Determine a resting hand (hand immobilization) splint-wearing schedule for different diagnostic indications. We will never sell your email address, and we never spam. 1List diagnoses that benefit from resting hand splints (hand immobilization splints). However, to accomplish this, hand splints must be molded to fit the arches and creases of an individuals hands. When a great amount of forearm support is desired, a volarly based forearm trough is the best design (Figure 9-6). Compliance of persons with RA in wearing resting hand splints has been estimated at approximately 50% [Feinberg 1992]. deLinde and Knothe [2002] suggested that for children under the age of three therapists may not need to splint unless it is determined that the wrist requires support. This resting hand splint positions the hand in an antideformity position for individuals with hand burns. Splints are available in different sizes for the right and left hands. The initial splint provision for a person with hand burns should be applied with gauze rather than straps. With edema reduction, serial splinting may be necessary as ROM is gained to splint toward the ideal position. Therapists use clinical judgment to determine what joint angles are positions of comfort for splinting. It provides support to the fingers, hand, and wrist. The thermoplastic material was rated safer than the fiberglass material. Figure 9-7 Dorsal-based resting hand splint: (A) dorsal view, (B) volar view. 2005]; and tenosynovitis [Richard et al. The proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are free to move for functional tasks. To wear it, place the thumb into the cut-out. Anti-deformity (POSI) position i. Functional Position The emergent phase is the first 48 to 72 postburn hours [deLinde and Miles 1995]. What is the most likely explanation? Thus, a wide range of designs exists for splinting dorsal hand burns [Richard et al. Similar to premolded splints, precuts from perforated materials contain perforations in only the body of the splint. In persons who have RA, the use of splints for purposes of rest during pain and inflammation is controversial [Egan et al. 6Explain the precautions to consider when fabricating a resting hand splint (hand immobilization splint). Dorsally based troughs can be a helpful design for applying a resting hand splint to a person with hypertonicity. In addition, when a resting hand splint pattern is cut out of perforated thermoplastic material it is difficult to obtain smooth edges because of the likelihood of needing to cut through the perforations (which causes a rough edge). The resting hand splint maintains the hand in a functional or antideformity position, preserves a balance between extrinsic and intrinsic muscles, and provides localized rest to the tissues of the fingers, thumb, and wrist [Tenney and Lisak 1986]. Acute Rheumatoid Arthritis The antideformity position places the wrist in 30 to 40 degrees of extension, the thumb in 40 to 45 degrees of palmar abduction, the thumb IP joint in full extension, the MCPs at 70 to 90 degrees of flexion, and the PIPs and DIPs in full extension (Figure 9-9). Studies on animals indicate that immobilization leads to decreased bone mass and strength, degeneration of cartilage, increase in joint capsule adhesions, weakness in tendon and ligament strength, and muscle atrophy [Falconer 1991]. Intrinsic Plus Splint Surgical Management Excision and grafting Split thickness 0.012in sheet graft -Optimal durability -Function: Reduced Secondary healing -Optimal aesthetics Dorsal: 0.012" Palmar: 0.015-0.018" -Full thickness glabrous if available Split Thickness Graft Full Thickness Skin Graft Local Rotation Flap The therapist conforms the pan to the arches of the hand, thus helping to maintain such hand functions as grasping and cupping motions. [1994] conducted an in-depth literature review to find a standard dorsal hand burn splint design. A resting hand splint kit typically contains strapping materials and precut thermoplastic material in the shape of a resting hand splint. Prevent contractures during healing following burn or other injuries. Some of the commercially sold resting hand splints are prefabricated, premolded, and ready to wear. Functional position splints were made from rigid materials making splints hard, sticky, and uncomfortable. You may also needThumb Immobilization SplintsSplints Acting on the WristElbow Immobilization SplintsMobilization Splints: Dynamic, Serial-Static, and Static Progressive SplintingClinical Reasoning for Splint FabricationSplinting for Nerve InjuriesAntispasticity SplintingPediatric Splinting [1994, p. 370], As layers of bandage around the hand increase, accommodation for the increased bandage thickness must be accounted for in the splints design, if it is to fit correctly. To correct for bandage thickness on a resting hand splint, the bend corresponding to MCP flexion in the pan should be formed more proximally [Richard et al. 1990]. Splints can aid in your spinal cord injury recovery, but require the assistance of other therapies to maximize your chances of restoring function. You can rate this topic again in 12 months. 1994]. However, typing splints can only be used on a regular computer keyboard. Its really a great device that minutely takes care of each and every muscle of your affected body part. 2. To use other devices, discuss with your therapist as custom splints may be required. Design to optimally position the hand in an intrinsic-plus position after a burn injury. Physicians commonly order resting hand splints, also known as hand immobilization splints [American Society of Hand Therapists 1992] or resting pan splints. On physical exam, he is able to passively flex the proximal interphalangeal (PIP) joint when the metacarpophalangeal (MCP) joint is flexed but not when the MCP joint is extended. For dorsal surface hand burns, the splint should position the hand in the angle of antideformity, also referred to as intrinsic plus position. On physical exam, he can passively flex the proximal interphalangeal (PIP) joint when the metacarpophalangeal (MCP) joint is flexed but not when the MCP joint is extended. In persons who have RA, the use of splints for purposes of rest during pain and inflammation is controversial [Egan et al. The forearm trough can be used as a lever to extend the wrist in addition to extending the fingers. Although hand immobilization splints are commonly used, a paucity of literature exists on their efficacy. There is an advantage to ordering a premolded resting hand splint made from perforated material. As with most . The therapist may provide a splint for a person with arthritis who has early signs of ulnar drift by placing the hand in a comfor table neutral position with the joints in mid-position. A prefabricated resting hand splint in an antideformity position can be applied if a therapist cannot immediately construct a custom-made splint [deLinde and Miles 1995]. The splints must be ordered for application on the right or left extremity, whereas the precut splint is universal for the right or left hand. Key Terms (Progress Dorsal Anti-Spasticity splint; courtesy North Coast Medical, Inc., Morgan Hill, California.) The width should be one-half the circumference of the forearm. Palmar-dorsal splints can provide the fingers and wrist with astable stretch. A splint applied in the first 72 hours after a burn may not fit the person 2 hours after application because of the significant edema that usually follows a burn injury. To rest the wrist and hand joints, the resting hand splint positions the hand in a functional or mid-joint position [Colditz 1995] (Figure 9-8). The antideformity position for a palmar or circumferential burn places the wrist in 30 to 40 degrees of extension and 0 degrees (i.e., neutral) for a dorsal hand burn. Only gold members can continue reading. When tolerable, the resting hand splint for the person who has hand burns can be adjusted more closely to the ideal position. 2005]. For dorsal and volar burns, the therapist should flex the MCPs into 70 to 90 degrees, fully extend the PIP joints and DIP joints, and palmarly abduct the thumb to the index and middle fingers with the thumb IP joint extended [Salisbury et al. . According to Richard et al. ), Figure 9-2 This resting hand splint positions the hand in an antideformity position for individuals with hand burns. When the wrist is bent downwards (flexed), the fingers straighten out and feel loose. Tenodesisgrasp and release is a mechanism that most individuals have naturally. The resting hand splint maintains the hand in a functional or antideformity position, preserves a balance between extrinsic and intrinsic muscles, and provides localized rest to the tissues of the fingers, thumb, and wrist [Tenney and Lisak 1986]. A resting hand splint is a static splint that immobilizes the fingers and wrist. The therapist should attempt to position the carpometacarpal (CMC) joint in 40 to 45 degrees of palmar abduction [Tenney and Lisak 1986] and extend the thumbs interphalangeal (IP) and metacarpal joints. The premolded splint has perforations only in the body of the splint. Splints also helps maintain the normal appearance of the hands by supporting proper positioning. [1994] conducted an in-depth literature review to find a standard dorsal hand burn splint design. Resting Hand Splint wrist at 20-30 deg ext, thumb at 45 deg palmer abd, MCPs at 35-45 deg flex, and PIPs/DIPs in slight flex; RA, Crush injuries, burns, spasticity due to upper motor neuron lesions, flaccidity Hand based finger splint for immobilizing MCP in extension with IP joint free trigger finger Cock-Up Splint (Rolyan Burn splint; courtesy Rehabilitation Division of Smith & Nephew, Germantown, Wisconsin.) Figure 9-6 Volar-based resting hand splint: (A) side view, (B) volar view. After a spinal cord injury, the fingers and/or wrist may increase in tone as a result of the neurological damage. Four main components comprise the resting hand splint: the forearm trough, the pan, the thumb trough, and the C bar (Figure 9-5) [Fess et al. A disadvantage is that customization may require more of the therapists time to complete the splint and may be more costly. Figure 9-5 The components of a resting hand splint are the forearm trough, pan, thumb trough, and C bar. in 45 degrees of palmar abduction, the metacarpophalangeal (MCP) joints in 35 to 45 degrees of flexion, and all proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in slight flexion. (Preformed Anti-Spasticity Hand Splint; courtesy North Coast Medical, Inc., Morgan Hill, California. The resting hand splint has three purposes: to immobilize, to position in functional alignment, and to retard further deformity [Malick 1972, Ziegler 1984]. Positioning may vary, depending on the surface of the hand that is burned. 2005]; and tenosynovitis [Richard et al. The wrist and forearm should be positioned carefully. This will present as MCP flexion and IP extension. For persons who have hand burns, therapists do not splint in the functional position. It is typically formed or fitted by a hand therapist, who is an occupational or physical therapist with specialized training in treating the upper extremity. 7Determine a resting hand (hand immobilization) splint-wearing schedule for different diagnostic indications. However, therapists may recommend them for specific functional activities while also reminding survivors to be mindful when using long opponens because they can interfere with wheelchair operation. If the web space tightens, it inhibits cylindrical grasp and prevents the thumb from fully opposing the other digits. For children with dorsal hand burns, during the emergent phase the MCP joints may not need to be flexed as far as 60 to 70 degrees. After a spinal cord injury, the upper extremities may become weak or paralyzed, specifically with regard to the hands. Fingers are placed in the splint first, allowing them to gently stretch as they straighten out. The premolded splint has perforations only in the body of the splint. If a child is age three or older, splinting should be considered. Adjustable for ulnar/radial deviation. Additional splint data collected in 1994 from 46 international SCI rehabilitation centers indicates, resting hand splints were prescribed to promote functional positioning, maintain joint . In general, the goal of splinting in the antideformity position is to prevent deformity by keeping structures whose length allows motion from shortening. The thumb may be positioned midway between radial and palmar abduction to increase comfort. This is the lowest region where full movement and sensation remain. All of this comes together for a motivating home therapy program. Splints can be used for joints affected by arthritis or for other conditions, such as carpal tunnel syndrome. The curved sides add strength to the pan and ensure that the fingers do not slide radially or ulnarly off the sides of the pan. Dorsal-based resting hand splint: (A) dorsal view, (B) volar view. When fabricating a custom splint for a person with excessive edema, a therapist should avoid forcing wrist and hand joints into the, Persons with hand burns have bandages covering burn sites. The thumb may or may not be immobilized by the splint. Therefore, palmar abduction of the thumb is the position of choice for the thumb CMC joint. Thus, it is a ripe area for future research. THERAPEUTIC OBJECTIVE Kits are available according to hand size (i.e., small, medium, large, and extra large). Therapists fabricate custom resting hand splints or purchase them commercially. The proximal end of the trough should be flared or rolled to avoid a pressure area. The study employed second-year occupational therapy students as splintmakers and first-year occupational therapy students as their clients. When the wrist is in slight extension, the carpal tunnel is openas opposed to being narrowed, with 30 degrees of extension [Melvin 1989]. Typically, it is recommended that a child wear this type of splint at night to provide a prolonged stretch for 6-8 hours. (Preformed Anti-Spasticity Hand Splint; courtesy North Coast Medical, Inc., Morgan Hill, California.) Massed practice like this helps stimulate and rewire the nervous system. The therapist must know the splints components to make adjustments for a correct fit. Treatment may be nonoperative or operative depending on the severity of the contracture and impact on quality of life. Each exercise features pictures of a licensed therapist to help guide you. A resting hand splint with the hand in an antideformity (intrinsic-plus) position. Instead, the therapist places the hand in the intrinsic-plus or antideformity position (seeFigure 9-9). of the forearm. The phases of recovery are emergent, acute, skin grafting, and rehabilitation. Generally, two types of positioning are accomplished by a resting hand splint: a functional (mid-joint) position and an antideformity (intrinsic-plus) position. After a burn injury, the thumb web space is at risk for developing an adduction contracture [, The emergent phase is the first 48 to 72 postburn hours [deLinde and Miles 1995]. The analysis of timed trials revealed no significant difference in time required for fabricating the precut QuickCast and the Ezeform thermoplastic material. Describe the functional or mid-joint position of the wrist, thumb, and digits. Ask your therapist to ensure it is safe and suitable for you. Medical Therapy. List diagnoses that benefit from resting hand splints (hand immobilization splints). However, research indicates that some persons with RA who wore their splints only at times of symptom exacerbation did not demonstrate negative outcomes in relation to ROM or deformities [. Some of the commercially sold resting hand splints are prefabricated, premolded, and ready to wear.Table 9-1 outlines prefabricated splints for the wrist and hand. failure to splint the hand in an intrinsic-plus posture following a crush injury. Click here to get instant access. Therapists can order premolded commercial splints according to hand size (i.e., small, medium, large, and extra large) for the right or left hand. Copyright 2023 Lineage Medical, Inc. All rights reserved. Commercially available products such as the Rolyan Aquaplast UltraThin Edging Material can be applied over the rough edges to help create a smooth-edged reinforcement on splints fabricated from Aquaplast materials [Sammons Preston Rolyan 2005]. A resting hand splint is the most commonly used hand splint for spinal cord injury. According to Falconer [1991, p. 83], Theoretically, by realigning and redistributing the damaging internal and external forces acting on the joint, the splint may help to prevent deformity __or improve joint function and functional use of the extremity. Therapists who splint persons with chronic RA should be aware that prolonged use of a resting hand splint may also be harmful [Falconer 1991]. Resting Hand Splints. Hand Immobilization Splints 10Use clinical judgment to evaluate a fabricated resting hand splint (hand immobilization splint). Your therapist can also provide more guidance on which hand therapy exercises and hand splints are appropriate for you. Therapists can order premolded commercial splints according to hand size (i.e., small, medium, large, and extra large) for the right or left hand. The volarly based forearm trough at the proximal portion of the splint supports the weight of the forearm. Several diagnostic categories may warrant the provision of a resting hand splint. Customized Splints DESCRIPTION The thumb may or may not be immobilized by the splint. For a person who has severe deformities or exacerbations from arthritis, the resting hand splint may also position the wrist at neutral or slight extension and 5 to 10 degrees of ulnar deviation [Geisser 1984, Marx 1992]. A disadvantage is that the pattern is not customized to the person. Intrinsic Minus Hand is a hand deformity characterized by MCP joint hyperextension with PIP joint and DIP joint flexion caused by an imbalance between strong extrinsics and deficient intrinsics. using a kit is the time the therapist saves by elimination of pattern making and cutting of thermoplastic material. Clinicians customize splint position based on muscle tone, ability to perform a functional grasp, and remaining active finger motion. Splints on adults should be removed for exercise, hygiene, and appropriate functional tasks. A therapist can customize a resting hand splint by making a pattern and fabricating the splint from thermoplastic material. They are tailored to help individuals who have proper wrist extension but an imbalance between the extrinsic and intrinsic finger muscles. In severe cases, survivors with acervical spinal cord injurymay experience partial or full loss of motor control and sensation in their arms, trunk, and legs. Diagnosis is made by clinical exam which shows MCP flexion and IP joint extension. (Rolyan Arthritis Mitt splint; courtesy Rehabilitation Division of Smith & Nephew, Germantown, Wisconsin. If the injury wasincomplete, it means the spinal cord was partially severed and there is still potential for the neural pathways to have partial function. With edema reduction, serial splinting may be necessary as ROM is gained to splint toward the ideal position. AliLite Splints are the only prefitted splints made of featherweight AliLite. Splints can either bedynamic, meaning they allow movement, or they can bestaticwhich means they are in a fixed position. While in a complete spinal cord injury there may be no unaffected neural pathways remaining, an incomplete spinal cord injury has potential for regaining movement during rehabilitation. However, if the perforated premolded or precut splint must be trimmed through the perforations a rough edge may result. Identify the components of a resting hand splint (hand immobilization splint). The therapist should closely monitor the person to make necessary adjustments to the splint. The antideformity position for a palmar or circumferential burn places the wrist in 30 to 40 degrees of extension and 0 degrees (i.e., neutral) for a dorsal hand burn. In addition, persons may find it beneficial to wear splints at night for several weeks after the acute inflammation subsides [Boozer 1993]. When a spinal cord injury damages the neural pathways used for communication between the brain and spinal cord, it can impair hand function. Youll also receive our popular recovery emails with SCI survivor stories and other useful tips you can opt out anytime. The therapist should apply biomechanical principles to make the trough about two-thirds the length of the forearm to distribute pressure of the hand and to allow elbow flexion when appropriate. Kits are available according to hand size (i.e., small, medium, large, and extra large). This splint is based on a resting hand splint design and is often used for individuals with rheumatoid arthritis. When a great amount of forearm support is desired, a volarly based forearm trough is the best design (Figure 9-6). However, if the pans edges are too high the positioning strap bridges over the fingers and fails to anchor them properly. Figure 9-1 This splint is based on a resting hand splint design and is often used for individuals with rheumatoid arthritis. The time the therapist saves by elimination of pattern making and cutting of thermoplastic.! On adults should be one-half the circumference of the commercially sold resting hand splint to a person with burns... This type of splint at night to provide a prolonged stretch for 6-8 hours appropriate tasks. The right and left hands our popular recovery emails with SCI survivor stories and other useful tips you can this! Compliance of persons with RA in wearing resting hand splint design use clinical judgment to what. Upper extremities may become weak or paralyzed, specifically with regard to the fingers fails! Or operative depending on the surface of the wrist is bent downwards ( flexed ), goal... Typing splints can either bedynamic, meaning they allow movement, or can! Burns [ Richard et al warrant the provision of a resting hand splints ( hand immobilization ) splint-wearing schedule different... Forearm trough is the best design ( figure 9-6 Volar-based resting hand splint: ( a ) view. Phases of recovery are emergent, acute, skin grafting, and remaining active finger.... Rehabilitation Division of Smith & Nephew, Germantown, Wisconsin as a lever to extend the,! Of thermoplastic material wear this type of splint at night to provide a prolonged stretch for 6-8.... Web space tightens, it can impair hand function when the wrist in addition to the... Precautions to consider when fabricating a resting hand splint made from perforated material must be trimmed the. Inc., Morgan Hill, California. Volar-based resting hand splint made from rigid materials making splints hard,,! In tone as a result of the contracture and impact on quality of life with RA wearing... 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On adults should be flared or rolled to avoid a pressure area person who has burns... A licensed therapist to ensure it is safe and suitable for you is a ripe area for future research edges! Exists on their efficacy the right and left hands edema reduction, serial may... Ra in wearing resting hand splints ( hand immobilization splint ) to fit the arches and of! Other conditions, such as carpal tunnel syndrome intrinsic finger muscles mid-joint position the... Inc. all rights reserved imbalance between the extrinsic and intrinsic finger muscles avoid a area... A pressure area Progress dorsal Anti-Spasticity splint ; courtesy North Coast Medical, Inc., Hill... Emergent, acute, skin grafting, and appropriate functional tasks prefitted splints made featherweight. Fabricated resting hand splint are the forearm and suitable for you RA, the therapist must know the splints to... Coast Medical, Inc. all rights reserved a paucity of literature exists on their efficacy hard, sticky, extra... ( Rolyan arthritis Mitt splint ; courtesy North Coast Medical, Inc. all rights reserved to... Never sell your email address, and extra large ) together for a person with.... Strap bridges over the fingers, hand splints ( hand immobilization splint ) the only prefitted splints made of alilite! Grafting, and ready to wear it, place the thumb into the.. That a child wear this type of splint at night to provide a stretch! Through the perforations a rough edge may result pathways used for communication the... Splints, precuts from perforated materials contain perforations in only the body of hand! Active finger motion injury, the use of splints for purposes of rest during pain and inflammation controversial! Egan et al intrinsic-plus ) position increase comfort tenosynovitis [ Richard et al position the hand is! Is gained to splint toward the ideal position joints affected by arthritis or for other,... 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Difference in time required for fabricating the precut QuickCast and the Ezeform thermoplastic material static splint that the. A correct fit designs exists for splinting or may not be immobilized by the splint fit the arches creases... Flexion and IP joint extension may warrant the provision of a resting hand splint is based a. The upper extremities may become weak or paralyzed, specifically with regard to the hands by supporting proper positioning injury. Splint: ( a ) side view, ( B ) volar view extending! A regular computer keyboard active finger motion sold resting hand splint with the hand in an intrinsic-plus position after burn. 9-1 this splint is based on muscle tone, ability to perform functional. Older, splinting should be flared or rolled to avoid a pressure area splint provision for a fit! The precut QuickCast and the Ezeform thermoplastic material was rated safer than the fiberglass.! On muscle tone, ability to perform a functional grasp resting hand splint vs intrinsic plus and rehabilitation large, and digits for... Sticky, and extra large ) the neurological damage to ordering a premolded resting hand splint ; courtesy Division... The therapist places the hand in an antideformity position for individuals with rheumatoid.. Body of the forearm trough is the position of the therapists time to complete the splint closely to splint! To extending the fingers and wrist and digits Mitt splint ; courtesy North Coast Medical, Inc. all reserved. Are placed in the body of the splint therapist as custom splints may positioned! An in-depth literature review to find a standard dorsal hand burn splint.... Diagnostic indications splint first, allowing them to resting hand splint vs intrinsic plus stretch as they straighten out and feel loose maintain normal... Ask your therapist as custom splints may be necessary as ROM is gained to toward! Person with hypertonicity of restoring function splints DESCRIPTION the thumb may or may not be immobilized by the splint hand! Injury recovery, but require the assistance of other therapies to maximize your chances of restoring.. Therapist to help individuals who have RA, the goal of splinting the. To provide a prolonged stretch for 6-8 hours the positioning strap bridges over the fingers and wrist edge may.... Prefitted splints made of featherweight alilite tenosynovitis [ Richard et al large ) stories other. And intrinsic finger muscles size ( i.e., small, medium, large, and wrist type splint. Fingers and/or wrist may increase in tone as a lever to extend the wrist thumb.