Lecture 4 Flashcards
Clinical applications for splints
- Hand and upper limb injuries
- Burns and plastics
- Neurological rehab
- General rehab
- Rheumatology
When should you use a splint?
- Splints are only ONE PART OF TREATMENT
- Splits do the hand harm by restricting movement and use of the hand
- They should only be used if the good that it will do will outweigh the harm and restriction
What do you need to consider when evaluating a hand?
- Diagnosis
- Stage of healing
- Individual needs regarding function
What do you need to assess when evaluating a hand?
- Observe, palpate and measure
- Pain, swelling, ROM, sensibility, skin/scarring
What to consider before you splint (2 main things)
- Why are you fitting the splint
- Will its benefit outweigh the harm?
Aims of splinting
- Protect healing tissues/promote healing
- Maintain optimal anatomic position
- Restrict/control movement
- Improve ROM
- Promote function
How does splinting protect health tissues/promote healing?
- Rest allows healing and minimises the inflammatory stage
Stages of tissue healing and repair
- Inflammatory stage
- Fibroblastic stage
- Remodelling phase
Inflammatory stage
- Initial stage after the injury - body is trying to get injury back to normal
- Involves a cellular and chemical response to fight infection and prepare for healing
How long does the inflammatory stage last for?
~ 72 hours
What is the inflammatory stage characterised by?
- Blood clot
- Pain
- Oedema
- Wound weakness
Fibroblastic stage
- Lays down immature collagen which cross links with time
- Requires significant O2 & nutrients (encourage good diet!)
When does the fibroblastic stage start and how long does it last for?
Starts from 3-5 days
Lasts for ~ 6 weeks
Why does the scar look red during the fibroblastic stage?
Extra blood vessels
What can slow inflammatory and fibroblastic stages?
- Extent of injury
- Infection
- Oedema
- Reduced O2 in tissues (smokers, diabetics, etc.)
- Nutrition
What does prolonged inflammatory stage increase the likelihood of?
Scarring and stiffness
Remodelling stage
- Equilibrium between collagen synthesis and degradation
How does splinting maintain optimal anatomic position
- Maintaining soft tissue length & alignment
What is the position of safe immobilisation?
- Position that maintains soft tissues in correct alignment and at sufficient length to minimise joint stiffness
What types of injuries would you use the position of safe immobilisation on?
- Severe crush injury
- Burns
- Infections
- Inflammatory arthritis
What types of injuries would you NOT use the position of safe immobilisation on?
- Extensor tendon repair
- Metacarpal fracture
Effects of prolonged immobilisation on soft tissue
- Skin: reduced length and glide
- Cartilage: degeneration
Restrict/limit motion benefits and weaknesses
- Allows tissue healing
- Prevents tissue adhesion
- Stiffness
Maintain/improve range of motion benefits
- Prevents stiffness
(e. g. night extension splint) - Gain range
What is a serial static?
Splint that is moulded at the end of range of elastic limit for a period of time to elicit plastic response in soft tissue length
- Take a joint to maximum, passive, comfortable range; add plaster and leave it on for a couple of days
How does splinting promote function?
- Optimal positioning
- Assist weak structures
Splint classification
- Articular joint
- Purpose of splint
- Basis of splint
- Description
Classification: articular joint e.g.
Elbow, forearm, wrist, hand, finger, thumb
Classification: purpose of splint e.g.
Immobilise, mobilise, restrict
Classification: basis of splint e.g.
Refers to the location of the splint: finger based, thumb based, forearm based, hand based
Classification: description
E.g.
Hand based thumb MP joint immobilisation splint
Forearm based wrist immobilisation splint
Principles of splinting
- Mechanical
- Fit
- Construction
- Design
- Edu
Main biomechanical principles
- Minimisation of pressure
- Advantageous application of forces
- Use of characteristics of materials
Pressure =
Total force/area of force application
- The lager the surface area, the small the degree of pressure
How to reduce pressure
- Increase the area of force application (longer splint)
Things to consider in terms of pressure
- Avoid shear stress
- Consider skin integrity/circulation/oedema
- Accommodate bony prominences
Design principles for splinting
- Purpose
- Patient functional needs
- Allow maximum sensation
- Ability to apply and remove
- Simple and attractive
- Time spent in splint
- DO THE BENEFITS OUTWEIGH THE RISKS
Common hand injuries/conditions that require splinting
- Fractures
- Tendon injuries
- Nerve compression
- Ligament injuries, sprains, dislocations
What is carpal tunnel syndrome
- Compression of median nerve at carpal tunnel as a result of increased carpal tunnel pressure
What is carpal tunnel syndrome characterised by?
Pins & needles, numbness in radial digits, night waking, less of dexterity
Conservative treatment for carpal tunnel syndrome
- Night splint in wrist neutral
- Reduce repetitive gripping, pressure through base palm
- Nerve gliding
What is De Quervain’s disease?
Inflammatory disease caused by acute trauma
What is De Quervain’s disease characterised by?
Radial wrist pain with tasks requiring pinch and wrist UD
What is Finkelstein’s test? (+ what it is used to test for)
De Quervain’s disease
- Pain on thumb F with wrist ulnar deviation
What is thumb MP UCL injury (SKIERS THUMB)
- Thumb forced into radial deviation/hyperextension
What is skiers thumb characterised by?
MP joint laxity into radial deviation
What is mallet finger characterised by?
- Swollen painful, active extension lag, passively correctable
Mallet finger treatment
- Splint in slight hyperextension for 6-8 weeks
