Review Purpose Immobilization Mobilization Restriction Torque Transmission

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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 imperative that the designer of the proposed splint clearly understands the reason for the application of the splint and adapts the splint design accordingly.

Immobilization splinting allows rest, protects healing structures, or strategically positions the part when motion loss is expected. Including one or multiple joints (Fig. 8-13, A), immobilization splints are commonly used to promote healing of osseous,

Immobilization Position

Fig. 8-11 B, Forearm supination mobilization splint, type 2 (3) A, In complicated cases, graphic identification of primary joints may aid the novice in splint design. B, In this supination splint, the forearm is the only primary joint. Both the wrist and elbow are included in the splint as secondary joints to provide better control of forearm position. [Courtesy (B) Barbara Smith, OTR, Edmond, Okla.]

Fig. 8-11 B, Forearm supination mobilization splint, type 2 (3) A, In complicated cases, graphic identification of primary joints may aid the novice in splint design. B, In this supination splint, the forearm is the only primary joint. Both the wrist and elbow are included in the splint as secondary joints to provide better control of forearm position. [Courtesy (B) Barbara Smith, OTR, Edmond, Okla.]

capsular, ligamentous, or tendonous structures and to provide rest to inflamed joints with the goal of lessening or preventing deformity. A badly damaged joint with no expectation of functional salvage may be splinted to allow stiffening in the most favorable position. Often worn for relatively short periods, the more pliable plastic materials or plaster are more suitable for fabricating these splints. Immobilization splints may also be used in conjunction with splints that have different purposes of application (Fig. 8-13, B).

Mobilization splints may substitute for absent active motion in supple joints or they may be used to improve passive range of motion of stiff joints through soft tissue remodeling. Mobilization splints that substitute for lost motion are traditionally applied to

Torque Transmission Splint Hand

Fig. 8-12 B,C, Ring-small finger MP extension restriction / IP extension torque transmission splint, type 0 (6) A-C, Combining MP extension restriction and IP extension torque transmission, this splint improves hand function by counteracting the typical MP hyperextension and IP flexion deforming forces associated with ulnar nerve paralysis. (Courtesy Peggy McLaughlin, OTR, CHT, San Bernadino, Calif.)

Fig. 8-12 B,C, Ring-small finger MP extension restriction / IP extension torque transmission splint, type 0 (6) A-C, Combining MP extension restriction and IP extension torque transmission, this splint improves hand function by counteracting the typical MP hyperextension and IP flexion deforming forces associated with ulnar nerve paralysis. (Courtesy Peggy McLaughlin, OTR, CHT, San Bernadino, Calif.)

improve hand or extremity function and may be fabricated of more durable, less adjustable materials because of their expected length of use. An example of a substitution splint is the use of a wrist and MP extension mobilization splint to provide wrist and finger MP extension in radial nerve paralysis (Fig. 810, F-H). To be effective, this group of mobilization splints requires full passive joint motion. If full joint excursion is not present, a different mobilization splint that uses elastic or inelastic traction to remodel shortened or adherent soft tissues is first required to decrease the existing deformity. Splints designed to increase passive range of motion are often temporary and should be easily adapted because configurative alterations must be made as the arc of joint motion changes (Fig. 8-14).

Fig. 8-13 A, Index-small finger MP flexion and IP extension immobilization splint, type 4 (16) B, Index-small finger MP extension restriction / long-ring finger PIP flexion mobilization splint, type 1 (7) \\ Finger DIP extension immobilization splint, type 0 (1); 2 splints long and ring finger separate

A, Individual finger straps ensure correct positioning in this finger immobilization splint. The thumb joints and wrist are included in the splint as secondary joints. B, Circumferential casts immobilize the distal joints of the long and ring fingers to allow fracture healing while the MP and PIP joints are mobilized for early passive mobilization of flexor tendon repairs. [Courtesy (A) Lin Beribak, OTR / L, CHT, Chicago, Ill.; (B) Robin Miller, OTR, CHT, Ft. Lauderdale, Fla.]

Fig. 8-13 A, Index-small finger MP flexion and IP extension immobilization splint, type 4 (16) B, Index-small finger MP extension restriction / long-ring finger PIP flexion mobilization splint, type 1 (7) \\ Finger DIP extension immobilization splint, type 0 (1); 2 splints long and ring finger separate

A, Individual finger straps ensure correct positioning in this finger immobilization splint. The thumb joints and wrist are included in the splint as secondary joints. B, Circumferential casts immobilize the distal joints of the long and ring fingers to allow fracture healing while the MP and PIP joints are mobilized for early passive mobilization of flexor tendon repairs. [Courtesy (A) Lin Beribak, OTR / L, CHT, Chicago, Ill.; (B) Robin Miller, OTR, CHT, Ft. Lauderdale, Fla.]

Restriction splints limit a joint's normal arc of motion to allow healing or to improve function. Depending on the physical characteristics of the materials from which they are made, restrictive splints prohibit motion on a continuum ranging from minimal restraint of joint motion using soft materials (Fig. 8-15, A) to exacting control of motion with thermoplastics or metals (Fig. 8-15, B). Splints that restrict joint motion are often used postoperatively to protect repairs while allowing partial active range of motion.

Torque transmission splints (Fig. 8-16, A-D) transfer movement longitudinally or transversely to sel

Thumb Cmc Palmar

Fig. 8-14 Thumb CMC palmar abduction splint, type 1 (2) Thermoplastic thumb CMC mobilization splints are used serially to increase carpometacarpal joint passive motion.

Thumb Mobilization

Fig. 8-15 A, Thumb CMC circumduction restriction splint, type 1 (2) B, Long finger PIP radial and ulnar deviation restriction splint, type 2 (3)

A, A neoprene splint provides gentle restrictive forces to a thumb CMC joint. B, PIP lateral motion is prohibited in this "bowling alley" splint design. [Courtesy (A) Joni Armstrong, OTR, CHT, Bemidji, Minn.]

Fig. 8-14 Thumb CMC palmar abduction splint, type 1 (2) Thermoplastic thumb CMC mobilization splints are used serially to increase carpometacarpal joint passive motion.

ected joints to provide motion to supple joints or to remodel stiff joints and effect a corresponding improvement in passive and active joint motion. Used autonomously or in conjunction with mobilization (Fig. 8-16, C) or restriction splints, torque transmission splints include one or more joints in order to augment motion at other joints by allowing an increase or decrease of tension on musculotendinous units. Torque transmission splints require sophisticated knowledge of anatomy, biomechanics, and the principles of splinting.

Drawing on the ingenuity and creativity of those responsible for creating splints, it is not unusual to have primary joints with different purpose requirements in the same hand. Splints may be designed to include various combinations of the above four purposes, e.g., restriction / torque transmission (Fig. 8-16, D) or restriction / mobilization / immobilization (Fig. 8-16, E,F).

Fig. 8-15 A, Thumb CMC circumduction restriction splint, type 1 (2) B, Long finger PIP radial and ulnar deviation restriction splint, type 2 (3)

A, A neoprene splint provides gentle restrictive forces to a thumb CMC joint. B, PIP lateral motion is prohibited in this "bowling alley" splint design. [Courtesy (A) Joni Armstrong, OTR, CHT, Bemidji, Minn.]

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Playing bowling with your friends can help you decide if it is indeed the hobby that you want to invest your time on today. Aside from that, it can help you get a better feel of the sport. More importantly, when you play with your friends, it would become a more fun activity, which you can look forward to each week.

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Responses

  • Yvonne
    What is the purpose of restriction with splint?
    9 months ago

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