Splinting Flashcards
Orthotic
The splint is a device that is applied to a part of the body for the purpose of protecting that part or assisting in the restoration or improvement of function
*Do have to have doctors orders for orthotics
Goals = to protect or support injured, weakened, or
repaired joints and soft tissue
(tendon repairs and arthritis)
to immobilize or restrict joint ROM
CTS, cubital tunnel syndrom, dequervain's
tenosynovitis
to correct or prevent joint deformity
(arthritic ulnar deviation)
to stabilize for weak and absent muscle fx
to inhibit abnormal muscle tone
(stroke)
to increase ROM
(static progressive splints)
Static splints
A splint that is molded to the hand to maintain the tissue in one position
Has no movable parts
May be used to:
- relieve pain but can help edema and swelling
- position and maintain joint alignment
- prevent adaptive shortening of soft tissue
- correct soft tissue contractors
- immobilize a joint or limb following trauma
Types of Static splints
Resting Hand Splint = RA, CTS, fractures, hand burns,
tendonitis, hemiplegia
intrinsic plus splint (modified resting
hand splint for burns (duck position)
to reduce contracture
70-90 degrees MCP flexion
IPs straight for burns
CMC Static splint
Ulnar Gutter Splint = any splint that comes up the ulnar
side is an ulnar gutter splint
AquaForm Zippered Wrist splint (long and short) =
more circumferential = provides more
immobilization
Anti-Spasticity Ball Splint = synergy rigid material
Thumb Hole Wrist Cock-Up Splint = wrist neutral splint
Wrist and Thumb Spica Splint with IP Immobilization
Hand-Based Thumb Spica Splint
Gauntlet Thumb Spica Splint
* Scaphoid fractures or DeQuervain’s
Clamshell Splint = prefab with straps, like my black one
good protection and immobilization
Buddy Straps = phalanx fractures, dislocations, encourages
full flexion
Tennis Elbow Band = prefab
Splint liners = fleecy web, foam lining, Terry foam padding
stockinette
absorb sweat, comfort
Terry cloth could cause sheering on skin
Dynamic Splints
A splint that applies force and movement to a joint
Have 3 parts: base
outrigger
dynamic traction force
Trying to improve motion or function
Substitutes for loss of Mm function
Correct deformity
Minimize adhesions formation
Ex: RA attacks soft tissue (ligaments and sagittal bands) helps to keep fingers tracking properly
Ex: radial n, extends wrist and fingers when nerve is damaged and pt can’t do that for a while so this helps to hold wrist in extension and fingers. Often pt will get it back in 3-4 months
Static Progressive Splints
- Similar to dynamic splints, but no movable components
- Applies low-load to joint while maintaining the tissue at its
max length - Worn for extended periods of time so that the tissue adapt
“grow” to its new length - Serial static splints
- May be used to: increase range of motion
correct soft tissue contractors
maintain improvement obtained through
other forms of tx, such as passive stretch
*** Always about ROM, better than passive stretching b/c
you need more time (low grade stretch for a long period
of time.
MCP Flexion Static-progressive = not elastic, they can’t extend against it, this is why it is not dynamic
Static Progressive Finger Flexion Splint
Static Progressive Finger Extension Splint
*Individual units for flex and ext
Dynamic wrist splint
Phoenix Wrist Hinge
PIP Short Extension Splint = ( still considered dynamic)
b/c of spring
Anatomical landmarks
- Clear the creases of mobile joints to allow full movement of the joint
Creases of the Hand:
- DIP crease
- PIP crease
- Palmer digital crease
- Distal palmer crease
- Proximal palmer crease
- Thenar crease
- Median crease
- Ulnar crease
- Wrist crease
Arches of the Hand
Custom made splint should maintain the arches of the hand
Arches of the Hand:
* Longitudinal arch = middle finger down to base of palm
* Distal Transverse arch = slightly distal of the distal palmer
crease
* Proximal Transverse arch = proximal of the proximal
palmer crease
The 3 arches of the hand allow the hand to conform to objects being held. This maximizes the amount of surface contact which enhances stability and increases sensory input. Loss of these arches results in severe impairment in the functional use of the hands = therefore you must support the arches
Longitudinal Arch
Maintained by activity in the hand’s intrinsic Mm
Flexible arch
Proximal Transverse arch
A stable bony arch that forms the posterior border of the carpal tunnel
Rigid arch
At the level of the CMC joint with the keystone being the capitate
Remains arched even when hand is open
Distal Transverse arch
Formed by the metacarpal heads
Combination of “radial” stability and “ulnar” mobility
Flexible arch
Level of MCP joints with the keystone being the 2nd and 3rd metacarpals. The 1st, 4th, and 5th metacarpals rotate around the 2nd and 3rd metacarpals to either flatten or increase its arch
Anatomical considerations
- Maintain the normal axis of motion
- Try not to splint unaffected joints
- When possible allow contact of palmar surface of palm and digits with the environment to permit greater sensory discrimination
Mechanical Principles
Resting Hand Position
- 10-20 degrees wrist extension
- wrist neutral
- flexion and abduction of the thumb
- 15-20 degrees flexion of MCP joints
Splinting principles:
* When flexed, fingers point to scaphoid bone
* Hooks should be attached to the proximal and central
aspect of the nail
* Maintain a perpendicular traction application (90 degrees
not to compress or distract the joint, want angle
straight up and down
* Increase material strength by adding contours
*Distribute forces equally =
Increase the area of force applied on the skin will reduce
the pressure on that area: forearm trough should be
2/3 forearm length
thumb or forearm trough
1/2 circumference * Rolled edges reduce pressure and avoid sharp points * Remember areas of impaired sensation * Use padding over bony prominence BEFORE splinting. Padding after will increase pressure
Pressure Areas
Patient should wear the splint for approximately 20-30 mins, remove the splint and check for redness
Red areas should not last for more than 20 mins after splint removed
Common Pressure Areas: * Ulnar styloid is biggest followed by * Metacarpal joints * PIPs * Fingertips * Theraputty to create a negative space to bubble area out and don't have to use padding
