Thumb CMC Splints

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 larger posterior ligament is similar to the collateral ligament at the finger MP joints with relaxation in extension and tension in flexion and opposition. To maintain or gain CMC joint ligament length, the splinted position of the first metacarpal should be alternated from full radial abduction to full palmar abduction to minimize the possibility of shortening of the five carpometacarpal articular ligaments as described by Haines5 and Napier.8 This may be accomplished through use of two splints with differing directional forces, one toward full palmar abduction and the other toward full radial abduction, and through a carefully supervised exercise routine. Some clinicians opt for a middle-of-the-road approach by positioning the first metacarpal midway between palmar and radial abduction. However, this requires vigilant monitoring of CMC joint motion to ensure that full palmar and radial abduction motion is not compromised inadvertently.

Immobilization Splints

Preventing motion at the most proximal thumb joint, CMC immobilization splints may include the CMC joint alone or they may incorporate one or more secondary joints sited distal or proximal to the thumb CMC joint. To achieve complete immobilization of the CMC joint, it is important that at least one proximal joint and one, preferably two, distal joints are included as secondary joint levels. Thumb CMC immobilization splints frequently position the thumb in palmar abduction but also may be used for thumb radial abduction, depending on patient-specific requisites.

Patients with CMC arthritis find a thumb car-pometacarpal palmar abduction immobilization splint decreases pain with prehension activities by alleviating stress on the thumb joint. These splints are fabricated in many designs, furnishing multiple options for adaptation according to each patient's lifestyle.

Type 0. Type 0 immobilization splints include only the primary thumb CMC joint. No secondary joints are integrated in type 0 thumb CMC immobilization splints (Fig. 12-2, A-C). Because purchase on the first metacarpal is difficult to achieve, exacting fit of the splinting material to the contours of the thenar eminence, first web space, and palmar arch is critical in order to immobilize the CMC joint in a type 0 splint. Even with good fit, increments of

Cmc Palmar Abduction

Fig. 12-2 A-C, Thumb CMC palmar abduction immobilization splint, type 0 (1) D,E, Thumb CMC palmar abduction immobilization splint, type 1 (2) F,G, Thumb CMC palmar abduction immobilization splint, type 1 (2) H, Thumb CMC palmar abduction immobilization splint, type 2

(3) I, Thumb CMC radial abduction immobilization splint, type 3 (4)

A-C, A type 0 immobilization splint is commonly used to decrease pain associated with overuse of the CMC joint. This splint nicely incorporates a rolled edge to allow unencumbered use of the MP joint and a padded proximal edge for comfort during wrist motion. D-G, A carpometacarpal immobilization splint, type 1 allows full range of motion of adjacent finger metacarpophalangeal joints while holding the first metacarpal stationary. D,E, Straps are designed to prevent distal migration of the splint. H, Mechanically, a type 2 CMC immobilization splint that incorporates both a proximal and a distal secondary joint provides excellent immobilization control of the thumb CMC joint. I, This CMC radial abduction splint protects the fracture supported by the external fixation device. The splint does not interfere with the orthopaedic appliance but immobilizes all segments distal to the injury and the index metacarpophalangeal joint for increased stability. [Courtesy (A-C) Rebecca Duncan, PT, Lynchburg, Va.; (F,G) Barbara Smith, OTR, Edmond, Okla.; (I) Brenda Hilfrank, PT, CHT, South Burlington, Vt.]

Splint For Thumb And Index FingerStability Joint Stability Joint

motion may occur at the CMC joint in splints in this classification.

Type 1 and Up. Type 1 and higher thumb CMC immobilization splints include one or more normal secondary joints. Distally sited secondary joints in thumb CMC immobilization splints may include the thumb MP (type 1), thumb MP and IP (type 2), the thumb MP, IP, and index MP (type 3), and so on. In contrast, proximally sited secondary joints are usually limited to the wrist (type 1) or occasionally the wrist and forearm (type 2). If both proximal and distal secondary joints are included, the type count may range from type 2 upward, depending on how many secondary joint levels are involved. For example, if thumb MP and IP and index finger MP joints are distal secondary joints and the wrist and forearm also are included proximally as secondary joints, the resulting splint is defined as a thumb CMC immobilization splint, type 5 (6).

Incorporation of one secondary joint, either the thumb MP or the wrist, increases splint mechanical advantage on the CMC joint, providing more secure immobilization control of the thumb CMC joint than a type 0 splint (Fig. 12-2, D-G). A type 1 CMC splint that immobilizes the wrist as a proximal secondary joint instead of the distal MP joint permits full motion of both thumb MP and IP joints. CMC immobilization splints that include two secondary joint levels are designated type 2 and may incorporate the thumb MP and IP joints, the wrist and forearm joints, or the wrist and thumb MP as secondary joints. A type 2 or type 3 splint that incorporates both a proximal and a distal secondary joint mechanically provides superior immobilization control of the thumb CMC joint than do splints that include two or more proximal or two or more distal secondary joints (Fig. 12-2, H). Hand-based splint designs that include, as secondary joints, the index finger MP in addition to the thumb

MP and IP joints to better stabilize the CMC joint are examples of type 3 CMC immobilization splints (Fig. 12-2, I). Despite inclusion of three or more distally situated secondary joints, these splints are not as efficient at immobilizing the thumb CMC joint as are splints that include a combination of both proximal and distal secondary joints.

Immobilization splinting of the CMC joint in arthritis patients has been shown to be an effective method of treatment that diminishes but does not eliminate symptoms of basilar joint disease.16,17 Clinically, patients with CMC joint disease seem to prefer type 1 CMC immobilization splints that leave the wrist free, although a study by Weiss, LaStayo, et al. found that splinting does not increase pinch strength or alter pain associated with pinch strength assessment.16

Mobilization Splints

Pathologic conditions at the carpometacarpal joint level will often result in limited motion of the first metacarpal with concomitant narrowing of the first web space. Any splint designed to maintain or increase passive range of thumb carpometacarpal motion must have its site of force application on the first metacarpal. Practically speaking, however, this is difficult because of the intervening soft tissue of the first web space. Many ill-conceived splints fitted with the intent of increasing CMC motion actually apply most of the rotational force to the proximal phalanx, resulting in attenuation of the ulnar collateral ligament of the metacarpophalangeal joint, radial deviation of the proximal phalanx, pressure over the radiometacarpal condyle, and instability of the thumb. Care must be taken to ensure that as much of the distal aspect of the first metacarpal is included in the splint as possible and that the primary site of the rotational force is directed toward the metacarpal (Fig. 12-3, A,B). To decrease the amount of pressure on the first metacarpal, the area of force application may be widened to include the proximal phalanx as a secondary joint. This addition, however, must not jeopardize the stability of the metacarpophalangeal joint by exerting a stretching force on the ulnar collateral ligament. In most instances the splint need not be extended distally beyond the interphalangeal flexion crease, thus allowing full motion of the distal phalanx. The splint should also be fitted proximal to the distal palmar flexion crease, permitting full metacarpophalangeal flexion of the adjacent fingers.10 When fingers and thumb both are involved, the thumb CMC joint should be positioned carefully. Radial abduction of the thumb to permit full digital flexion may compromise CMC joint motion by allowing unwarranted ligament shortening. Mobilization of the

Distal Interphalangeal Flexion Crease

Fig. 12-3 A,B, Thumb CMC palmar abduction mobilization splint, type 1 (2)

To avoid damage to the metacarpophalangeal ulnar collateral ligament when mobilizing a thumb carpometacarpal joint, force should be directed toward the head of the first metacarpal instead of the proximal phalanx. A, Incorrect. B, Correct. C, When using elastic traction to mobilize the thumb carpometacarpal joint, this modified Phelps/Weeks thumb sling fits on the first metacarpal and provides two-directional force application to the first metacarpal. [(A,B) from Fess EE: Splinting for mobilization of the thumb. In Hunter JM, et al: Rehabilitation of the hand, ed 2, Mosby, 1984, St. Louis; (C) Karen Priest Barrett, OTR, Atlanta, Ga.]

Fig. 12-3 A,B, Thumb CMC palmar abduction mobilization splint, type 1 (2)

To avoid damage to the metacarpophalangeal ulnar collateral ligament when mobilizing a thumb carpometacarpal joint, force should be directed toward the head of the first metacarpal instead of the proximal phalanx. A, Incorrect. B, Correct. C, When using elastic traction to mobilize the thumb carpometacarpal joint, this modified Phelps/Weeks thumb sling fits on the first metacarpal and provides two-directional force application to the first metacarpal. [(A,B) from Fess EE: Splinting for mobilization of the thumb. In Hunter JM, et al: Rehabilitation of the hand, ed 2, Mosby, 1984, St. Louis; (C) Karen Priest Barrett, OTR, Atlanta, Ga.]

thumb carpometacarpal joint in palmar abduction is critical to attaining a functional hand. A thumb held in adduction cannot be used in opposition. Radial abduction is also important to hand function, allowing wider grasp span and open hand contact for push movements.

Type 0. Type 0 CMC mobilization splints affect motion at the CMC joint without incorporating secondary joints. Depending on CMC joint mobility, these splints may be fabricated from various materials whose properties range from flexible to rigid. If a CMC joint is supple or near supple, maintenance of joint motion may be accomplished with simple splint designs in soft or semirigid materials (Fig. 12-4, A,B). If full passive range of motion is not present at the car-pometacarpal joint, slow, progressive, inelastic mobilization traction may be applied through the use of serial CMC abduction mobilization splints (Fig. 12-4, C) that are adjusted to increase palmar or radial abduction every 2 or 3 days. Progressive splinting of the thumb is continued until the passive measurements of abduction duplicate those of the normal thumb or until the passive motion remains unchanged for three or four consecutive splint adjustments. In

Thumb Mobilization

Fig. 12-4 A,B, Thumb CMC radial abduction mobilization splint, type 0 (1) C, Thumb CMC palmar abduction mobilization splint, type 1 (2)

A,B, A splint fabricated in neoprene is comfortable, lightweight, and easy to apply and remove. The thumb strap component mobilizes the CMC into radial abduction. C, Serial CMC mobilization splints are widened every 2 or 3 days. [Courtesy (A,B) Elizabeth Spencer Steffa, OTR/L, CHT, Seattle, Wash.; (C) from Fess EE: Splinting for mobilization of the thumb. In Hunter JM, et al: Rehabilitation of the hand, ed 2, Mosby, 1984, St. Louis, Mo.]

most instances, inelastic serial carpometacarpal mobilization splints are more effective than elastic traction splinting for increasing the passive range of motion of the thumb carpometacarpal joint. This, of course, depends on the patient's ability to return for frequent splint changes.

Type 1 and Up. Type 1 CMC mobilization splints incorporate one normal secondary joint, sited either proximally or distally, to improve splint control and enhance mechanical effect. These splints often include the thumb MP as a distal secondary joint to achieve better purchase on the first metacarpal (Fig. 12-2, D-G). As noted above, corrective forces must be applied to the first metacarpal, not to the proximal phalanx.

CMC mobilization splints that include more than one secondary joint are classified according to the number of secondary joint levels incorporated in each splint. As with CMC immobilization splints, type 3 mobilization splints often include the index finger MP joint in addition to the thumb MP and IP joints to disperse pressure and increase mechanical advantage (Fig. 12-5, A,B). If thumb extrinsic tendons are tethered by scar, incorporation of the wrist as a secondary joint is necessary to remodel restraining scar tissue (Fig. 12-5, C).

Restriction Splints

Fitted to protect healing tissues, decrease pain, or increase function, thumb CMC restriction splints limit one or more selected motions of the CMC joint. Secondary joints may or may not be included in these splints, depending on individual patient needs. Generally speaking, unidirectional splints that restrict motion in one plane frequently are based on a single layer "wrapped strap" design while circumduction restriction splints tend to be more circumferential in design or they incorporate multiple layers of "strapping."

Type 0. Only CMC joint motion is affected with type 1 thumb CMC restriction splints. These "strap" splint designs may be constructed in soft materials when splinting smaller hands or when minimal to moderate control is required. For example, functional hand use may improve with a neoprene type 0 thumb CMC radial adduction restriction splint that blocks the final 10-20° thumb adduction arc of motion. These simple splints bring the thumb out of the palm while allowing other CMC joint motions for patients with upper motor neuron dysfunction (Fig. 12-6, A,B).

Type 1. A thumb CMC restriction splint, type 1 (2) includes one secondary joint, usually the thumb MP. As with type 0 splints, restricted motion may involve one (Fig. 12-6, C,D) or multiple planes (Fig. 12-6, E-H) as dictated by patient requirements.

Cmc Palmar Abduction

Fig. 12-5 A,B, Thumb CMC palmar abduction mobilization splint, type 3 (4) C, Thumb CMC radial abduction mobilization splint, type 5 (6)

A,B, This two-piece jointed splint mobilizes the thumb CMC by serially adjusting the first metacarpal into palmar abduction. C, To increase lever arms for CMC radial abduction, five secondary joints are included in the splint's design. (Courtesy Daniel Lupo, OTR, CHT, Ventura, Calif.)

Fig. 12-5 A,B, Thumb CMC palmar abduction mobilization splint, type 3 (4) C, Thumb CMC radial abduction mobilization splint, type 5 (6)

A,B, This two-piece jointed splint mobilizes the thumb CMC by serially adjusting the first metacarpal into palmar abduction. C, To increase lever arms for CMC radial abduction, five secondary joints are included in the splint's design. (Courtesy Daniel Lupo, OTR, CHT, Ventura, Calif.)

Fig. 12-6 A,B, Thumb CMC adduction restriction splint, type 0 (1) C,D, Thumb CMC adduction restriction splint, type 1 (2) E,F, Thumb CMC circumduction restriction splint, type 1 (2) G,H, Thumb CMC circumduction restriction splint, type 1 (2) I, Thumb CMC circumduction restriction splint, type 2 (3) J,K, Thumb CMC circumduction torque transmission splint, type 2 (3) L, Thumb CMC circumduction torque transmission splint, type 3 (4) A,B, A neoprene splint restricting the final degrees of thumb CMC adduction allows functional activities to be achieved through lateral prehension of the thumb and index finger. C,D, Strap direction of pull on this circumferentially fitting neoprene splint limits CMC adduction. E-H, By altering the placement and configuration of wrapping, soft splinting materials restrict thumb CMC joint motion. I, This commercially available soft splint restricts the extremes of thumb CMC joint motion. J,K, These type 2 and (L) type 3 torque transmission splints focus transferred active thumb motion to the thumb CMC. [Courtesy (A,B) Joni Armstrong, OTR, CHT, Bemidji, Minn.; (C,D) Shelli Dellinger, OTR, CHT, San Diego, Calif.; (E-H) Bobbie-Ann Neel, OTR, Opelika, Ala. (Splint, patent pending.)]

Stability Joint
Fig. 12-6, cont'd For legend see p. 335.
Cmc Joint Planes Motion

Type 2. With two secondary joints, the wrist and thumb MP, more stability is provided to the CMC joint while allowing motion in all planes with extremes of motion restricted (Fig. 12-6, I).

Torque Transmission Splints

Torque transmission splints may be used to transfer moment to the thumb CMC joint, to mobilize the CMC joint if it is supple, or to remodel it if passive range of motion is limited.

Type 2. Type 2 CMC torque transmission splints include two secondary joints in addition to the primary thumb CMC joint. The two secondary joints are almost always situated distal to the CMC joint (Fig. 12-6, J,K).

Type 3. The wrist, thumb MP, and IP joint levels are incorporated secondarily in type 3 thumb CMC

torque transmission splints (Fig. 12-6, L). Specific thumb CMC joint motions may be facilitated by positioning the wrist in attitudes that either encourage or discourage thumb extrinsic tendon excursion.

Thumb CMC, MP Splints

Incorporating two primary thumb joints, these splints immobilize, mobilize, restrict motion, or transmit torque at/to the thumb CMC and MP joints. Proximal and/or distal secondary joints may or may not be included in thumb CMC, MP splints. Although similar in configuration to earlier described CMC type 1 splints that include a normal thumb MP as a secondary joint in order to enhance inherent splint mechanical action, these splints differ in that both CMC and MP joints are primary joints, indicating that pathology exists at the MP as well as the CMC joint.

Immobilization Splints

Thumb CMC, MP immobilization splints halt passive and active motion at both the thumb CMC and MP joints. Secondary joints may or may not be included in these splints.

Type 0. Stopping motion at the thumb's two most proximal joints, type 0 CMC, MP immobilization splints usually hold the CMC joint in either palmar abduction or radial abduction and the MP joint in extension to allow healing of injured or surgically repaired thumb structures (Fig. 12-7, A,B). Type 0 CMC, MP splints do not include adjacent proximal or distal normal articulations as secondary joints.

Mobilization Splints

Corrective forces are focused on both the thumb CMC and MP joints in thumb CMC, MP mobilization splints. These splints may or may not include secondary joints to improve mechanical application.

Type 0. Because both thumb CMC and MP joints are mobilized in type 0 CMC, MP mobilization splints, it is critical that the force line of application be carefully analyzed and directed. The force line of application must be perpendicular to the rotational axis of the MP joint. If it is not perpendicular, unequal mobilization forces will be directed to thumb MP joint radial and ulnar collateral ligaments, causing differential remodeling of the ligaments and eventual joint instability. Thumb CMC joint articular structures remodel in line with the mobilization forces directed to the MP joint, meaning that full CMC joint motion may not be attained if limitations exist in extreme radial or palmar abduction. Progress of passive CMC joint motion must be monitored carefully to ensure that desired motion is accomplished in all planes. There are no secondary joints in type 0 thumb CMC, MP mobilization splints (Fig. 12-8, A-C).

Mobilization/Immobilization Splints

In thumb CMC mobilization / MP immobilization splints, remodeling forces are applied to the CMC joint and stabilizing forces are applied to the MP joint simultaneously, allowing healing of MP periarticular structures and corrective remodeling of problematic CMC structures. Normal adjacent joints may or may not be included as secondary joints.

Type 0. Mobilization forces to the thumb CMC joint may include elastic traction mobilization assists (Fig. 12-9, A) or inelastic traction in the form of sequential serial adjustments (Fig. 12-9, B). The MP joint may be immobilized in full extension or in designated increments of flexion, depending on the specific rationale for splint application. No secondary joints are included in type 0 CMC mobilization/MP

Cmc Joint Mobilization

Fig. 12-7 A, Thumb CMC palmar abduction and MP extension immobilization splint, type 0 (2) B, Thumb CMC palmar abduction and MP flexion immobilization splint, type 0 (2)

Three-point pressure forces are dispersed along the length of the splinted thumb first metacarpal, MP joint, and proximal phalanx in these circumferential design splints that immobilize the CMC and MP joints.

Fig. 12-7 A, Thumb CMC palmar abduction and MP extension immobilization splint, type 0 (2) B, Thumb CMC palmar abduction and MP flexion immobilization splint, type 0 (2)

Three-point pressure forces are dispersed along the length of the splinted thumb first metacarpal, MP joint, and proximal phalanx in these circumferential design splints that immobilize the CMC and MP joints.

immobilization splints. Both the CMC and MP joints are primary joints.

Thumb CMC, MP, IP Splints

All three thumb joints are included as primary joints in thumb CMC, MP, IP splints. These splints may be single purpose to immobilize, mobilize, or restrict thumb joint motion or they may be multipurpose with combined objectives, e.g., simultaneous mobilization of two thumb joints with restriction of motion at the third joint. Adjacent joints may or may not be included as secondary joints.

Immobilization Splints

Halting motion at all three thumb joints, thumb CMC, MP, IP immobilization splints allow healing of injured or surgically repaired thumb structures. Secondary joints may or may not be included depending on specific patient requirements.

Type 1. Type 1 thumb1 (CMC, MP, IP) immobilization splints incorporate the wrist as a secondary joint. These splints frequently are employed to manage thumb extrinsic tendon inflammation problems, tendon repairs, some fractures, and selected reconstructive procedures (Fig. 12-10, A,B). Wrist and thumb positions are critical and diagnosis specific. Close communication between referring surgeons and those clinicians responsible for designing and fabricating splints is important to ensure that all involved, including patients, understand the rationale for splint application.

Mobilization Splints

Traction forces are simultaneously directed to all three thumb articulations in thumb mobilization splints. Incorporation of secondary joints may or may not be present.

Type 0. A type 0 thumb (CMC, MP, IP) mobilization splint uses a unidirectional corrective force to mobilize all three joints of the thumb simultaneously. The mobilizing force must be applied perpendicular to the rotational axes of the thumb MP and IP joints to avoid unequal force application on the respective MP and IP joint collateral ligaments (Fig. 12-11, A,B). Collateral ligament attenuation and ensuing joint instability of the MP, IP, or of both joints may result if application of the mobilizing force is not perpendicular. Because the resultant mobilizing force to the CMC joint follows the direction of force application at the MP and IP joints, full passive CMC joint motion may not be realized in all CMC motion planes. Careful monitoring of CMC joint passive motion is requisite to achieving multiplanar CMC joint passive motion.

Cmc Abduction

Fig. 12-8 A,B, Thumb CMC palmar abduction and MP flexion mobilization splint, type 0 (2) C, Thumb CMC palmar abduction and MP flexion mobilization splint, type 0 (2) A,B, Incremental adjustments of the mobilization assist are facilitated with this innovative commercially available mobilization assist. C, Applying elastic traction, this splint is simple in design and aesthetically pleasing. [Courtesy (A,B) Nelson Vazquez, OTR, CHT, Miami, Fla.; (C) Provan, Knokke, Belgium.]

Fig. 12-8 A,B, Thumb CMC palmar abduction and MP flexion mobilization splint, type 0 (2) C, Thumb CMC palmar abduction and MP flexion mobilization splint, type 0 (2) A,B, Incremental adjustments of the mobilization assist are facilitated with this innovative commercially available mobilization assist. C, Applying elastic traction, this splint is simple in design and aesthetically pleasing. [Courtesy (A,B) Nelson Vazquez, OTR, CHT, Miami, Fla.; (C) Provan, Knokke, Belgium.]

*When all joints of a digital ray are designated primary joints, the ESCS location is identified by the name of the digital ray, e.g., thumb, index finger, etc.

Finger Splint Stl

Fig. 12-9 A, Thumb CMC radial abduction mobilization / thumb MP flexion immobilization splint, type 0 (2) B, Thumb CMC palmar abduction mobilization / thumb MP flexion immobilization splint, type 0 (2)

Different in their designs, both these splints have dual purposes: to mobilize and to immobilize simultaneously. While both immobilize the thumb MP joint in slight flexion, the CMC joint is mobilized into radial abduction using elastic traction in splint (A) and into palmar abduction using inelastic traction through sequential serial adjustments in splint (B). [Courtesy (A) Carol Hierman, OTR, CHT, Cedar Grove, N.C., and Elisha Denny, PTA, OTA, Pittsboro, N.C., © UNC Hand Rehabilitation Center, Chapel Hill, N.C.]

Fig. 12-9 A, Thumb CMC radial abduction mobilization / thumb MP flexion immobilization splint, type 0 (2) B, Thumb CMC palmar abduction mobilization / thumb MP flexion immobilization splint, type 0 (2)

Different in their designs, both these splints have dual purposes: to mobilize and to immobilize simultaneously. While both immobilize the thumb MP joint in slight flexion, the CMC joint is mobilized into radial abduction using elastic traction in splint (A) and into palmar abduction using inelastic traction through sequential serial adjustments in splint (B). [Courtesy (A) Carol Hierman, OTR, CHT, Cedar Grove, N.C., and Elisha Denny, PTA, OTA, Pittsboro, N.C., © UNC Hand Rehabilitation Center, Chapel Hill, N.C.]

Cmc Joint Mobilization

Fig. 12-10 A, Thumb CMC radial abduction and MP-IP extension immobilization splint, type 1 (4) B, Thumb CMC radial abduction and MP-IP extension immobilization splint, type 1 (4)

The wrist is included as a secondary joint in these type 1 immobilization splints.

Fig. 12-10 A, Thumb CMC radial abduction and MP-IP extension immobilization splint, type 1 (4) B, Thumb CMC radial abduction and MP-IP extension immobilization splint, type 1 (4)

The wrist is included as a secondary joint in these type 1 immobilization splints.

in type 1 thumb restriction /mobilization splints (Fig. 12-12, A,B).

Thumb CMC, IP Splints

Reflecting unique patient requirements, thumb CMC, IP splints incorporate the MP joint as a secondary joint. These splints may immobilize, mobilize, restrict, or transmit torque to the thumb CMC and IP primary joints.

Restriction/Mobilization Splints

With all thumb joints involved, specified joint motion is restricted while the remaining joint or joints are mobilized in thumb restriction / mobilization splints. Secondary joints may or may not be included to enhance mechanical effect.

Type 1. Type 1 thumb restriction / mobilization splints usually restrict specific motion at the thumb CMC joint and, at the same time, act to increase motion at all three joints or only at the thumb MP and IP joints. One secondary joint, the wrist, is included

Mobilization Splints

Type 1. A type 1 thumb CMC, IP mobilization splint focuses traction forces on the thumb CMC and IP joints to increase motion at these two joints. The thumb MP joint is included in the splint as a secondary joint (Fig. 12-13). Mobilization forces may be elastic, inelastic, or a combination of the two. In designing and fitting this splint, it is important that the splinting material fully extends around the proximal phalanx of the thumb, thus rendering the metacar-pophalangeal joint immobile and diminishing the

Cmc Palmar Abduction

Fig. 12-11 A,B Thumb CMC palmar abduction and MP-IP flexion mobilization splint, type 0 (3)

All three joints of the thumb are mobilized in this splint using two assists to apply individual mobilizing forces perpendicular to the MP and IP joint rotational axes. (Courtesy Nelson Vazquez, OTR, CHT, Miami, Fla.)

Fig. 12-11 A,B Thumb CMC palmar abduction and MP-IP flexion mobilization splint, type 0 (3)

All three joints of the thumb are mobilized in this splint using two assists to apply individual mobilizing forces perpendicular to the MP and IP joint rotational axes. (Courtesy Nelson Vazquez, OTR, CHT, Miami, Fla.)

pressure on the palmar aspect of the phalanx. Once again, the angle of approach of the rubber band should be at a 90° angle to the distal phalanx and perpendicular to the center of the axis of rotation of the inter-phalangeal joint. The metacarpophalangeal joints of the fingers should also be permitted a full range of motion into flexion.

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