Splinting Instructions
-
Upload
irismadrigal -
Category
Documents
-
view
167 -
download
3
Transcript of Splinting Instructions
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 Page 1
Cutting Splint Material
Cold material may be scored with a utility knife and cracked into smaller pieces.
Holes are punched on cold material prior to heating.
Material is easier to cut when semi soft. Do not heat the material until completely limp when cutting. Heat only until edges are clear and material remains opaque.
After the splint is formed, trim the material while it is semi soft.
Use a heat gun to soften an edge and rub out any scissors cut irregularities. Never grind, file or sand edges.
Heating Splint Material
Material may be heated in water at 165 or with an industrial heat gun. Material will not readily bond to itself when wet or double coated.
Dry heated material bonds well, especially if the protective coating has been removed.
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. Never place plastic mesh in the pan without water while the heat is on.
Splint material is heated until completely limp before molding. Material is draped and gently stroked to form to the desired shape.
Do not pinch or grasp the material firmly— which may create pressure points.
Padding may be placed over a bony prominence before molding the material or the material stretched to “dome” over the area.
Lotion may be used on the patient to decrease the heat intolerance on infants, young children and the elderly. Lotion also prevents material from bonding prematurely, but also must be removed from the splint before attaching adhesive backed strap material.
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.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 2
Molding the Splint
Position the patient with the upper extremity to be splinted on a table, if possible.
A neutral position in function is desired but not always possible.
The patient may be positioned with the elbow stabilized in flexion, supported on the table, wrist in neutral, fingers relaxed and thumb in palmar opposition. A towel or pad under the elbow decreases pressure to the ulnar nerve.
Material is molded to support the arches of the hand. A flat hand is a potential stiff hand and weak hand.
Form the areas to be stretched first (holes, curves or folds) before the material begins to cool.
Splint Straps
Velcro© loop or hook may be attached directly to the splint material. 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.
When a strap is used over the dorsum of the hand, 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.
Splint Wear and Care
The splint will not change shape unless exposed to heat greater than 125. It may be worn in the sun or in a sauna but not left in a car, on a windowsill or in a clothes dryer.
The thermal plastic may be cleaned with mild soap and warm water or deodorized with rubbing alcohol.
Strap adhesive will not tolerate cleaning and metal rivets may rust when exposed to moisture.
The splint and straps must be thoroughly dry before wearing.
Cotton stockinet or a terry knit tube sock may be worn with the splint to absorb moisture.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 3
Precautions and Contraindications
The custom splint is fabricated by a qualified healthcare professional per physician prescription.
Circumferential splinting should not be used when edema is present.
Splint or straps should not restrict circulation.
The splint should not produce pain or skin discoloration.
The patient or care giver must be instructed in the splint wearing schedule, precautions and splint care. Written instructions are recommended.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 4
Hand Based Thumb Spica Splint Fabrication:
The preferred position is with the thumb in palmar abduction and the
adductor muscle length maintained.
The hand based thumb splint is frequently used to provide CMC support
for the patient with arthritis. Osteoarthritis may enlarge the IP joint—which
may make splint removal difficult. It is important not to create additional
joint trauma with the splint.
A. The splint provides thumb CMC support without limiting wrist or thumb IP
motion. The splint may be fabricated over the dorsum of the hand or the
palm—per patient and therapist preference.
o Gently drape the softened thermoplastic material over the hand
and wrap the tabs around the thumb. Use care not to stretch the
material tightly around the thumb.
o As the thermoplastic cools, place a large paper clip between the
thumb and the thermoplastic—maintaining a consistent cylinder
between the MP and IP joints, and preventing an hour glass
shape as the paper clip is moved around the thumb.
B. Another method of splinting the thumb CMC is with a symmetrical pattern
with an ulnar hand opening. The center of the wings is placed in the
webspace and the two straight edges are kissed together. Excess
material is trimmed away with scissors. As the thermoplastic cools, place
the large paper clip between the thumb and the thermoplastic,
maintaining a consistent cylinder between MP and IP joints.
C. The circumferential splint may fasten on the volar or dorsal area per
therapist and patient preference. It is a little more difficult to don and doff,
but provides good support when performing more resistive use. Drape the
softened thermoplastic over the hand and wrap the material around the
thumb with care not to stretch or crimp the material. Again, the large
paper clip is used to maintain the cylinder.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 5
Han
d B
ased
Thu
mb
Splin
t:
Ad
diti
onal
sup
por
t fo
r th
umb
CM
C is
pro
vide
d w
ith
out
lim
itin
g w
rist
m
otio
n. T
he s
plin
t is
eas
y to
don
and
dof
f th
roug
h th
e ul
nar
open
ing.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 6
Hand Based Thumb Splint: The ulnar opening makes this splint easy to don and doff through the side opening. It limits most CMC motion but allows the hand to mold to objects when grasping.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 7
Han
d B
ased
Th
um
b S
pli
nt:
Th
e ci
rcu
mfe
ren
tial
han
d b
ased
th
um
b s
pli
nt
may
ove
rlap
an
d f
ast
en
wit
h V
elcr
o® in
th
e p
alm
or
on t
he
dor
sum
of
the
han
d p
er pat
ien
t an
d
ther
apis
t p
refe
ren
ce.
It p
rovi
des
th
e m
ost
CM
C s
tab
ilit
y fo
r a
han
d b
ased
th
um
b s
pli
nt.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 8
Wrist Extension Splint Fabrication:
A wrist extension splint is usually fabricated with the wrist in 20° - 30° extension. It
allows full thumb and finger motion but should prevent wrist motion. The splint does
not limit pronation and supination. The wrist extension splint may be fabricated with
the forearm in a neutral position—midway between pronation and supination. Straps
should not compromise circulation. The splint should be easy to don and doff without
pressure to the radial and ulnar styloids.
A. The volar wrist extension splint may be referred to as an ulnar gutter splint.
It is easy to don and doff. Because it does not have any circumferential
thermoplastic areas, this splint may be the preferred choice for a patient with
edema.
B. The thumb hole wrist extension splint provides more support to the radial
carpals. The thumb hole is tolled away from the thumb—providing full thumb
circumferential motion and opposition. A limited thumb hole wrist extension
splint is not recommended when thumb edema is present. The patient
position with the thumb opposed to the middle finger is used to maintain the
palmar arches. Straps are placed across the dorsum of the hand, wrist and
proximal forearm.
C. The dorsal wrist extension splint places the fingers through the palmar
opening and is circumferential. It is not recommended for the patient with
hand edema. This splint has the advantage of requiring only a proximal
forearm strap for some patients, which allows the hand to be placed in water
without wetting the splint straps.
• The splint is fabricated by inserting the fingers through the distal
opening—slide back to the palmar crease. The wider part of the distal
opening is for the radial side of the hand.
• Gently drape the remaining material over the dorsum of the hand, wrist
and forearm.
• Oppose patient’s thumb to middle finger to define the palmar arches and
smooth the material on the radial and ulnar edges into folds.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 9
Volar Wrist Extension Splint
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 10
Thumb hole Wrist Extension Splint
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 11
Dorsal Wrist Extension Splint
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 12
Volar Pan / Resting Splint Fabrication
The volar pan or resting splint may also be referred to as a safe splint.
the wrist is positioned in 20° extension, the finger MP’s in flexion and the PIP’s
and DIP’s extended. The position maintains MP collateral ligament and intrinsic
muscle length.
The thumb is placed in palmar abduction and the radial splint edge is formed into
a “C” bar.
The splint limits digit and wrist motion—but does not limit pronation and
supination.
Straps are placed across the digits, dorsum of the hand, wrist and proximal
forearm. The strap over the dorsum of the hand should not restrict circulation.
The splint should be easy to don and doff without pressure to the radial or ulnar
styloids.
The splint is placed on the volar hand and forearm area. The thumb “C” bar area
is stretched while the material is very pliable. Care is used to maintain the wrist
and digits in proper position while the material cools. Continue to form the splint
—curving radial and ulnar edges to increase the splint’s strength and customize
the fit.
Safe Splint Extensor Tendon Repair MP Implant Arthroplasty
(zones V, VI, VII & VIII)
Wrist Extension 30º Wrist Extension 30º Wrist Extension 0-15º
MP Flexion 90º MP full Extension MP full Extension
Finger IP’s 0º Finger IP’s 0º Finger dividers neutral to
radial deviation
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 13
Volar Resting Pan Splint
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 14
Volar Forearm Based Thumb Spica Splint:
The wrist extension splint with thumb spica provides additional support to the
thumb CMC, scaphoid and lunate. Due to the circumferential fit of the thumb
piece, it is not recommended for use when edema is present. Thumb IP motion is
not restricted.
The splint material is placed on the volar surface of the hand to the
palmar crease, and to the thumb IP joint.
The thumb is placed in opposition to the middle finger and the wrist in 20°
to 30° extension.
The material is molded to the hand and forearm.
A large paper clip is used in the thumb piece to maintain the cylinder.
Straps are placed over the dorsum of the hand, wrist and proximal
forearm.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 15
Volar Forearm based Thumb Spica Splint
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 16
SPLINT SELECTION READY REFERENCE
WRIST
Ulnar Cock-Up: Preferred wrist extension splint following dressing or cast removal when increased edema present following injury, fracture or surgery.
Thumbhole Cock-Up: Preferred when more support is required for the radial wrist area or TFCC, provides more protection but may not be used when excess edema present due to thumb hole.
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.
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.
Wrist Extension Dynamic or Static Progressive Splint: May be used following radial nerve injury, to regain lost functional wrist extension following wrist fracture, trauma or joint reconstruction.
THUMB
Hand Based Static Thumb Spica Splint: used following MP ligament injury (game keeper’s thumb skiing injury) or, CMC degenerative joint disease.
Forearm Based Static Thumb Spica Splint: used following MP ligament surgical repair, thumb CMC arthroplasty or de Quervain’s first dorsal compartment inflammation.
JOINT RECONSTRUCTION OR ARTHROPLASTY MP Arthroplasty requires s forearm based MP Dynamic Extension Splint for up to 6 weeks. A Volar Pan Resting splint is used nighttime for up to 6 months.
Thumb CMC Arthroplasty requires a Forearm Based Thumb Spica Splint.
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 17
Splints: Clinical Examples
Hand Based Thumb Spica Splint
Volar Wrist Extension (cock-up) Splint
Dorsal Wrist Extension Splint
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 18
Rheumatoid Arthritis CMC arthritis, OA older patient MP arthritis Radial or Ulnar collateral ligament strain/sprain
Rheumatoid Arthritis Carpal Tunnel Syndrome Radial Tunnel Syndrome s/p Total Wrist Arthroplasty s/p Ulnar Styloid Fracture s/p Radial Nerve Repair
Rheumatoid Arthritis Carpal Tunnel Syndrome Radial Tunnel Syndrome
Thumbhole Wrist Extension Splint
Forearm Based Thumb Spica Splint
Volar Pan Resting Splint
© 2003-2005 E. Spencer Steffa, OTR/L, CHT Page 19
Rheumatoid Arthritis Carpal Tunnel Syndrome Total Wrist Fusion Partial Wrist Fusion TFCC Injury
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
Rheumatoid Arthritis s/p MP Joint Arthroplasty night splint s/p Dupuytren’s Contracture fasciectomy Extensor Tendon Repositioning, subluxation at MP joint
level s/p Flexor Tenosynovectomy s/p Extensor Tenolysis Zones I-V