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 splinting. Ray resection with accompanying metacarpal transposition requires protection of the osseous fixation site in addition to protection of the reapproximated transverse inter-

metacarpal ligament.108 Splinting following this procedure is essentially similar to treating an openly reduced and fixated proximal metacarpal fracture with additional attention to the reapproximated transverse intermetacarpal ligament.17

Replantation/Free Tissue Transfer/Transplantation

Splinting programs employed with patients who have undergone replantation, free tissue transfer, or transplantation procedures emphasizes attainment and maintenance of motion in adjacent uninvolved joints and in the replanted segment.* Because of the obligatory immobilization of repaired structures to promote healing, the interval between the initiations of each type of splinting is often several weeks.

Depending on the level of severance, viability status of the replant or transplant, and size of the postoperative dressing, splinting and exercises may be carried out on joints not included in the dressing within the first postoperative week, provided that the mobilization does not stress repaired structures. Initiation of exercises to the replanted/transferred/transplanted part is determined by the particular operative procedures performed and the patient's status as he advances through the requisite physiologic stages of wound healing. It is imperative that splints and exercises appropriately correspond with the healing stages through which the patient progresses (e.g., early active or passive vs. active or passive). Close coordination between surgeon, therapist, and patient is essential, first toward preserving viability of the reat-tached/attached part and later toward achieving maximum patient rehabilitative potential.

With immobilization splints providing external support to internally fixated fractures and healing soft tissue structures, gentle mobilization traction designed according to individual requirements may be initiated. Because of lack of sensation and the potential damaging effect of edema, careful attention must be directed to obtaining a congruous splint fit that does not produce pressure, obstruct venous return, or impair arterial flow. Straps and splint components may be widened to alleviate undue pressure on underlying soft tissue (Fig. 15-30). Splints that apply small areas of three-point pressure or are circumferential in design are contraindicated during the early mobilization of a replanted segment. Careful monitoring of the replant is essential after splint application. An alteration of digital color or increase in edema of the replanted segment necessitates immediate removal of the splint. As the vascular status becomes less tenuous, its sensitivity to pressure decreases, allowing the use of more conventional splint designs.

Fig. 15-29 A, Nonarticular metacarpal splint B, Nonarticular metacarpal splint C, Nonarticular metacarpal splint D, Nonarticular metacarpal splint

A, Along with a well-formed palmar bar supporting the transverse metacarpal arch, the radial and ulnar bars of this splint apply a gentle medially directed force to protect the healing transverse inter-metacarpal ligament. B, As postoperative edema decreases the splint becomes loose and nonsup-portive, necessitating periodic adjustments. C, Fabricating the splint in a thin, flexible thermoplastic material, rather than the standard --inch rigid material, allows the patient to tighten the splint as needed in response to its loosening as edema decreases. D, Another splinting option includes use of a strap or an elastic wrap to provide support to the healing transverse intermetacarpal ligament. This option allows simple yet effective adjustments as edema decreases. Careful attention to fit is necessary to ensure that the transverse metacarpal arch is not flattened or exaggerated once the strap or elastic wrap is secured in place. Since the splint fits circumferentially, it is important to make certain that vascular structures are not compromised.


Unfortunately, amputation of portions of a digit or hand may occur after severe injury. From both a psychological and functional standpoint, it is important that all efforts be devoted to rapidly restoring the amputation victim to a productive status.

Splinting a hand that has undergone amputation of a part may be directed toward (1) the maintenance of motion of uninvolved joints, (2) protective splinting to the area of amputation, and (3) functional splinting to improve prehensive patterns.2,103,108 Emphasis is placed on prevention of adhesions and the return of

Fig. 15-30 A, Index-small finger flexion mobilization splint, type 1 (13) B, Wrist neutral immobilization / index-small finger MP extension restriction / index-small finger PIP extension, thumb CMC palmar abduction and MP-IP flexion mobilization splint, type 0 (16) \\ Finger DIP extension immobilization splint, type 0 (1); 4 splints @ finger separate

A, The wristband of this finger flexion splint has been widened to decrease pressure from the splint on the distal forearm. B, Used with the nation's first upper extremity transplant patient, this splint was designed to increase finger IP extension, and thumb palmar abduction and MP-IP flexion. The index-small finger DIPs are immobilized in extension with individual extension immobilization splints. [Courtesy (B) Jewish Hospital, Louisville, Ky.]

Fig. 15-30 A, Index-small finger flexion mobilization splint, type 1 (13) B, Wrist neutral immobilization / index-small finger MP extension restriction / index-small finger PIP extension, thumb CMC palmar abduction and MP-IP flexion mobilization splint, type 0 (16) \\ Finger DIP extension immobilization splint, type 0 (1); 4 splints @ finger separate

A, The wristband of this finger flexion splint has been widened to decrease pressure from the splint on the distal forearm. B, Used with the nation's first upper extremity transplant patient, this splint was designed to increase finger IP extension, and thumb palmar abduction and MP-IP flexion. The index-small finger DIPs are immobilized in extension with individual extension immobilization splints. [Courtesy (B) Jewish Hospital, Louisville, Ky.]

maximum function commensurate with the particular loss. The unnecessary stiffening of unaffected joints after amputation usually reflects a failure to establish motion programs at an early stage. The patient with an amputation is often reluctant to remove bandages and resume motion because of self-consciousness and fear of pain. The upper extremity specialist must be especially supportive, while reinforcing constantly the need to use the extremity and to resume social contacts.

Fingertip amputations are generally the most common kind of amputation seen in the therapy clinic. A tip protector may be needed along with wound management, exercises, and edema control (see Fig. 15-28, A). Stump wrapping to the digit and Silastic molds can improve the final cosmetic appearance and decrease stump hypersensitivity.

Amputation often results in generalized edema of the extremity, increasing the risk of stiffness in the remaining adjacent joints. Splinting therefore may be required to augment exercise programs. In the early postamputation phase, joints in adjacent digits readily respond to uncomplicated traction devices, such as wide rubber bands and glove rubber bands for flexion and three-point fixation splints for extension. Joints proximal to the site of amputation may be more resistant to the establishment and maintenance of good passive and active range of motion, requiring more complicated splints to attain an acceptable level of motion. To encourage early use of the hand in purposeful activity, a temporary splint may be designed to fit over the distal aspect of the remaining digit (Fig. 15-31, A-C). This prevents unintentional bumping of the tender stump and allows more uninhibited use of the hand as healing progresses. These splints are frequently fitted over dressings and should be removed during inactive periods for cleaning and to allow ventilation. Care should be taken to prevent wound maceration from an improper splint-wearing schedule and poor skin hygiene.

The potential for dependence on a protective splint should be acknowledged, and measures taken to gradually wean the patient from the splint as self-confidence increases and area sensitivity decreases. The initiation of a desensitization program is often instrumental in hastening unprotected hand use. Persistent hypersensitivity at the healed site of amputation may indicate unresolved problems such as retained terminal neuromas, and evaluation by a physician should be requested.

Functional splinting of a partially amputated hand permits accomplishment of special occupational tasks (Fig. 15-31). Splint design ranges from relatively simple to extremely complicated, depending on specific anatomic loss and patient requirements. Durability of the splint is often a key factor and may necessitate collaboration with an orthotist.

Individualized, beautifully made cosmetic pros-theses are available for cosmetic coverage of digital, hand, and forearm amputations. Above-elbow and below-elbow amputees require evaluation and training with conventional functional body-powered or electric-powered prostheses.

It is important that an excellent rapport is established with the amputation patient. Initial education

Fig. 15-31 A, Thumb CMC palmar abduction and MP extension mobilization splint, type 0 (2)

B, Thumb MP-IP splint-prosthesis \\ Long finger PIP extension immobilization splint, type 0 (1)

C, Thumb CMC circumduction / [thumb MP-IP flexion fixed] torque transmission splint-prosthesis, type 0 (1) D, Thumb CMC circumduction / [thumb MP-IP flexion fixed] torque transmission splint-prosthesis, type 0 (0) E, [Thumb CMC radial abduction, MP-IP flexion fixed] splint-prosthesis, type 0 (0) F, G, Index finger MP flexion immobilization / [index finger IP flexion, long-small finger flexion fixed] splint-prosthesis, type 0 (1) H, Wrist extension: [finger prosthesis flexion] / wrist flexion: [finger prosthesis extension] torque transmission splint-prosthesis, type 0 (1)

A, This thumb CMC mobilization splint helps prevent joint contracture and loss of thumb motion in a hand that has sustained a partial amputation. B,C, A nonskid thumb pad and simulated thumbnail increase functional prehension for this patient using his prototype thumb splint-prosthesis. Prototypes for prostheses may be fabricated in thermoplastic materials, allowing identification of optimal functional designs. D, This splint-prosthesis simulated a final prosthetic device and allowed the patient to perform daily tasks ensuring the final design would meet the patient's needs. E, Prosthetic thumb post provides a stable surface against which normal fingers can oppose for pinch and grasp activities. F,G, Provision of an adapted gripping surface against which the thumb may oppose allowed this patient to grasp and use a hammer. H, Because this man required splint durability that could not be attained with routine splinting materials, he was referred to an orthotist who specializes in metal hand braces. [Courtesy (A,E) Jolene Eastburn, OTR, Scranton, Pa.; (B-D) J. Robin Janson, MS, OTR, CHT, Indianapolis, Ind.; (F,G) Joan Farrell, OTR, Miami, Fla. (H) Lawrence Czap, OTR, Columbus, Ohio;]

for phantom sensation and nightmares is essential for every patient post-amputation. The loss of a body part is a severe psychological blow, regardless of the level, and the patient must be gently brought to understand the importance of accepting the loss and devoting efforts toward maintaining and restoring maximum function in the remaining hand. See Chapter 23, Splint Prostheses, for additional information.


The same principles of mechanics, outriggers and mobilization assists, design, construction and fit that define custom-made splints must also be used to analyze prefabricated splints. Application of these principles is unconditionally fundamental to ensuring

the effectiveness and safety of prefabricated splints as treatment modalities. Inattention to these time-honored splinting principles when applying any splint, whether custom or prefabricated, has considerable potential to cause patient harm.

Typically purchased through commercial vendors, prefabricated splints are premolded to "fit" various upper extremity sections/parts. These splints are available in a multiplicity of designs, according to mass-production standard sizes, in a variety of materials including low- and high-temperature thermoplastics, leather, vinyl, fabric, and neoprene. Prefabricated splints may be a splinting source for clinicians who are not proficient at custom splint fabrication and for experienced splint makers; in special circumstances, they may be more cost efficient than custom-fabricated splints. Because of these perceived advantages, prefabricated splints have found widespread use in clinical settings.

Some prefabricated splints permit minor adjustments to achieve better fit. For example, material may be trimmed to clear flexion creases so long as splint fit and structural stability are not sacrificed. Metal stays in many prefabricated wrist immobilization splints do not fit the normal contour of the volar wrist and proximal palm and stays may not bend at the proper angle required for the diagnosis for which the splints are issued. To correct these problems, metal stays may be reformed or replaced with custom-fabricated low-temperature thermoplastic stays to achieve greater contiguous fit and proper wrist angle.

Appropriate selection between a custom and prefabricated splint is predicated on the complexity of patient-specific requirements. For example, prefabricated splints, when properly fitted, may be adequate for the conservative treatment of carpal tunnel syndrome. In contrast, custom-fitted splints are indicated for postoperative splinting of flexor tendon repairs where well-fitting splints that accurately position joints at precise angles are required. When choosing between a custom or prefabricated splint for a shoul der condition, after an analysis of the cost, time, and feasibility of fabrication, a properly fitted prefabricated shoulder splint may be the splint of choice simply because of the large physical mass and inherent strength requisites associated with an adult-size shoulder splint. However, if optimum fit and mechanics cannot be achieved with a prefabricated splint, its use is contraindicated. See Chapter 14, Splints Acting on the Elbow and Shoulder, for further information.

As emphasized in the introduction of this chapter, various splint configurations and designs may be appropriate for any given upper extremity condition. Once a splint's purpose and basic design have been determined, the next sequential phase is splint construction. It is at the construction stage that the pros and cons of custom-fabricated splints versus prefabricated splints may be analyzed as they relate to the patient-specific situation at hand. This is a critical decision as it entails profound consequences that will significantly influence the efficacy of the patient's rehabilitative course.

Deciding whether or not to use a prefabricated splint is dependent on fundamental questions that must be addressed with candor and unbiased analysis: (1) Does a prefabricated splint achieve the same purpose as a custom splint? (2) Does it meet the same standards of mechanics, outriggers and mobilization assists, design, and fit as a custom splint? (3) Will its produced outcome be as clinically effective as that of a custom splint? (4) Does it meet individual patient needs as well as a custom splint? (5) Is it as adjustable as is a custom splint, if adjustments are required? (6) In the long run, will it be as cost-effective as a custom splint? The ability of the patient to achieve maximum rehabilitation potential is always paramount. If the answer is "no" to any of the above questions, then use of a prefabricated splint is inappropriate.

The judicious use of prefabricated splints requires time to study the splints available on the market and to stay current with changing products.50 Preliminary trial fittings with careful attention to detail help separate potentially useful splints from useless contraptions and cost analysis is a must. Prefabs are not indicated for every splinting situation, but they do provide additional choices when they fit properly. Remember, it may take longer to adjust a preformed splint properly than it would take to make and fit a custom splint from scratch, thus negating anticipated cost and time efficacy.

While many prefabricated splints can be stocked in the clinic in various sizes, other prefabricated commercial splints must be rented or purchased through medical supply companies that take care of paperwork (billing, etc.) and send a representative to fit the

Fig. 15-32 A, Elbow extension mobilization splint, type 1 (2) B, Wrist extension mobilization splint, type 0 (1) C, Wrist flexion mobilization splint, type 5 (14)

Not limited to the illustrated examples, prefabricated wrist and elbow splints are available commercially in many designs. Special care is required to achieve correct alignment of joints and proper splint positioning. Splinting principles must be followed in fitting all prefabricated splints. [Courtesy (A,B) DeRoyal/LMB, Powell, Tenn.; (C) Joint Active Systems, Effingham, Ill.]

Fig. 15-32 A, Elbow extension mobilization splint, type 1 (2) B, Wrist extension mobilization splint, type 0 (1) C, Wrist flexion mobilization splint, type 5 (14)

Not limited to the illustrated examples, prefabricated wrist and elbow splints are available commercially in many designs. Special care is required to achieve correct alignment of joints and proper splint positioning. Splinting principles must be followed in fitting all prefabricated splints. [Courtesy (A,B) DeRoyal/LMB, Powell, Tenn.; (C) Joint Active Systems, Effingham, Ill.]

splints. These splints are typically more expensive, including CPMs and complicated mechanized wrist, elbow, and shoulder splints. The bottom line, however, is that patient care is the responsibility of the clinician, not the company representative. When a company representative fits a splint on your patient, it is essential that you, the therapist, evaluate and approve the fit (Fig. 15-32).

As noted above, a prefabricated splint, as with a custom splint, must meet exacting patient requisites according to the specific diagnosis for which it is applied. If a prefabricated splint fails to achieve required parameters, it is not a suitable treatment option regardless of how cost-effective or time saving it may be.


One can see that special problems relating to upper extremity injury and disease and the appropriate surgical management of these conditions present somewhat predictable splinting requirements. Although broad generalization with regard to the splinting of these problems may be offered, it is obvious that wide variations occur in the clinical presentation of each problem and its therapeutic approach. Armed with an appreciation of the potential peculiarities of each of these general categories, one must become familiar with the individual circumstances and subsequently initiate the most applicable splinting and exercise program.


1. Abbott K, Burke FD, McGrouther DA: A review of attitudes to splintage in Dupuytren's contracture, J Hand Surg [Br] 12(3):326-8, 1987.

2. Bennett JE: Skin and soft tissue injuries of the hand in children, Pediatr Clin North Am 22(2):443-9, 1975.

3. Blair WF, Steyers CM: Extensor tendon injuries, Orthop Clin North Am 23Q):141-8, 1992.

4. Blue AI, Spira M, Hardy SB: Repair of extensor tendon injuries of the hand, Am J Surg 132(1):128-32, 1976.

5. Bracker MD, Ralph LP: The numb arm and hand, Am Fam Physician 51(1):103-16, 1995.

6. Brand PW: The reconstruction of the hand in leprosy, Ann Royal College of Surg 11:350, 1952.

7. Brand PW: Rehabilitation of the hand with motor and sensory impairment, Orthop Clin North Am 4:1135-9, 1973.

8. Brand PW: Clinical mechanics of the hand, Mosby, 1985, St. Louis.

9. Brand PW, Hollister A: Clinical mechanics of the hand, ed 2, Mosby, 1993, St. Louis.

10. Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

11. Brand PW, Hollister A: Operations to restore muscle balance to the hand. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

12. Brooks G: Exercise physiology: human bioenergetics and its applications, ed 3, Mayfield Publishing, 2000, Mountain View, CA.

13. Browne EZ, Ribik CA: Early dynamic splinting for extensor tendon injuries, J Hand Surg [Am] 14(1):72-6, 1989.

14. Buch VI: Clinical and functional assessment of the hand after metacarpophalangeal capsulotomy, Plast Reconstr Surg 53(4):452-7, 1974.

15. Burke DT, Burke MA, Bell R, et al: Subjective swelling: a new sign for carpal tunnel syndrome, Am J Phys Med Rehabil 78(6):504-8, 1999.

16. Cannon N: Enhancing flexor tendon glide through tenoly-sis . . . and hand therapy, J Hand Ther 2(2):122-38, 1989.

17. Cannon N, et al: Diagnosis and treatment manual for physicians and therapists, ed 4, Hand Rehabilitation Center of Indiana, 2001, Indianapolis.

18. Chester DL, Beale S, Beveridge L, et al: A prospective, controlled, randomized trial comparing early active extension with passive extension using a dynamic splint in the rehabilitation of repaired extensor tendons, J Hand Surg [Br] 27(3):283-8, 2002.

19. Chow JA, Dovelle S, Thomes LJ, et al: A comparison of results of extensor tendon repair followed by early controlled mobilisation versus static immobilisation, J Hand Surg [Br] 14(1):18-20, 1989.

20. Chow JA, Thomes LJ, Dovelle S, et al: Controlled motion rehabilitation after flexor tendon repair and grafting. A multi-centre study, J Bone Joint Surg Br 70(4):591-5, 1988.

21. Chowdhury SR, Chowdhury AK: Management of long standing post burn deformities of hand, J Indian Med Assoc 87(11): 251-3, 1989.

22. Citron ND, Forster A: Dynamic splinting following flexor tendon repair, J Hand Surg [Br] 12(1):96-100, 1987.

23. Colditz JC: Splinting for radial nerve palsy, J Hand Ther 1(1):18-23, 1987.

24. Colditz JC: Preliminary report on a new technique for casting motion to mobilize stiffness in the hand. In Proceedings, American Society of Hand Therapists 22nd annual meeting, J Hand Ther 13(1):72-73, 2000.

25. Cooney W, Lin G, An KN: Improved tendon excursion following flexor tendon repair, J Hand Ther 2(2):102-6, 1989.

26. Curtin M: Development of a tetraplegic hand assessment and splinting protocol, Paraplegia 32(3):159-69, 1994.

27. de Jonge JJ, et al: Phalangeal fractures of the hand. An analysis of gender and age-related incidence and aetiology, J Hand Surg [Br] 19(2):168-70, 1994.

28. de Jonge JJ, Kingma J, van der Lei B, et al: Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature, Injury 25(6):365-9, 1994.

29. deLeeuw C: Personal communication from Carolina deLeeuw: fingernail hooks for positioning burned hands, E.E. Fess, Editor. 1963, deLeeuw, C.: Tacoma, WA.

30. Dillingham T, et al: Orthosis for the complete median and radial nerve-injured war casualty, J Hand Ther 5(4):212-5, 1992.

31. Duran R, Houser R: Controlled passive motion following flexor tendon repair in zones 2 and 3. In Hunter J, Schneider L: American Academy of Orthopaedic Surgeons symposium on tendon surgery in the hand, Mosby, 1975, St. Louis.

32. Duran R, et al: Management of flexor tendon lacerations in Zone 2 using controlled passive motion postoperatively. In Hunter J, Schneider L, Mackin E: Tendon surgery in the hand, Mosby, 1987, St. Louis.

33. Ebskov LB, et al: Results after surgery for severe Dupuytren's contracture: does a dynamic extension splint influence outcome? Scand J Plast Reconstr Surg Hand Surg 34(2):155-60, 2000.

34. Evans R: An analysis of factors that support the early active short arc motion of the repaired central slip, J Hand Ther 5(4):187-201, 1992.

35. Evans RB: Clinical application of controlled stress to the healing extensor tendon: a review of 112 cases, Phys Ther 69(12):1041-9, 1989.

36. Evans RB: Immediate active short arc motion following extensor tendon repair, Hand Clin 11(3):483-512, 1995.

37. Evans RB, Burkhalter WE: A study of the dynamic anatomy of extensor tendons and implications for treatment, J Hand Surg [Am] 11(5):774-9, 1986.

38. Evans RB, Thompson DE: The application of force to the healing tendon, J Hand Ther 6(4):266-84, 1993.

39. Eversmann WW: Compression and entrapment neuropathies of the upper extremity, J Hand Surg [Am] 8(5 Pt 2):759-66, 1983.

40. Fess EE: Splinting flexor tendon injuries, Hand Surg 7(1): 101-8, 2002.

41. Formal CS, Cawley MF, Stiens SA: Spinal cord injury rehabilitation. 3. Functional outcomes, Arch Phys Med Rehabil 78(3 Suppl):S59-64, 1997.

42. Frykman GK, Waylett J: Rehabilitation of peripheral nerve injuries, Orthop Clin North Am 12(2):361-79, 1981.

43. Goloborod'ko S: Training splint for EIP to EPL transfer, J Hand Ther 10(1):48, 1997.

44. Gould JS, Nicholson BG: Capsulectomy of the metacarpopha-langeal and proximal interphalangeal joints, J Hand Surg [Am] 4(5):482-6, 1979.

45. Gowitzke B, Milner M: Understanding the scientific basis of human movement, ed 2, Williams & Wilkins, 1984, Baltimore.

46. Gratton P: Early active mobilization after flexor tendon repairs, J Hand Ther 6(4):285-9, 1993.

47. Gustilo RB, Simpson L, Nixon R, et al: Analysis of 511 open fractures, Clin Orthop 66:148-54, 1969.

48. Hannah S, Hudak P: Splinting and radial nerve palsy: a single-subject design, J Hand Ther 14(3):216-8, 2001.

49. Harper B: The drop-out splint: an alternative to the conservative management of ulnar nerve intrapment at the elbow, J Hand Ther 3(4):199, 1990.

50. Harrell P: Splinting of the hand. In Robbins L, et al: Clinical care in the rheumatic diseases, American College of Rheumatology, 2001, Atlanta.

51. Hodges A, Chesher S, Feranda S: Hand transplantation: rehabilitation—a case report, Microsurgery 20:389-92, 2000.

52. Hunter JM, Singer DI, Jaeger SH, et al: Active tendon implants in flexor tendon reconstruction, J Hand Surg [Am] 13(6):849-59, 1988.

53. James JIP: Fractures of the proximal and middle phalanges of the fingers, Acta Orthop Scand 32:401-12, 1962.

54. James JIP: Common, simple errors in the management of hand injuries. In Royal Society of Medicine, Royal Society of Medicine, 1970.

55. Jansen C, Minerbo G: Comparison between early dynamically controlled mobilization and immobilization after flexor tendon repair in zone 2 of the hand, J Hand Ther 3(1):20-5, 1990.

56. Kasabian A, McCarthy J, Karp N: Use of a multiplanar distracter for the correction of a proximal interphalangeal joint contracture, Ann Plast Surg 40(4):378-81, 1998.

57. Kleinert HE, Kutz J, Cohen M: Primary repair of zone 2 flexor tendon lacerations. In Hunter J, Schneider L: American Academy of Orthopaedic Surgeons symposium on tendon surgery in the hand, Mosby, 1975, St. Louis.

58. Kleinert HE, et al: Primary repair of flexor tendons in no-man's land, J Bone Joint Surg 49A:577, 1967.

59. Konirova M, Sinkorova B: Early rehabilitation of the hands after the suture of flexors and after tendon grafts with the use of dynamic splints, Acta Chir Plast 37(2):58-9, 1995.

60. Krajnik SR, Bridle MJ: Hand splinting in quadriplegia: current practice, Am J Occup Ther 46(2):149-56, 1992.

61. Kruger VL, Kraft GH, Deitz JC, et al: Carpal tunnel syndrome: objective measures and splint use, Arch Phys Med Rehabil 72(7):517-20, 1991.

62. Lille S, Brown RE, Zook EE, et al: Free nonvascularized composite nail grafts: an institutional experience, Plast Reconstr Surg 105(7):2412-5, 2000.

63. Littler JW: Tendon transfers and arthrodesis in combined median and ulnar nerve paralysis, J Bone Joint Surg 31A:225-34, 1949.

64. Mackin EJ: Prevention of complications in hand therapy, Hand Clin 2(2):429-47, 1986.

65. Malick M, Meyer C: Manual on management of the quadriplegic upper extremity, Harmarville Rehabilitation Center, 1978, Pittsburgh.

66. Manente G, Torrieri F, Di Blasio F, et al: An innovative hand brace for carpal tunnel syndrome: a randomized controlled trial, Muscle Nerve 24(8):1020-5, 2001.

67. Mason ML: Injuries to nerves and tendons of the hand, JAMA 116(13):1375-97, 1941.

68. May EJ, Silfverskiold KL, Sollerman CJ: Controlled mobilization after flexor tendon repair in zone II: a prospective comparison of three methods, J Hand Surg [Am] 17(5):942-52, 1992.

69. Messer RS, Bankers RM: Evaluating and treating common upper extremity nerve compression and tendonitis syndromes . . . without becoming cumulatively traumatized, Nurse Pract Forum 6(3):152-66, 1995.

70. Moberg E: Surgical treatment for absent single-hand grip and elbow extension in quadriplegia. Principles and preliminary experience, J Bone Joint Surg Am 57(2):196-206, 1975.

71. Mullins PA: Postsurgical rehabilitation of Dupuytren's disease, Hand Clin 15(1):167-74, 1999.

72. Neviaser J: Splint for correction of claw hand, J Bone Joint Surg 12:440-3, 1930.

73. Nichols PJ, Peach SL, Haworth RJ, et al: The value of flexor hinge hand splints, Prosthet Orthot Int 2(2):86-94, 1978.

74. Opgrande JD, Westphal SA: Fractures of the hand, Orthop Clin North Am 14(4):779-92, 1983.

75. Parry W: Rehabilitation of the hand, ed 3, Butterworth, 1973, London.

76. Parry W: Rehabilitation of the hand, ed 4, Butterworth, 1981, London.

77. Peck F, et al: An audit of flexor tendon injuries in Zone II and its influence on management, J Hand Ther 9(4):306-8, 1996.

78. Peterson-Bethea D: Static progressive splint for Dupuytren's release, J Hand Ther 10(4):312, 1997.

79. Posner MA: Compressive neuropathies of the ulnar nerve at the elbow and wrist, Instr Course Lect 49:305-17, 2000.

80. Prosser R, Conolly WB: Complications following surgical treatment for Dupuytren's contracture, J Hand Ther 9(4): 344-8, 1996.

81. Purcell T, Eadie PA, Murugan S, et al: Static splinting of extensor tendon repairs, J Hand Surg [Br] 25(2):180-2, 2000.

82. Robbins F, Reece T: Hand rehabilitation after great toe transfer for thumb reconstruction, Arch Phys Med Rehabil 66(2):109-12, 1985.

83. Sato Y, Kaji M, Tsuru T, et al: Carpal tunnel syndrome involving unaffected limbs of stroke patients, Stroke 30(2):414-8, 1999.

84. Scheker LR, Chesher SP, Netscher DT, et al: Functional results of dynamic splinting after transmetacarpal, wrist, and distal forearm replantation, J Hand Surg [Br] 20(5):584-90, 1995.

85. Schneider LH: Tenolysis and capsulectomy after hand fractures, Clin Orthop (327):72-8, 1996.

86. Schneider LH, McEntee P: Flexor tendon injuries. Treatment of the acute problem, Hand Clin 2(1):119-31, 1986.

87. Schultz-Johnson K: Static progressive splinting, J Hand Ther 15(2):163-78, 2002.

88. Silfverskiold KL, May EJ: Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion, J Hand Surg [Am] 19(1):53-60, 1994.

89. Silfverskiold KL, May EJ, Tornvall AH: Tendon excursions after flexor tendon repair in zone. II: Results with a new controlled-motion program, J Hand Surg [Am] 18(3):403-10, 1993.

90. Silverman P, Willett-Green V, Petrilli J: Early protective motion in digital revascularization and replantation, J Hand Ther 2(2):84-101, 1989.

91. Slater RR, Bynum DK: Simplified functional splinting after extensor tenorrhaphy, J Hand Surg [Am] 22(3):445-51, 1997.

92. Smith RJ: Tendon transfers of the hand and forearm, Little, Brown, 1987, New York.

93. Strickland JW: Biologic rationale, clinical application, and results of early motion following flexor tendon repair, J Hand Ther 2(2):71-83, 1989.

94. Strickland JW, et al: Factors influencing digital performance following phalangeal fractures, Presented at American Society for Surgery of the Hand, Annual Symposium 1979, San Francisco.

95. Strickland JW, Glogovac SV: Digital function following flexor tendon repair in Zone II: A comparison of immobilization and controlled passive motion techniques, J Hand Surg [Am] 5(6):537-43, 1980.

96. Strickland JW, Gettle K: Flexor tendon repair: the Indianapolis method. In Hunter J, Schneider L, Mackin E: Tendon and nerve surgery in the hand: a third decade, Mosby, 1997, St. Louis.

97. Stuart D, Zambia L: Duration of splinting after repair of extensor tendons in the hand, J Bone Joint Surg 47B:72-9,


98. Taams KO, Ash GJ, Johannes S: Maintaining the safe position in a palmar splint. The "double-T" plaster splint, J Hand Surg [Br] 21(3):396-9, 1996.

99. Tajima T: Indication and techniques for early postoperative motion after repair of digital flexor tendon praticularly in zone II. In Hunter J, Schneider L, Mackin E: Tendon and nerve surgery in the hand: a third decade, Mosby, 1997, St. Louis.

100. Talbot JD, Villemure JG, Bushnell MC, et al: Evaluation of pain perception after anterior capsulotomy: a case report, Somatosens Mot Res 12(2):115-26, 1995.

101. Thomas D, Moutet F, Guinard D: Postoperative management of extensor tendon repairs in Zones V, VI, and VII, J Hand Ther 9(4):309-14, 1996.

102. Thomas FB: A splint for radial (musculospiral) nerve palsy, J Bone Joint Surg 26(July):602-5, 1944.

103. Upton J, Littler JW, Eaton RG: Primary care of the injured hand, part 1, Postgrad Med 66(2):115-22, 1979.

104. Verdugo RJ, et al: Surgical versus non-surgical treatment for carpal tunnel syndrome, Cochrane Database Syst Rev (2):CD001552, 2002.

105. Von Prince K, Yeakel M: The splinting of burn patients, Charles C. Thomas, 1974, Springfield, 1ll.

106. Von Prince KM, Curreri PW, Pruitt BA: Application of fingernail hooks in splinting of burned hands, Am J Occup Ther 24(8):556-9, 1970.

107. Walker WC, Metzler M, Cifu DX, et al: Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions, Arch Phys Med Rehabil 81(4):424-9, 2000.

108. Ware LC: Digital amputation and ray resection. In Hand rehabilitation: a practical guide, Churchill Livingstone, 1998, London.

109. Weeks PM: Volar approach for metacarpophalangeal joint capsulotomy, Plast Reconstr Surg 46(5):473-6, 1970.

110. Weimer LH, et al: Serial studies of carpal tunnel syndrome during and after pregnancy, Muscle Nerve 25(6):914-7, 2002.

111. Whitley JM, McDonnell DE: Carpal tunnel syndrome. A guide to prompt intervention, Postgrad Med 97(1):89-92, 95-6, 1995.

112. Willis B: The use of orthoplast isoprene splints in the treatment of the acutely burned child: preliminary report, AJOT 23(1):57-61, 1969.

113. Wilson CS, Alpert BS, Buncke HJ, et al: Replantation of the upper extremity, Clin Plast Surg 10(1):85-101, 1983.

114. Zook EG: Nail bed injuries, Hand Clin 1(4):701-16, 1985.

115. Zook EG, Russell RC: Reconstruction of a functional and esthetic nail, Hand Clin 6(1):59-68, 1990.

116. Zook EG, Guy RJ, Russell RC: A study of nail bed injuries: causes, treatment, and prognosis, J Hand Surg [Am] 9(2):247-52, 1984.


Brand PW, Hollister A: Clinical mechanics of the hand, Mosby, ed

Green DP, Hotchkiss R, Pederson W: Operative hand surgery, ed

4, London, 1998, Churchill Livingstone.

Mackin EJ, Callahan AD, Osterman AL, et al: Hunter, Mackin & Callahan's rehabilitation of the hand and upper extremity, ed

Omer G, Spinner M, Van Beek A: Management of peripheral nerve problems, ed 2, W. B. Saunders, 1998, Philadelphia.

Strickland JW, ed. The hand, Lippincott-Raven 1998, Philadelphia.

Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.

Get My Free Ebook

Post a comment