Forearm Wrist Thumb Splints

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Mobilization Splints

Type 0. 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).

I NONARTICULAR FOREARM SPLINTS

Forearm Supination Mobilization

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 multiple attachment sites for mobilization forces (rubber bands) that pull perpendicular to the rotational axis of the forearm, enhancing pronation (A) and supination (B). (Courtesy Kay Colello-Abraham, OTR, CHT, Orange, Calif.)

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 multiple attachment sites for mobilization forces (rubber bands) that pull perpendicular to the rotational axis of the forearm, enhancing pronation (A) and supination (B). (Courtesy Kay Colello-Abraham, OTR, CHT, Orange, Calif.)

underlying cutaneous surfaces. Most problems with both custom and commercial forearm mobilization splints, however, arise from overenthusiastic application of mobilization forces rather than from lack of appropriate fit.

Forearm, Finger Splints Mobilization/Restriction Splints

Type 1. Type 1 forearm mobilization, finger restriction splints are usually one-of-a-kind splints that reflect unique needs specific to individual patients. These splints incorporate the distal forearm

Nonarticular forearm splints use coaptational forces to support, restrict, or facilitate underlying soft tissues and/or osseous structures. Allowing graded force application to meet individual patient requirements, splints in this classification may be fabricated from a wide selection of materials ranging from rigid to flexible or combinations thereof (Fig. 13-32).

I SUMMARY

The integrity of the wrist joint with its complex anatomic and motion architecture has been established as the key to hand function. It is uniquely vulnerable to a variety of injury and disease processes that may result in pain, stiffness, or instability, which may interfere with normal upper extremity function at all levels. The management of these wrist maladies may be substantially enhanced by proper splinting with objectives ranging from pain relief and protection to prevention and correction of deformity. In addition, wrist splinting may be used to negate or augment long extrinsic tenodesis functions in the management of digital pathologic conditions. Postoperative splinting protects healing structures while allowing predefined motion to involved and noninvolved joints. Therefore, it is imperative that careful consideration be directed toward the anatomic, kinesiologic, and functional effects of any splint created to traverse this important joint.

The radioulnar joints provide the distal extremity with the very important increment of transverse rotation, allowing the hand to be positioned in a multitude of functional attitudes. In addition to a thorough knowledge of forearm anatomy, the key to splinting these joints lies in understanding their cooperative kinesiologic role.

Close communication between therapist, surgeon, and patient is crucial to attaining optimum patient

Types Splints

Fig. 13-27 A,B, Forearm pronation mobilization splint, type 2 (3) C,D, Forearm supination mobilization splint, type 2 (3) E, Forearm supination mobilization splint, type 2 (3) This two-piece combination elbow and wrist splint for forearm mobilization in pronation (A,B) and supination (C-E) is simple in design and efficient in fabrication time. The two-piece design permits serial adjustments through an adjustable strap that firmly attaches the two splints together. [Courtesy (A-D) Paul Van Lede, OT, MS, Orfit Industries, Wijnegem, Belgium.]

Fig. 13-27 A,B, Forearm pronation mobilization splint, type 2 (3) C,D, Forearm supination mobilization splint, type 2 (3) E, Forearm supination mobilization splint, type 2 (3) This two-piece combination elbow and wrist splint for forearm mobilization in pronation (A,B) and supination (C-E) is simple in design and efficient in fabrication time. The two-piece design permits serial adjustments through an adjustable strap that firmly attaches the two splints together. [Courtesy (A-D) Paul Van Lede, OT, MS, Orfit Industries, Wijnegem, Belgium.]

Two Piece Forearm Supination SplintSplinting For Spastic Upper Extremity

Fig. 13-28 A,B, Forearm supination mobilization splint, type 2 (3) C, Forearm supination mobilization splint, type 2 (3) D,E, Forearm supination mobilization splint, type 2 (3)

Forearm mobilization splints vary in design and materials. The elbow and wrist are secondary joints (A-E). [Courtesy (C) Jason Willoughby, OTR, Richmond, Ky.; (D,E) Connor McCullough, OTR, Canoga Park, Calif.]

Supination

Fig. 13-29 A, Forearm supination mobilization splint, type 2 (3) B, Forearm pronation mobilization splint, type 4 (8)

Forearm mobilization splints are available commercially in various prefabricated forms (not all inclusive of the many splints available). [Courtesy (A) EMPI, St. Paul, Minn.; (B) Joint Active Systems, Inc., Effingham, 1ll.]

Fig. 13-29 A, Forearm supination mobilization splint, type 2 (3) B, Forearm pronation mobilization splint, type 4 (8)

Forearm mobilization splints are available commercially in various prefabricated forms (not all inclusive of the many splints available). [Courtesy (A) EMPI, St. Paul, Minn.; (B) Joint Active Systems, Inc., Effingham, 1ll.]

Mobilization Extension Splint

Fig. 13-30 Forearm pronation mobilization / Index-small finger MP extension restriction splint, type 1 (6)

This innovative splint design uses a radially mounted weight as a mobilization assist to increase forearm pronation while restricting extension of the finger MP joints. (Courtesy Robin Miller, OTR/L, CHT, Ft. Lauderdale, Fla.)

Fig. 13-30 Forearm pronation mobilization / Index-small finger MP extension restriction splint, type 1 (6)

This innovative splint design uses a radially mounted weight as a mobilization assist to increase forearm pronation while restricting extension of the finger MP joints. (Courtesy Robin Miller, OTR/L, CHT, Ft. Lauderdale, Fla.)

Forearm And Wrist Supination Splint

Fig. 13-31 Forearm supination, wrist extension, thumb CMC palmar abduction mobilization splint, type 0 (3) This type 0 splint assists supination, wrist extension, and thumb palmar abduction by facilitating functional use of the extremity without inhibiting sensory input. (Courtesy Joni Armstrong, OTR, CHT, Bemidji, Minn.)

Fig. 13-31 Forearm supination, wrist extension, thumb CMC palmar abduction mobilization splint, type 0 (3) This type 0 splint assists supination, wrist extension, and thumb palmar abduction by facilitating functional use of the extremity without inhibiting sensory input. (Courtesy Joni Armstrong, OTR, CHT, Bemidji, Minn.)

Wrist Ext Self Mobilization

Fig. 13-32 Nonarticular proximal forearm splint

This Aircast Armband is but one of many splints commercially available that may be used for treating lateral epicondylitis.

Fig. 13-32 Nonarticular proximal forearm splint

This Aircast Armband is but one of many splints commercially available that may be used for treating lateral epicondylitis.

rehabilitation potential. Assessment and adaptation of patients' work, home, and/or avocational environments also may be necessary to allow independent return to normal activities.

REFERENCES

1. Alexander CE, Lichtman DM: Ulnar carpal instabilities, Orthop Clin North Am 15(2):307-20, 1984.

2. Bora FW Jr, Culp RW, Osterman AL, et al: A flexible wrist splint, J Hand Surg [Am] 14(3):574-5, 1989.

3. Brown DE, Lichtman DM: Midcarpal instability, Hand Clin 3(1):135-40, 1987.

4. Contesti LA: The radioulnar joints and forearm axis: therapist's commentary, J Hand Ther 12(2):85-91, 1999.

5. Garcia-Elias M, Dobyns J: Bones and joints. In Cooney W, Linscheid RL, Dobyns J: The wrist: diagnosis and operative treatment, Mosby, 1998, St. Louis.

6. Green DP: Carpal dislocations and instabilities. In Green DP: Operative hand surgery, Churchill Livingstone, 1994, London.

7. Hagert CG: Distal radius fracture and the distal radioulnar joint—anatomical considerations, Handchir Mikrochir Plast Chir 26(1):22-6, 1994.

8. Hagert CG: The distal radioulnar joint, Hand Clin 3(1):41-50, 1987.

9. Hagert CG: The distal radioulnar joint in relation to the whole forearm, Clin Orthop (275):56-64, 1992.

10. Henshaw J, Satren J, Wrightsman J: Semi-flexible support: an alternative for the hand-injured worker, J Hand Ther 2(1):35, 1989.

11. Jansen C, Olson S, Hasson S: The effectiveness of use of a wrist orthosis during functional activities on surface elec-tromyography of the wrist extensors in normal subjects, J Hand Ther 10(4):283-9, 1997.

12. Kleinman W: DRUJ contracture release, Tech Hand Upper Extremity Surg 3(1):13-22, 1999.

13. Lichtman DM, Galenslen E, Pollock G: Midcarpal and proximal carpal instabilities. In Lichtman DM: The wrist and its disorders, Saunders, 1977, Philadelphia.

14. Lichtman DM, Bruckner JD, Culp RW, et al: Palmar midcarpal instability: results of surgical reconstruction, J Hand Surg [Am] 18(2):307-15, 1993.

15. Malick M: Manual on static hand splinting, vol 1, Rev ed, Harmarville Rehabilitation Center, 1972, Pittsburgh.

16. Malick M: Manual on dynamic hand splinting with thermoplastic materials, Harmarville Rehabilitation Center, 1974, Pittsburgh.

17. Palmer A, Werner F: Biomechanics of the distal radioulnar joint, Clin Orthop 187:26-35, 1984.

18. Taleisnik J: Carpal kinematics. In Taleisnick J: The wrist, Churchill Livingstone, 1985, London.

19. Taleisnick J: The wrist, Churchill Livingstone, 1985, London.

20. Taleisnik J: Wrist: anatomy, function and injury, American Academy of Orthopaedic Surgeons' Instructional Course Lectures 27:61, 1978.

21. Taleisnik J, Watson HK: Midcarpal instability caused by malunited fractures of the distal radius, J Hand Surg [Am] 9(3):350-7, 1984.

22. Wright TW, Dobyns J: Carpal instability non-dissociative. In Cooney W, Linsheid R, Dobyns J: The wrist: diagnosis and operative treatment, Mosby, 1998, St. Louis.

Midcarpal Instability Splint

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