wear and removal, the splint should be designed for simple hand and forearm insertion with straps provided that can be tightened or loosened without great difficulty. Individual adaptations in the splint design, fastening devices, or...

Proximal Phalanx Fracture

Proximal phalangeal fractures are also commonly encountered sports and work injuries. These fractures may have complicated medical courses because of the intricate balance of extrinsic and intrinsic muscle tendon units, extensor mechanism, and ligamentous structures that may be involved. The proximal phalanx is more commonly fractured than the distal or middle phalanx because under certain circumstances the length of the finger imparts a mechanical leverage on the proximal phalanx.30 Suddenly...

R

Radial artery, 66, 74 Radial collateral ligament, 49, 73 Radial deviation in child, 482t Radial nerve, 64-66, 64f, 66f injury to, 408, 408f-409f Radial styloid process, 258 Radioscaphocapitate ligament, 49 Radioscapholunate ligament, 49 Radius, 352 elbow and, 72 Range of motion in assessment, 150-151, 151f in proximal interphalangeal joint, 101, 101f swelling and, 105 torque, 109f Rapport with patient, 271-272 Ray resection, 428, 429f Reaction effect at secondary joint, 173, 173f Reciprocal...

Referral and Interview Information

The information provided in the signed referral and ensuing initial interview is paramount because it directly influences the eventual splint design and subsequent treatment. In addition to the patient's name, age, sex, hand dominance, hospital number, and designation of involved extremity, the referral should include diagnosis, date and circumstances of injury and or onset of medical problem, purpose and timing of splint application, and specific instructions and precautions. The patient...

Replicasting Making Molds of the Hand

General Concepts of Mold Fabrication Matrix Method Using Molding Alginate Brush-On Method Using Silicone Rubber Prepared directly on a subject's hand, a negative mold provides the external frame or shell for a positive reproduction or mold* of the hand in plaster, dental acrylic, or similar casting material. After removal, the negative mold is filled with a liquid material that, through an endogenous heat process, dries and hardens. When this material is completely solid, the negative mold is...

Restriction Mobilizationlmmobilization

Extension, flexion 1 (13) Index-small Index-small finger extension restriction index-ring finger flexion mobilization splint, 5-5 B type 1 (1 3) Index-small finger extension restriction ring finger flexion mobilization splint, 6-20 type 1 (1 3) Index-small finger extension restriction index-ring finger flexion mobilization splint, 8-10 B-C type 1 (1 3) Index-small finger extension restriction index-small finger flexion mobilization splint, 11-12 A-D type 1 (1 3) Index-small finger MP extension...

Scaphoid Fractures

Biomechanical action and anatomical structure combine to predispose scaphoid bones to fractures. Because the scaphoid bridges the intercarpal joint, it is impinged upon the radius with wrist extension dorsiflexion and radial deviation. Further, the scaphoid bone's narrow waist makes it vulnerable to Fig. 17-17 A, Wrist extension, thumb CMC palmar abduction and MP flexion immobilization splint, type 0 (3) B, Wrist extension, thumb CMC palmar abduction immobilization MP flexion restriction...

Select Appropriate Design Configuration

The type of outrigger used in a mobilization splint should be reflective of individual patient needs. The number of primary joints being mobilized, their specific range of motions, and the number and positions of secondary joints included in the splint all influence the shape of an outrigger. The purpose of the splint is also important to outrigger design. Is the splint intended to correct joint deformity or to substitute for loss of muscle power Although specific outrigger configurations and...

Skin and Subcutaneous Tissue

Thorough examination of the surface condition and contours of the extremity helps define pathology and influences splint configuration. Closely correlated with neurovascular status, tissue viability, and the inflammatory process are skin color, temperature, texture, and moisture. These should be carefully noted. Alterations from normal extremity size and contour should also be identified, including areas of atrophy, tissue deficit, scarring, local swelling, generalized edema, and abnormal...

Skin Soft Tissue

Adapt for Skin Soft Tissue Alterations Poor fitting splints can jeopardize the healing process by causing further damage through application of unwarranted destructive shear or pressure forces. Splints fitted over portions of an extremity where skin or soft tissue is of questionable viability or where soft tissue defects exist present serious challenges. Depending on specific individual circumstances, avoidance of splinting material around and over problematic areas, including major soft tissue...

Soft Tissue

Although of dissimilar etiologies, extensive soft tissue damage resulting in crush, burn, and frostbite injuries often requires similar conservative treatment. Splinting requirements after these injuries depend on the site and extent of tissue damage. When a major portion of the hand is involved, early use of an anti-deformity or safe position splint (finger MP flexion, IP extension immobilization splint) alternated with exercise facilitates preservation of collateral ligament length by...

Splint Component Integration

Individual splint components combine to allow a splint to function in the manner for which it was designed to operate, with each part providing an integral task toward achieving the overall goal of the splint (Fig. 4-30). Those who see only the external configurations of splints miss critical nuances that make splinting endeavors successful. The astute upper extremity specialist knows how component parts function individually, understands how they relate to each other, and is able to manipulate...

Splints Acting on the Fingers

Mobilization Restriction Torque Transmission Splints This chapter follows the expanded ASHT SCS Once articular splints are sorted according to their format by first dividing splints into articular or primary joints, they are divided according to one of nonarticular categories. In the articular cate- four purposes immobilization, mobilization, restric- gory, splints are further grouped according to the tion, or torque transmission. Dual-purpose categories primary joints they influence. Splints...

Ss

10s Thumb ray 20s Index ray 30s Long ray 40s Ring ray 50s Small ray 60s Carpus* 1s Distal phalanx 2s Middle phalanx 3s Proximal phalanx 4s Distal palm 5s Mid palm 6 7s Proximal palm* *Modification suggested by J. Bell, 1982. D Distal P Proximal R Radial U Ulnar Pearsall, G., & Ruderman, R. J Hand Surg., 3 211,1978. SENSORY EVALUATION SEMMES-WEINSTEIN CALIBRATED MONOFILAMENTS Medical College of Virginia Virginia Commonwealth University Courtesy Karen Hull Lauckardt, M.A., R.P.T. HAND...

Superficial Anatomy

It is particularly important for the person engaged in splint preparation to thoroughly understand the surface anatomy of the forearm and hand, including the various landmarks that represent underlying anatomic structures. Respect for bony prominences and a knowledge of the position of underlying joints will be particularly important if one is to prepare splint devices that are comfortable and either immo- Fig. 2-26 Palmar aponeurosis reflected distally reveals septa and underlying palmar...

Swan Neck Deformity

The swan neck deformity is similar to the boutonniere deformity in that it quickly becomes a fixed contracture and usually requires surgical correction of the underlying problem to prevent contractures from recurring (Fig. 22-7, A). Rupture of the lateral bands at their attachment on the distal interphalangeal joint or disruption of the palmar plate at the proximal inter-phalangeal joint can cause the deformity. If recognized and casted or splinted early, deformity might be arrested or...

Thumb IP Splints

Although strong interphalangeal joint motion is valuable to thumb performance, its absence is not critical. In most cases thumb functions are possible if there is a good carpometacarpal joint and perhaps some metacarpophalangeal joint motion. Thumb IP splints are applied to immobilize, mobilize, restrict, or transmit torque to the IP joint. Secondary joints are often incorporated in these splints but are not mandatory. Type 0. Only the distal thumb joint is immobilized in a type 0 thumb IP...

Thumb MP Splints

The middle joint in the important thumb intercalated chain is the metacarpophalangeal joint. At this level, stability is a more important consideration than mobility. A wide discrepancy exists in the amount of thumb metacarpophalangeal motion found in the general population, with flexion ranging from only a few degrees to 90 . It is apparent that the functional sequela of limited or absent metacarpophalangeal motion is negligible if the joint is positioned properly Fig. 12-12 A,B Thumb CMC...

Thumb MP Ulnar Collateral Ligament Tear or Rupture

The metacarpophalangeal joint of the thumb is vulnerable when the thumb is abducted because, in abduction, the MP joint is locked, allowing forces to the distal thumb to be transmitted to the MP joint. Lateral stress with the thumb in abduction stresses the ulnar collateral ligament (UCL).30 Commonly referred to as gamekeeper's thumb or skier's thumb, injuries to the ulnar collateral ligament of the thumb MP joint precipitate MP joint instability. Causative factors include falling with the...

Upper Extremity Assessment and Splinting

EXAMINATIONS CLINICAL EXAMINATION OF THE UPPER EXTREMITY Referral and Interview Information Posture UPPER EXTREMITY ASSESSMENT INSTRUMENTS Activities of Daily Living, Vocation, and Avocation Thorough and unbiased assessment procedures furnish essential foundations for splinting programs by delineating baseline pathology from which splint designs may be created and patient progress and splinting methods may be evaluated. Assessment information also assists in predicting the rehabilitation...

Use Optimum Rotational Force

The mobilization of stiffened joints through traction requires a thorough understanding of the resolution of forces to obtain optimum splint effectiveness. This must be achieved without producing patient frustration or increased tissue damage through joint compression or separation. Theoretically, any force applied to a bony segment to mobilize a joint may be resolved into a pair of concurrent rectangular components acting in definite directions. These two components consist of a rotational...

Vascular Status

In addition to vascular studies, volumetric measurements, circumferential measurements, thermal imaging, and biofeedback may be used to assist in monitoring upper extremity vascular status. Skin temperature and color and composite mass of the extremity provide essential clues to understanding the vascular status of a diseased or injured hand or arm. Areas with questionable tissue viability should be Fig. 5-5 A, Elbow Flexion and Extension restriction splint, type 0 (1) B, Index-small finger...

Work Efficiently

The use of devices or methods that increase the efficiency of the molding time may also be of considerable benefit. Lightly wrapping a warmed, low-temperature, thermal material splint to the patient's hand and forearm with an elastic bandage allows the therapist's full attention to be directed to the positioning of the hand. Strategically applied tape holds Fig. 10-38 Elbow extension restriction splint, type 2 (3) The elbow-locking device restricts elbow joint extension, allowing remodeling of...

Wrist Finger Mp Pip Dip Thumb Cmc Mp Ip Immobilization

Extension, flexion, 0 (16) Index-small, thumb Wrist circumduction, thumb CMC circumduction and MP flexion restriction splint, 17-18 B type 0 (3) Wrist circumduction, thumb CMC circumduction and MP flexion restriction splint, 1 7-18 C type 0 (3) Wrist extension, thumb CMC palmar abduction and MP flexion restriction splint, 9-12 B type 0 (3) Wrist extension, index-small finger MP extension, extension mobilization splint, type 0 (7) Wrist extension, index-small finger MP extension, extension...

Wrist Finger Thumb Splints

Torque Transmission Immobilization Splints Type 2. As noted earlier, the presence of a colon punctuation mark ( ) in a splint's technical name indicates the splint transfers active motion at one or more joints to create passive joint motion at another joint Fig. 13-19 A-C, Wrist radial and ulnar deviation restriction Thumb CMC palmar abduction immobilization splint, type 1 (3) This splint incorporates flexible thermoplastic tubes to restrict wrist deviation and allow active wrist extension,...

Wrist Splintscontd

Wrist, Finger MP, PIP, DIP, Thumb CMC, MP, IP Fig. 18-14A Wrist extension, index-small finger MP extension and IP flexion, thumb CMC radial abduction and MP-IP extension mobilization splint, type 0 (16) Fig. 18-14B Wrist extension, index-small finger MP extension and IP flexion, thumb CMC radial abduction and MP-IP extension mobilization splint, type 0 (16) Fig. 18-14C Wrist extension, index-small finger MP extension and IP flexion, thumb CMC radial abduction and MP-IP extension mobilization...

View the Past

Cmc Palmar Abduction

ELAINE EWING FESS, MS, OTR, FAOTA, CHT The splinting of extremities rendered dysfunctional by injury or disease is not a new concept, and yet *This section originally was published as an article in the Journal of Hand Therapy (JHT), vol 15 2, 2002, with the understanding that it would later appear in Chapter 1 of this third edition of Hand and Upper Extremity Splinting Principles and Methods. Since the JHT publication of this chapter, additional references have been added and some splint...

Asht Splint Nomenclature Task Force Splint Classification System Garner

1980 - Fig. 1-14 The Splint Nomenclature Task Force members created the ASHT Splint Classification System at a 1991 meeting in Indianapolis, IN. Members attending were (front row, from left) Lori Klerekoper DeMott, OTR, CHT, Maude Malick, OTR, Janet Bailey, OTR, CHT (task force leader), Karan Gettle, MBA, OTR, CHT, and Ellen Ziegler, MS, OTR, CHT (back row, from left) Cynthia Philips, MA, OTR, CHT, Elaine Fess, MS, OTR, CHT, and Jean Casanova, OTR, CHT (1991 Director, ASHT Clinical Assessment...