SPLINTING Elizabeth L.

Spencer Steffa, OTR/L, CHT
INTRODUCTION Splinting Force Newton: “To every action, there is an equal and opposite reaction.” Know and control force. Pressure is equal to the force divided by the area and is referred to as pounds per square inch. Splint Design A pattern may be made by drawing an outline of the area to be splinted. When drawing a pattern of the hand or forearm, the hand is placed palm down on the pattern paper. If the injury prevents the palm down position, a drawing of the other hand may be used and reversed. Locate and indicate anatomy landmarks on the pattern. The splint is 2/3 the length and 2/3 the circumference for a three point pressure splint. Patterns may be drawn on the splint material with ball point pen and ink removed with rubbing alcohol. Flow pens will wash off when the splint material is heated in water. A China marking pen may be used but will not wash off with alcohol. Splint Materials Reveals™, Aquaplast® and similar splint materials will shrink approximately 3 % as it cools. Reveals™, Aquaplast® and similar splint materials may be cracked to break the bond when cold. Wiping both sides of the splint material with a moist sponge and acrylic floor wax gives additional control for a difficult splint. Ultra-coated material may be ordered from WFR Corp.

© 2003-2005 E. Spencer Steffa, OTR/L, CHT

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trim the material while it is semi soft. Lotion may be used on the patient to decrease the heat intolerance on infants. Heat only until edges are clear and material remains opaque. young children and the elderly. especially if the protective coating has been removed. Dry heated material bonds well. Never grind. Material is draped and gently stroked to form to the desired shape. © 2003-2005 E. Padding may be placed over a bony prominence before molding the material or the material stretched to “dome” over the area. Material is easier to cut when semi soft. Splint material is placed on a towel to remove excess hot water before placing material in contact with the patient’s skin to avoid possible burns. Spencer Steffa. High temperature plastic mesh pan guard or paper towel may be used to keep material from sticking to the bottom of the pan and may be used to lift the softened material from the water to avoid stretching. After the splint is formed. Do not pinch or grasp the material firmly— which may create pressure points. Heating Splint Material Material may be heated in water at 165° or with an industrial heat gun. Use a heat gun to soften an edge and rub out any scissors cut irregularities. OTR/L. Lotion also prevents material from bonding prematurely. Do not heat the material until completely limp when cutting. Holes are punched on cold material prior to heating. file or sand edges. Material will not readily bond to itself when wet or double coated. CHT Page 2 .Cutting Splint Material Cold material may be scored with a utility knife and cracked into smaller pieces. Never place plastic mesh in the pan without water while the heat is on. but also must be removed from the splint before attaching adhesive backed strap material. Splint material is heated until completely limp before molding.

The Velcro© will not pull off when folded back on itself forming a tab. A 2 inch wide strap distributes the pressure more effectively than a 1 inch strap. fingers relaxed and thumb in palmar opposition. on a windowsill or in a clothes dryer. When a strap is used over the dorsum of the hand. CHT Page 3 . supported on the table. The splint and straps must be thoroughly dry before wearing. if possible. It may be worn in the sun or in a sauna but not left in a car. curves or folds) before the material begins to cool. Strap adhesive will not tolerate cleaning and metal rivets may rust when exposed to moisture. Spencer Steffa. The thermal plastic may be cleaned with mild soap and warm water or deodorized with rubbing alcohol. the patient is advised to avoid pressure over the venous return to prevent distal edema to the hand and digits. A small crescent cut may be used to decrease pressure around the thumb web space or wrist area at the radial nerve. A flat hand is a potential stiff hand and weak hand. Cotton stockinet or a terry knit tube sock may be worn with the splint to absorb moisture. A neutral position in function is desired but not always possible. Form the areas to be stretched first (holes. Splint Straps Velcro© loop or hook may be attached directly to the splint material. OTR/L.Molding the Splint Position the patient with the upper extremity to be splinted on a table. The patient may be positioned with the elbow stabilized in flexion. wrist in neutral. Splint Wear and Care The splint will not change shape unless exposed to heat greater than 125°. © 2003-2005 E. Material is molded to support the arches of the hand. A towel or pad under the elbow decreases pressure to the ulnar nerve.

Circumferential splinting should not be used when edema is present. Splint or straps should not restrict circulation. precautions and splint care. Spencer Steffa. Written instructions are recommended. The patient or care giver must be instructed in the splint wearing schedule. © 2003-2005 E. CHT Page 4 .Precautions and Contraindications • • • • • The custom splint is fabricated by a qualified healthcare professional per physician prescription. The splint should not produce pain or skin discoloration. OTR/L.

OTR/L. place a large paper clip between the thumb and the thermoplastic—maintaining a consistent cylinder between the MP and IP joints.Hand Based Thumb Spica Splint Fabrication: • • The preferred position is with the thumb in palmar abduction and the The hand based thumb splint is frequently used to provide CMC adductor muscle length maintained. Drape the softened thermoplastic over the hand and wrap the material around the thumb with care not to stretch or crimp the material. Excess material is trimmed away with scissors. maintaining a consistent cylinder between MP and IP joints. the large paper clip is used to maintain the cylinder. B. © 2003-2005 E. and preventing an hour glass shape as the paper clip is moved around the thumb. As the thermoplastic cools. It is important not to create additional joint trauma with the splint. The splint provides thumb CMC support without limiting wrist or thumb IP motion. Another method of splinting the thumb CMC is with a symmetrical pattern Gently drape the softened thermoplastic material over the hand and wrap the tabs around the thumb. It is a little more difficult to don and doff. o As the thermoplastic cools. The center of the wings is placed in the webspace and the two straight edges are kissed together. place the large paper clip between the thumb and the thermoplastic. support for the patient with arthritis. Again. CHT Page 5 . Use care not to stretch the material tightly with an ulnar hand opening. Spencer Steffa. C. The splint may be fabricated over the dorsum of the hand or the palm—per patient and therapist preference. but provides good support when performing more resistive use. o around the thumb. Osteoarthritis may enlarge the IP joint —which may make splint removal difficult. The circumferential splint may fasten on the volar or dorsal area per therapist and patient preference. A.

OTR/L. The splint is easy to don and doff through the ulnar opening.Hand Based Thumb Splint: Additional support for thumb CMC is provided without limiting wrist motion. © 2003-2005 E. CHT Page 6 . Spencer Steffa.

CHT Page 7 . OTR/L.Hand Based Thumb Splint: The ulnar opening makes this splint easy to don and doff through the side opening. © 2003-2005 E. It limits most CMC motion but allows the hand to mold to objects when grasping. Spencer Steffa.

Hand Based Thumb Splint: The circumferential hand based thumb splint may overlap and fa sten ® with Velcro in the palm or on the dorsum of the hand per p atient and therapist preference. © 2003-2005 E. OTR/L. Spencer Steffa. CHT It provides the most CMC stability for a hand based thumb splint. Page 8 .

It is easy to don and doff. The thumb hole wrist extension splint provides more support to the radial carpals. © 2003-2005 E. Spencer Steffa.Wrist Extension Splint Fabrication: A wrist extension splint is usually fabricated with the wrist in 20° . • Oppose patient’s thumb to middle finger to define the palmar arches and smooth the material on the radial and ulnar edges into folds. C. A limited thumb hole wrist extension splint is not recommended when thumb edema is present. Because it does not have any circumferential thermoplastic areas. The thumb hole is tolled away from the thumb—providing full thumb circumferential motion and opposition. The splint should be easy to don and doff without pressure to the radial and ulnar styloids. • The splint is fabricated by inserting the fingers through the distal opening—slide back to the palmar crease. • Gently drape the remaining material over the dorsum of the hand. which allows the hand to be placed in water without wetting the splint straps. wrist and proximal forearm. A. Straps should not compromise circulation. CHT Page 9 . It allows full thumb and finger motion but should prevent wrist motion. OTR/L. This splint has the advantage of requiring only a proximal forearm strap for some patients. The volar wrist extension splint may be referred to as an ulnar gutter splint. The patient position with the thumb opposed to the middle finger is used to maintain the palmar arches. The dorsal wrist extension splint places the fingers through the palmar opening and is circumferential.30° extension. this splint may be the preferred choice for a patient with edema. It is not recommended for the patient with hand edema. The splint does not limit pronation and supination. wrist and forearm. B. The wrist extension splint may be fabricated with the forearm in a neutral position—midway between pronation and supination. Straps are placed across the dorsum of the hand. The wider part of the distal opening is for the radial side of the hand.

Spencer Steffa. OTR/L. CHT Page 10 .Volar Wrist Extension Splint © 2003-2005 E.

Spencer Steffa. OTR/L.Thumb hole Wrist Extension Splint © 2003-2005 E. CHT Page 11 .

Spencer Steffa. CHT Page 12 . OTR/L.Dorsal Wrist Extension Splint © 2003-2005 E.

CHT Page 13 . Continue to form the splint—curving radial and ulnar edges to increase the splint’s strength and customize the fit.Volar Pan / Resting Splint Fabrication • • length. dorsum of the hand. VII & VIII) Wrist Extension 30º MP full Extension Finger IP’s 0º MP Implant Arthroplasty Wrist Extension 0-15º MP full Extension Finger dividers neutral to radial deviation The volar pan or resting splint may also be referred to as a safe splint. Safe Splint Wrist Extension 30º MP Flexion 90º Finger IP’s 0º Extensor Tendon Repair (zones V. supination. the finger MP’s in flexion and the PIP’s and DIP’s extended. • • • • • The thumb is placed in palmar abduction and the radial splint edge is formed into The splint limits digit and wrist motion—but does not limit pronation and Straps are placed across the digits. Spencer Steffa. Care is used to maintain the wrist and digits in proper position while the material cools. VI. The position maintains MP collateral ligament and intrinsic muscle © 2003-2005 E. The strap over the dorsum of the hand should not restrict circulation. wrist and proximal The splint should be easy to don and doff without pressure to the radial or ulnar The splint is placed on the volar hand and forearm area. OTR/L. forearm. styloids. The thumb “C” bar area a “C” bar. the wrist is positioned in 20° extension. is stretched while the material is very pliable.

CHT Page 14 .Volar Resting Pan Splint © 2003-2005 E. OTR/L. Spencer Steffa.

A large paper clip is used in the thumb piece to maintain the cylinder. scaphoid and lunate. and to the thumb IP joint. • • • • • forearm. it is not recommended for use when edema is present. OTR/L. Spencer Steffa. The splint material is placed on the volar surface of the hand to the The thumb is placed in opposition to the middle finger and the wrist in 20° The material is molded to the hand and forearm. to 30° extension. © 2003-2005 E. Straps are placed over the dorsum of the hand. Due to the circumferential fit of the thumb piece. Thumb IP motion is not restricted. wrist and proximal palmar crease.Volar Forearm Based Thumb Spica Splint: The wrist extension splint with thumb spica provides additional support to the thumb CMC. CHT Page 15 .

Volar Forearm based Thumb Spica Splint © 2003-2005 E. Spencer Steffa. OTR/L. CHT Page 16 .

CHT Page 17 . Wrist Extension Dynamic or Static Progressive Splint: May be used following radial nerve injury. OTR/L.SPLINT SELECTION READY REFERENCE WRIST Ulnar Cock-Up: Preferred wrist extension splint following dressing or cast removal when increased edema present following injury. THUMB Hand Based Static Thumb Spica Splint: used following MP ligament injury (game keeper’s thumb skiing injury) or. to regain lost functional wrist extension following wrist fracture. fracture or surgery. trauma or joint reconstruction. thumb CMC arthroplasty or de Quervain’s first dorsal compartment inflammation. Thumb CMC Arthroplasty requires a Forearm Based Thumb Spica Splint. Forearm Based Static Thumb Spica Splint: used following MP ligament surgical repair. © 2003-2005 E. Dorsal Cock-Up: Preferred for light support such as carpal tunnel syndrome and may be used during the day for the individual who must be able to wash their hands frequently. Thumbhole Cock-Up: Preferred when more support is required for the radial wrist area or TFCC. A Volar Pan Resting splint is used nighttime for up to 6 months. JOINT RECONSTRUCTION OR ARTHROPLASTY MP Arthroplasty requires s forearm based MP Dynamic Extension Splint for up to 6 weeks. Spencer Steffa. CMC degenerative joint disease. provides more protection but may not be used when excess edema present due to thumb hole. Forearm Based Thumb Spica: Used for wrist support when the Scaphoid is involved such as a fracture or scapho-lunate ligament injury or following thumb CMC surgery.

Spencer Steffa. OTR/L. CHT Page 18 .Splints: Clinical Examples Hand Based Thumb Spica Splint • • • • Rheumatoid Arthritis CMC arthritis. OA older patient MP arthritis Radial or Ulnar collateral ligament strain/sprain Volar Wrist Extension (cock-up) Splint • • • • • • Rheumatoid Arthritis Carpal Tunnel Syndrome Radial Tunnel Syndrome s/p Total Wrist Arthroplasty s/p Ulnar Styloid Fracture s/p Radial Nerve Repair Dorsal Wrist Extension Splint • • • Rheumatoid Arthritis Carpal Tunnel Syndrome Radial Tunnel Syndrome © 2003-2005 E.

Spencer Steffa. subluxation at MP joint level s/p Flexor Tenosynovectomy s/p Extensor Tenolysis Zones I-V © 2003-2005 E. CHT Page 19 . OTR/L.Thumbhole Wrist Extension Splint • • • • • Rheumatoid Arthritis Carpal Tunnel Syndrome Total Wrist Fusion Partial Wrist Fusion TFCC Injury Forearm Based Thumb Spica Splint • • • • • • • Rheumatoid Arthritis De Quervain’s Intersection Syndrome s/p Arthroplasty Thumb CMC soft tissue reconstruction s/p EPB and APL repair Bennett’s Fracture Scaphoid Fracture Volar Pan Resting Splint • • • • • • Rheumatoid Arthritis s/p MP Joint Arthroplasty night splint s/p Dupuytren’s Contracture fasciectomy Extensor Tendon Repositioning.

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