Splinting Flashcards
What is splinting?
Splinting is a commonly used therapeutic procedure in the management of hand injuries.
What are the 6 main purposes of splinting?
1) Manage acute injury after operation
2) Maintain joint alignment
3) Protect tissues form deformity
4) Optimise functional use
5) A substitute for paralysis
6) Corrects deformity
Name and explain the possible consequences of using a splint incorrectly or for too long?
- Reduced mobility
- Immobilising joints is not always ideal- fatty tissue connected to cartilage, prevents gliding of the joint.
- Adhesion of tendons
- Atrophy of tissues around the joints
- Weakening of structures around joint
When splinting the hand, therapists need to maintain three arches of the hand, to promote both comfort and function. What are these 3 arches?
1) Distal transverse
2) Proximal transverse
3) Longitudinal transverse
Describe the 3 phases of wound healing, including what happens on a cellular level during each stage.
1) Inflammatory (lasts 72 hours)
- Swelling
- Initial healing
- Dying cells and bacteria
2) Proliferation (Day 2-5)
- Building new tissues and forms new collagen
- Healthy tissue granulation
3) Remodelling (Week 2-12 months)
- Fibres orientated flat
- Stretching joints and scar tissue to maximise movement
What are the 3 points of pressure, where are they and why are they essential?
1) Joint axis at wrist
2) Proximal/Forearm end- force
3) Distal/Palmar end- resistance
- Act as counterforce against opposing middle force supplied by the worst strap
Describe the position of safe immobilisation, including the anatomical position of each of these joints: wrist, thumb CMCJ and MCPJ, MCPJs 2-5 and IPJs.
Wrist
-Neutral 10 deg extension
CMC and MCP J, MCPJs 2-5
-45 deg flexion (min)
-Fingers should always be in neutral as they are prone to stiffness
-Thumb is in palmar abduction, extension, rotation
What does 2/3 of the forearm mean and why its it important to use this length?
Force = (Resistance x Resistance Arm ) / Force Arm Length
“Like a seesaw”.
What is the properties of both materials and uses of both?
Aquaplast -Drapability (easier to conform) to arches in palm, bony hands, shapes to the joint -Elastic memory (stretch and pinch) -Adhesive/sticky Tailor Splint -Breathability. -Rigid/stronger. -Control.
What are the 2 types of finger splints?
- Butonneise
- Swan Neck
What do you think is happening at the CMC joint?
- Thumb seems to be in a position that is collapsed
- Joints not stable and wear/tear of cartilage in thumb
- Bones of the thumb has bone to bone contact, rubbing together
- Deforming forces pulling to incorrect position (can get a tight abductor).
What is the clinical reasoning for using a thumb splint?
Thumb is a saddle joint, very mobile
- All planes of movement
- Push forward to hyperextend joint
What symptoms are you trying to address through treatment of thumb splint?
- Pain/swelling (OA, support form splint)
- Poor ROM or positioning (square thumb, MC pulled out of saddle joint which is why it becomes collapsed)
- Reduce strength (loading in a good position)
- Stability
- OA
What approach is taken from thumb splint?
1) Assessment
2) Patient education
3) Pinch test (terrible vs good position)
4) Positioning and serially adjusting splint (‘C’ shape, web space, teach not to hyperextend MCP joint)
5) Pinch- functionality
6) Loading in good position
What joints need to be immobilised and left free on a thumb splint?
CMC and MCP joints
-Thumbs still moves
-Encourage no hyperextension
IP joints left free.
What conditions do you think the wrist splint could be used for?
- Carpal tunnel syndrome: small, pregnant women (hormonal changes), mechanical compression
- Inflammation, tendonitis, tenosynovitis, tennis elbow (lateral epicondylitis)
- OA in CMC and between STT joint
- # on distal radius, scaphoid, hamate, pisiform, triquetrum, carpal bones, ulnar styloid or MC base fracture
What are the markings for hand-based thumb immobilisation splint?
1) Distal palmar crease
2) Wrist crease
3) IP joint
4) Extend around thumb and ulnar border
* remove hand*
5) Fill in distal palmar crease and wrist crease
6) Thumb tail
What is the process of wrist splinting for carpal tunnel syndrome?
1) Conducting assessments (history, Tinel’s/Phalen’s Test for 2 mins).
2) Patient education important (CTS; why they have it; how they fix it).
3) TP Wrist Splint (wear at night to position wrist, 20-0 deg extension-neutral).
4) Encourage median nerve glides (light stretch as they improve)
What are the 3 thumb joints to consider?
EPL, EPB, APL
- Distal Phalanx
- Proximal Phalanx
- Metacarpal
- Carpo meta carpal
What are the bones of the hand?
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
- Trapezium
- Trapezoid
- Hamate
- Capatate
What is a static splint?
The static splint has no movable parts and is designed to support or limit joint activity.
What is the rationale for static splinting?
1) Protects joint integrity by immobilisation of the joint
2) Maintains correct joint alignment
3) Prevents developing contractures
4) Provides support for joint laxity or for a ligament injury
5) Maintains passive ROM gained with dynamic splinting or passive stretching
6) Positions one joint to improve another
What is a dynamic splint?
Application of a moving force compartment that remains approximately constant as the part moves.
What is the rationale for dynamic splinting
1) Provides resistance
2) Prolongs stretching
3) Substitution
