Finger Thumb CMC Splints Immobilization Splints

Finger, thumb CMC immobilization splints prevent motion of the finger MP, PIP, DIP joints and the thumb CMC joint to rest or to allow healing of soft tissue. The decision of whether to immobilize in an antideformity position or a functional position is key, especially Fig. 11-35 Small finger DIP extension mobilization splint, type 0 (1) To avoid causing injury from shear, splints designed to mobilize the DIP joint must be well stabilized on the finger. Elastic mobilization forces produce soft...

Finger Mp Pip Splints

Finger MP-PIP splints range from simple to complex designs depending on individual patient circumstances. Because MP joints are condyloid in nature and move in multiple planes, and PIP joints are hinge articulations with movement in one plane, proper alignment of these longitudinally situated joints is critical to successful splint application. Further, the combined length of proximal and middle phalanges in finger MP-PIP splints results in longer force arms and greater potential torque on...

Brachial Plexus Mnemonic

Grant Anatomy Brachial Plexus

53-year-old Robert Taylor is a simple memory device for learning the nomenclature and form of the brachial plexus.1 It is not intended to replace formal study of the brachial plexus. The mnemonic Robert Taylor Drinks Coffee Black has been used to recall the nomenclature of the levels of the brachial plexus (proximal to distal) R Rami, T Trunks, D Divisions, C Cords, and B Branches. The rationale for Robert Taylor's age of 53 years is that the structures at each of the levels are in groups of...

Splinting for Work Sports and the Performing Arts

CASE EXAMPLES Musician Worker Athlete Trigger Finger (Stenosing Tenosynovitis) Thumb MP Ulnar Collateral Ligament Tear or Rupture INJURIES CONDITIONS Cubital Tunnel Syndrome Lateral Epicondylitis Medial Epicondylitis Elbow Dislocations Fractures COMMON SHOULDER INJURIES CONDITIONS Humeral Fracture Shoulder Subluxation Dislocation Posterior Subluxation Dislocation Anterior Subluxation Dislocation INSTRUCTIONS FOR SILICONE RUBBER PLAYING CAST FABRICATION Materials Fabrication SUMMARY The upper...

Biologic Basis for Hand and Upper Extremity Splinting

Splints are used to put all or part of the hand at rest so that diseased, injured, or surgically violated tissues can undergo orderly, uninterrupted healing. They are also used to favorably influence tissue healing and minimize the development of restrictive scar tissue, which has a detrimental effect on normal joint and tendon movement. In many clinical situations, there is an appropriate time for the use of immobilizing, mobilizing, restriction, and torque transmission splints to control the...

Humerus Splints

Functional splinting of the humerus following a humerus diaphysis fracture has been an accepted form of treatment for a number of years. While exact percentages vary with individual studies, this technique is associated with a high rate of fracture Fig. 14-19 A, Nonarticular humerus splint Wrist extension mobilization splint, type 0 (1) B, Nonarticular humerus splint Through its circumferential application, a nonarticular humerus splint provides a coaptation force for support of a humerus...

Take into Account Patient Associated Risk Factors

Variables that extend duration of wound healing stages, cause skin or soft tissues to be friable, or pre dispose tissue to scarring or nerve damage must be taken into consideration when designing splints and splint wearing schedules. These variables may include, but are not limited to, therapeutic intervention factors, such as medication or radiation systemic diseases like peripheral vascular disease, poor nutritional status, diabetes mellitus, rheumatoid arthritis, scleroderma, or Raynaud's...

Tissue Remodeling

Section 1 Biologic Basis for Hand and Upper Extremity Splinting TISSUE HEALING INFLAMMATION FIBROPLASIA SCAR MATURATION WOUND CONTRACTURE SPECIFIC TISSUE HEALING Bone and Cartilage Healing Tendon Healing Nerve Healing JOINT STIFFNESS AND TENDON ADHESIONS Joint Stiffness Distal Interphalangeal Joint Contracture Proximal Interphalangeal Joint Extension Contracture Proximal Interphalangeal Joint Flexion Contracture Metacarpophalangeal Joint Extension Contracture Metacarpophalangeal Joint Flexion...

Bone

Occurring at all ages, trauma resulting in upper extremity fractures is prevalent. Fracture of the small bones of the hand is one of the most commonly encountered injuries of the upper extremity.28 Fractures of the distal phalanx occur most frequently, followed by metacarpal, proximal phalangeal, and finally, middle phalangeal fractures.27 The potential functional loss from this kind of injury may be underestimated. Even if fracture healing occurs uneventfully, residual joint stiffness may...

Extremity Spasticity1

SPECIFIC LITERATURE REVIEW SPLINTS USED IN THE CONSERVATIVE TREATMENT OF UE SPASTICITY Articular Splints Shoulder, Elbow Splints Elbow Splints Elbow, Forearm, Wrist, Finger MP, PIP, DIP, Thumb CMC, MP, IP Splints Elbow, Forearm, Wrist, Thumb CMC Splints Forearm, Wrist, Thumb CMC, MP Splints Wrist Splints Wrist, Finger MP, Thumb CMC, MP Splints Wrist, Finger MP, PIP, DIP, Thumb CMC Splints Wrist, Finger MP, PIP, DIP, Thumb CMC, MP, IP Splints Finger MP, PIP, Thumb CMC, MP, IP Splints Finger MP,...

Joint Stiffness

Joint stiffness may result from direct injury or may occur secondarily when afflictions of the skin, fascia, tendon, tendon sheath, muscle, or retinacular Fig. 3-4 Nerve healing. Axonal regeneration following peripheral nerve severance and repair. A, Injury results in degeneration of the axon and myelin distal to the wound and for a short distance proximal to the wound. B, A cell body and proximal stump of the axon enlarge as metabolic activity necessary for regeneration commences. The Schwann...

Tendon Adhesions

Limited excursion may result from direct injury to flexor, extensor, or intrinsic tendons, and the scar resulting from the healing of contiguous tissues may also result in excursion-limiting adhesions to these structures. In particular, fractures of the metacarpals or phalanges, in areas where they have a close anatomic relationship to the digital tendons, may result in the tendons becoming bound in an unyielding fracture callus, which, in addition to reducing the amount of active motion...

Splint Biodynamics

It is important that those involved in the preparation and application of splints have an understanding of what tissues are the limiting factors in the diminished movement of a given joint. Is it periarticular scarring or adherent tendons or a combination of both that prevents joint rotation The injured extremity should be inspected for areas of wounding, edema, inflammation, infection, and the amount of active and passive motion loss. Alterations in joint movement produced by variations in the...

Splinting for Tendon Adhesions

The high propensity for injured tendons to develop excursion-limiting adhesions following repair has resulted in a number of techniques designed to impart a controlled amount of tendon motion at an early stage of tendon healing.92 It is hoped that these methods will favorably modify the quantity, strength, and length of adhesions and permit the maximum recovery of tendon performance. Flexor tendon injuries in the digital canal are particularly prone to the development of adhesions, and programs...

Measurements of Biologic Activity

In an effort to determine the effectiveness of splinting programs in modifying the biologic processes involved in tissue healing and scar formation it is important to measure the response of the affected tissues. Hand performance perhaps can best be determined by serially measuring changes in the active and passive range of motion throughout the course of the splinting program (Fig. 3-14). Brand indicates that torque-angle measurements are more objective for passive range of motion and use...

Biomechanics Splinting and Tissue Remodeling

JUDITH BELL KROTOSKI, OTR, FAOTA, CHT The hand is the dynamic precision operating tool of the upper extremity. It has to be splinted with its internal and external capacities for force and movement in mind, and with regard to how these are balanced and interplay for efficient and effective skill in our endless variety of tasks performed in everyday living. Our hands function through critical balance and movement of bony structures. These bony components are motored by muscles acting on tendons...

Soft Tissue Remodeling

Hand upper extremity specialists know from experiential knowledge derived from years of clinical practice that splinting is the most efficacious method currently available for improving joint motion limited by soft tissue contracture and or fibrosis. Unfortunately, a paucity of research studies documenting the efficacy of splinting endeavors exists in current medical literature. Sometimes that which is most evident is the last to be researched formally. While the daily gains of splinting...

Purpose Immobilization Mobilization Restriction Torque Transmission

The fourth element in building an SCS splint name divides articular splints into one of four groups according to the primary objective of the splint immobilization, mobilization, restriction, or torque transmission. Does the splint immobilize, mobilize, restrict motion of, or transmit torque to the primary focus joint(s) By describing intended anatomic joint motion rather than splint component motion, the SCS eliminates past confusion encountered when static splints splints with no moving parts...

Descriptive Phrase

Introduced in the first edition of this book in 1981, the descriptive phrase approach to categorizing splints was the first method to recognize the important role of secondary joints, which are included in splints for mechanical control purposes, but are not the primary target joints of splints.3 An important prelude to the development of the ASHT Splint Classification System (SCS), this method lacked the power, extensiveness, and refinement of the SCS. I ASHT SPLINT CLASSIFICATION SYSTEM (SCS)...

Purpose of Application

Splints may be designed to prevent deformity by substituting for weak or absent muscle strength, as in peripheral nerve injuries, spinal cord lesions, and neu-romuscular diseases. They may be used to support, protect, or immobilize joints, allowing healing to occur after bone, tendon, vascular, nerve, joint, or soft tissue injury or inflammation. Correction of existing deformity represents another commonly encountered reason for splint application. To achieve full active joint motion potential,...

Boutonniere

Dubbed boutonniere or buttonhole deformity, injury to the extensor tendon central slip is the second most frequently occurring closed tendon injury in athletes. Etiology of this injury involves trauma to the central slip or a sudden forced flexion of the PIP joint, as with a blow to the dorsal middle phalanx that forces PIP flexion as the digit is extended. Boutonniere injuries are more frequently associated with contact sports such as football,34,35 but also occur in nonsports situations....

Sensibility Assessment Instruments

Sensibility relies on neural continuity, impulse transmission, receptor acuity, and cortical perception. Assessment of sensibility may be divided into sudo-motor sympathetic response and the abilities to detect, discriminate, quantify, and recognize stimuli (see Appendix B-9). Moberg's ninhydrin test and the wrinkle test identify areas of disturbance of sweat secretion after peripheral nerve disruption. The involvement of sympathetic fibers in a peripheral nerve injury results in areas of dry...

Arches

Support Distal Transverse Arch Splinting

The three skeletal arches of the hand (proximal transverse, distal transverse, and longitudinal) must be taken into consideration in attaining congruous splint fit. The distal transverse or metacarpal arch consists Fig. 10-13 A, Wrist extension immobilization splint, type 0 (1) Pressure over bony prominences may be decreased by avoidance (A), wider area of contact (B), or contoured padding (C). Fig. 10-13 A, Wrist extension immobilization splint, type 0 (1) Pressure over bony prominences may be...

Classification and Nomenclature of Splints and Splint Components

Mechanical Characteristics Source of Power Materials Anatomic Part Descriptive Phrase ASHT SPLINT CLASSIFICATION SYSTEM (SCS) Total Number of Joints Design Options Connector Bar Crossbar Cuff or Strap Deviation Bar Mobilization Assist or Traction Device Finger Cuff Fingernail Attachment Forearm Humerus Bar or Trough Hypothenar Bar Joint Metacarpal Bar Opponens Bar Outrigger Splint Component Integration SUMMARY Good communication, an essential to efficacious patient intervention, is dependent...

Nerve Healing

Tendon Healing

Injury to peripheral nerves necessitates an entirely different type of tissue healing in that the severed nerve fiber must regenerate distally from the point of injury. The injury results in degeneration of the axon and myelin distal to the wound and, for a short distance, proximal to the wound (Fig. 3-4, A). Schwann cells in the distal stump grow toward the proximal stump, and macrophages clear cellular debris from the distal nerve. The cell body and proximal stump of the axon enlarge as the...

Avoid High Shear Stress

To begin, it is necessary to define a few important terms that describe the material behavior of soft tissues. 1. Force is a vector and therefore has a magnitude, direction, and point of application. It changes the direction and or velocity of objects, and when applied to a surface, forces result in deformation of solid or semisolid substances. 2. Strain is a measure of the deformation of a material. It is defined as a ratio of the change in a reference length (gauge length) to the original...

Medial Epicondylitis

Medial epicondylitis is similar to lateral epicondylitis but involves the muscles originating on the medial epi-condyle of the humerus. Repetitive pronation with wrist flexion often leads to medial epicondylitis. Stress and microtearing to the pronator teres, flexor carpi radialis, flexor digitorum sublimus, and flexor carpi ulnaris occur in pitchers in the acceleration phase of throwing, during tennis serves, hitting a forehand shot, and with golf swings. Gymnasts place stress traction on the...

Functional Patterns

Ergonomics Human Figure Hand

The prehensile function of the hand depends on the integrity of the kinetic chain of bones and joints extending from the wrist to the distal phalanges. Interruptions of the transverse and longitudinal arch systems formed by these structures will always result in instability, deformity, or functional loss at a more proximal or distal level. Similarly, the balanced syn-ergism-antagonism relationship between the long extrinsic muscles and the intrinsic muscles is a requisite for the composite...

General Concepts of Mold Fabrication Precautions

Before starting on any mold-making project, always ask the subject and all others who will be in the immediate area, including staff and patient family members, if they have allergies to any of the products to be used. If someone is allergic to one or more of the materials, the person must leave the area or the project must be discontinued. Although infrequent, allergic reactions to materials range from a mild rash to serious respiratory problems. The work area must be well ventilated, and both...

Resistive Exercise

Splint Wearing Schedule Form

The purpose of resistive exercise is to produce sufficient muscle strength to allow maximum tendon excursion, full joint motion, and the execution of normal daily activities. This may be accomplished through purposeful graded activities and progressive resistive exercises. Strengthening is traditionally divided into isometric, eccentric, and concentric exercises. Emphasis includes improving endurance and or strengthening. Caution is needed in adapting strengthening programs for patients with...

Function Assessment Instruments

Normal Grip Strength Measurements

Hand function reflects the integration of all systems and is measured in terms of handedness tests, grip pinch, coordination and dexterity, and ability to participate in activities of daily living and vocational and avocational tasks. The Waterloo Handedness Questionnaire (WHQ) is a 32-item self-administered questionnaire that has high reliability46,53 and has been shown to be more specific and accurate than the traditional self-report for determining handedness.36,40 Further, when the WHQ is...

Trigger Finger Stenosing Tenosynovitis

Splint With Finger Typing Meme

Repetitive trauma to the area of the A-1 digital pulley is seen in baseball catchers, gymnasts, weightlifters, workers who employ handled gripping tools such as pliers, and musicians who encounter persistent pressure from holding an instrument.20 Direct pressure from a hard surface applied to the flexor tendon at the Fig. 17-6 Long finger PIP extension and flexion torque transmission splint, type 2 (4) A noninjured digit protects an adjacent digit with a newly healed stable fracture from...

Shoulder Subluxation Dislocation

Complete separation of the articular surfaces by a direct or indirect force results in a dislocation of the glenohumeral joint.47 Dislocation includes a disruption of the ligaments of the joint, while a partial dislocation involves a subluxation of the shoulder joint, the sequela of a sprain. A dislocation may self-reduce, or be reduced by a teammate, coach, trainer, or physi cian. A minimum of 6 weeks is considered necessary for ligaments to mend, with protection that limits shoulder motion,...

Shoulder Anatomy

The shoulder girdle represents the most proximal aspect of the upper extremity. Movements of the scapula in relation to the chest wall as well as movements of the glenohumeral joint profoundly affect one's ability to place the hand in space. Passing through the region of the shoulder girdle are the nerves and vascular structures that supply the entire upper extremity. The clavicle, scapula, and proximal humerus form the bony elements of the shoulder girdle. The clavicle is a doubly curved bone...

Lateral Epicondylitis

Frequently referred to as tennis elbow, rug beater's elbow, or jailer's elbow, lateral epicondylitis is a common condition found in athletes, workers, and musicians. Arising from the humeral lateral epicondyle, the extensor-supinator muscles may be strained or contused through repetitive shear activities that cause microscopic tearing and inflammation at the origin of the common extensor tendon. Gripping an instrument, a piece of sporting equipment, or a tool further aggravates the injury. The...

Wrist Splints

Restricted Extension Elbow

When used to control articular motion, wrist splints affect motion of the multiple carpal joints in a similar manner. They may be used to immobilize, mobilize, restrict motion, or transmit torque. It is important to understand that in order to control digital extrinsic muscle tendon glide, the wrist must be included in the splint. Recommendations and designs for wrist splints are numerous. Much of this is due to the proliferation of upper extremity cumulative trauma cases over the past few...

Splinting for Joint Contractures

When collateral ligaments are subjected to increasing load, their response may be somewhat different from that seen in the tendon. Weeks127 carried out experiments and determined the percentage of elongation of ligaments subjected to various loads. He plotted his information on a stress-strain curve (Fig. 3-12). Ligaments were found to exhibit a much greater elongation with a much smaller load than do flexor tendons. He further noted that when a ligament with predominantly elastic fibers was...

Mechanical Principles

Understand Basic Force Systems Increase the Area of Force Application Increase Mechanical Advantage Use Optimum Rotational Force Consider the Torque Effect Consider the Relative Degree of Passive Mobility of Successive Joints Control Reaction Effect at Secondary Joints Consider the Effects of Reciprocal Parallel Forces Use Appropriate Outrigger Systems Incorporate Articulated Components Appropriately Increase Material Strength by Providing Contour Stress Concentrations (Scar, Changes in Elastic...

Thumb Distal Phalanx Splints

Thumb Splint For Distal Interphalangeal

Thumb nail bed splints and splints that protect the tip of the thumb without incorporating thumb joints are Fig. 12-19 A,B, Thumb IP flexion mobilization splint, type 2 (3) C, Thumb IP flexion mobilization splint, type 2 (3) D,E, Thumb IP extension or flexion mobilization splint, type 2 (3) F, Thumb IP extension mobilization splint, type 3 (4) G, Thumb IP extension mobilization splint, type 3 (4) A-C, Using a variety of mobilization assists and outriggers, these type 2 IP flexion splints allow...

Wrist Splintscontd

Fig. 1 8-1 1 A Wrist extension, index-small finger MP extension, thumb CMC radial abduction and MP extension mobilization splint, type 0 (7) (Fig. 18-11A) The MacKinnon splint is designed under the principle that pressure applied to the metacarpal heads with stretch to the intrinsics causes relaxation of flexor spasticity. With this relaxation, increased wrist and finger extension and thumb abduction are sometimes seen. This results in less fisting with an increase in hand use. Improvements are...

Short Opponens Hand Splint

Wrist Extension Mobilization Splint

Capsulectomy involves the surgical division (capsulotomy) or excision (capsulectomy) of a portion of the collateral ligaments of a digital joint with normal articular surfaces but limited passive motion due to contracted periarticular ligamentous structures. Although a substantial improvement of motion may be reliably anticipated at the MP level, the results of a capsulectomy procedure at the PIP joint are less predictable.14,44,85,100,109 Mobilization efforts are usually initiated within 1 to...

Thumb CMC Splints

Distal Interphalangeal Flexion Crease

The carpometacarpal joint of the thumb is a triaxial saddle articulation that allows movement through multiple planes. CMC joint ligaments provide first metacarpal stability in palmar abduction and allow metacarpal rotation in neutral. Palmar ligaments include the anterior intermetacarpal ligament, the anterior oblique carpometacarpal ligament, and the radial carpometacarpal ligament. Dorsal ligaments are the posterior oblique carpometacarpal and the posterior intermetacarpal ligaments. The...

Articular Nonarticular

The first division separates splints into two groups (1) those that affect articular structures and (2) those that affect an anatomic segment or structure but do not affect joint motion or cross a joint. Comprising the vast majority of splints, articular splints use three-point pressure systems to affect a joint or joints by immobilizing, mobilizing, restricting, or transmitting torque. Since most splints are articular in nature, the term articular is assumed and is not included as part of the...

Splinting the Pediatric Patient

IDEAS TO AID IN SPLINT CONSTRUCTION MATERIALS SELECTION HOW TO IMPROVE THE LIKELIHOOD THAT A SPLINT WILL BE WORN IDEAS TO AID IN SPLINT DESIGN IDEAS TO PREVENT UNWANTED SPLINT REMOVAL ARTICULAR SPLINTS Thumb Splints Wrist Splints Forearm Splints Elbow Splints OTHER Splinting in the pediatric population can occur as early as the neonatal intensive care unit and may persist into adulthood for those who continue to be challenged by abnormal tone. Review of the literature finds very little...

Indications for Splinting

Degree Wrist Extension Splint

The patient with rheumatoid arthritis presents numerous treatment challenges to the rehabilitation team.3,23 Whether or not to splint is a major decision. A rheumatoid arthritic hand may be splinted for the following reasons (1) to help decrease inflammation, (2) to rest and support weakened joint structures, (3) to properly position joints, (4) to help minimize joint contractures, or (5) to help improve function through better positioning of the joints. Controversy, however, still surrounds...

Pathomechanics

Before undertaking a splinting program with a patient with rheumatoid arthritis, the therapist must understand the pathomechanics of the disease process. Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation primarily in synovial tissue, often leading to tendon, ligament, and bone involvement.2 The disease is usually polyarthritic, in that it affects multiple joints, and may have systemic manifestations. The course of the disease is unpredictable, but it is usually one...

Finger MP Splints

Mcp Joints Capsule Tape Ring Finger

The metacarpophalangeal joints of the index, long, ring, and small fingers are condyloid with the rounded metacarpal head fitting into a small concavity at the base of the proximal phalanx. The ligamentous arrangement at each MP joint consists of two collateral ligaments and one palmar ligament that allow anteroposterior and mediolateral motion in addition to a slight amount of phalangeal rotation. Since the ligaments must extend around the cam-shaped palmar portion of the joint, the collateral...

Hand Wrist and Forearm

Mcp Extensor Muscles

I ANATOMY AND KINESIOLOGY OF THE HAND, WRIST, AND FOREARM One cannot expect to adequately participate in the treatment of disorders of the hand and arm without a solid working knowledge of the intricate anatomic and kinesiologic relationships of the upper extremity. The preparation of externally applied splinting devices to the forearm, wrist, and hand necessitates a thorough understanding of and respect for the underlying anatomic structures. Only through comprehension of the normal anatomy of...

Influence on Scar Remodeling

It is apparent that the scar formation and wound contracture that are an integral part of the orderly healing of hand tissues may have a great influence on tendon gliding and joint movement. Measures designed to prevent digital stiffness include elevation, positioning of joints to lessen the possibility of collateral ligament shortening, implementation of early motion programs, relief of pain, control of edema, elimination of hematoma formation, prevention of infection, and the use of splints....

Splints Acting on the Thumb

ARTICULAR THUMB SPLINTS Thumb CMC Splints Immobilization Splints Mobilization Splints Restriction Splints Torque Transmission Splints Thumb CMC, MP Splints Immobilization Splints Mobilization Splints Mobilization Immobilization Splints Thumb CMC, MP, IP Splints Immobilization Splints Mobilization Splints Restriction Mobilization Splints Thumb CMC, IP Splints Mobilization Splints Thumb MP Splints Immobilization Splints Mobilization Splints Restriction Splints Thumb MP, IP Splints Immobilization...

Carpal Tunnel Syndrome

To upper extremity clinicians, carpal tunnel syndrome (CTS) seems as though it is the nerve compression that won't go away By far the most common neuropathy in the upper extremity, high incidence of CTS is found in workers, athletes, and performing artists.55 The large variety of commercially available splints and soft splints attests to the fact that commonly employed treatment approaches have not completely alleviated patients' symptoms. CTS is caused by compression of the median nerve at the...

Patient Satisfaction

Testing of patient satisfaction has become an integral part of rehabilitation endeavors. Just as other test instruments must meet instrumentation criteria, so too must patient satisfaction assessment tools meet these criteria. Satisfaction surveys are often in the form of patient-completed questionnaires. Current symptom satisfaction tools that are used in evaluating patients with upper extremity injury or dysfunction include the Medical Outcomes Study 36-Item Health Survey (SF-36),10 the Upper...

Hand Amputations

Partial Hand

Judith Bell Krotoski, OTR, FAOTA, CHT INTRODUCTION A VIEW OF THE PROBLEM A CHANGING FUTURE PLASTER OF PARIS CAST EARLY FIT PROSTHESIS PARTIAL HAND SPLINT PROSTHESIS FABRICATION OF PARTIAL HAND SPLINT PROSTHESES Steps 1-10 DUAL-OPERATED LATERAL THUMB DESIGN PROSTHESIS SUMMARY As surgeons and therapists understand what is necessary to reconstruct a functioning hand after traumatic injury, the same concepts and principles need to be applied to prosthetic hand design. Countless times, a decision is...

Review Purpose Immobilization Mobilization Restriction Torque Transmission

Immobilization Position

Once key joints are determined, direction of forces and splint purpose are defined almost simultaneously. Purpose identifies the functional objective(s) of a given splint. Are joints to be immobilized to allow healing Is it desirable to increase or to maintain the passive range of motion or to substitute for absent active motion Should articular motion be allowed within predefined limitations Is the splint applied to transfer moment or torque to joints outside the boundaries of the splint It is...

Choose the Most Appropriate Materials

The wide variety of splinting materials currently available allows the upper extremity specialist to selectively match materials to meet the specific requirements of individual patients. Each material has idiosyncratic properties that are advantageous or less advantageous to given situations. Some are stronger or more durable (Fig. 8-26, A), while others mold so closely and evenly that fine skin creases are duplicated on the internal surface of the splint. The property of becoming translucent...

Splints Acting on the Wrist and Forearm

Torque Transmission Immobilization Splints This chapter follows the expanded ASHT ESCS format by first dividing splints into articular or nonarticular categories. In the articular category, splints are next grouped according to the primary joint or joints they influence. Splints in the nonarticular category are defined by the anatomical segments upon which they are based. Once articular splints are grouped according to their primary joints, they are further defined by direction of force...

Allow for Optimum Sensation

Finger Tapen

Without sensation, the hand is perceptively blind20 and functionally limited. Because cutaneous stimuli provide feedback for activity, splint designs should leave as much of the palmar tactile surface areas and the radial and ulnar borders of the hand as free from occlusive material as possible (Fig. 8-7). Fig. 8-4 A, Ring finger PIP flexion mobilization splint, type 1 (2) B, Finger IP flexion mobilization splint, type 0 (2) 4 splints finger separate C-E, Long finger MP extension and flexion...

Shoulder Splints

Joint Immobilization Splint

Because of its inherent complexity and size, splinting the shoulder is one of the more challenging splinting endeavors clinicians may encounter. The shoulder is a composite of four articulations that work together in a complex symphony to provide three degrees of freedom of motion in multiple planes. The four joints of the shoulder include the glenohumeral joint, the sternoclavicular joint, the acromioclavicular joint, and the scapulothoracic joint.24 Positioning of the shoulder following...

Forearm Wrist Thumb Splints

A type 0 forearm, wrist, thumb splint will include as primary joints the forearm, wrist, and thumb. Patients note improved function with the thumb positioned in palmar abduction, wrist in extension, and forearm in supination. The splint is typically fabricated for children with mild hypertonia (Fig. 13-31). Fig. 13-26 A, Forearm pronation mobilization splint, type 2 (3) B, Forearm supination mobilization splint, type 2 (3) Dual outriggers that run parallel to the forearm provide...