Basic Splinting for the Upper Extremity Faculty: Mathew Shaw ot/cht Sherry Manary pt

Case Studies

Purpose & Function of Orthosis Protective Corrective Assistive

Orthosis Classification Anatomic part Purpose/ functional use Mechanical characteristic - Static / serial static / static progressive - Dynamic / pseudo or semi-dynamic Orientation on extremity-volar/dorsal/circumferential Location of outrigger Material used Diagnosis

Classification continued… Appearance Articular /Non- Articular-fracture bracing (humerus) Custom vs Commercial American Society of Hand Therapists Splint Classification System See slide following

Splinting 1. Hand, Wrist, Forearm, volar resting, static, immobilization, Polyform 11 Diagnosis: Extensor tendon Zone 5 laceration Treatment: Protective Fabrication: Custom

Biomechanics, Design, & Fit Principles Key questions to Address before Fitting a Patient with an Orthosis Identification of primary, secondary, and associated problems: does pathology or diagnosis dictate position of the extremity or joint in the orthosis? Eg Dupuytren’s What impact might immobilizing or mobilizing a joint/s on the biomechanics of proximal and distal joints? What do I expect to accomplish through the use of an orthosis? What classification of splint should be used? What joints should be included in the orthosis? What is the patient’s physical, emotional, or cognitive status?

Anatomy & Kinesiology of the Hand Relative to Fit Principles 1. Bone structure Longitudinal arch Proximal transverse arch Distal transverse arch A. B. Dual obliquity 3. Joint motion & creases Distal Proximal palmar Thenar

Anatomy & Kinesiology of the Hand Relative to Fit Principles Con’t.. 4. Ligaments Each phalangeal joint is stabilized by a volar plate and collateral ligaments. At the MP’s, the collateral ligaments are shortened in extension. At the PIP’s they are shortened in flexion.

Anatomy & Kinesiology of the Hand Relative to Fit Principles Con’t.. Nerves When determining volar or dorsal application of orthoses, consider that pressure is best tolerated on the volar surface of the hand, but the volar surface also makes the greatest contribution to functional sensation of the hand.

Mechanical Principles & Fit Considerations Wherever there is a bony prominence, there is the potential for pressure areas. Ulnar styloid process Radial styloid process Pisiform Dorsal /radial aspect of index MP head Olecranon process Lateral/medial epicondyles Dorsal aspect of metacarpals Padding is NOT a substitute for a poor fit. If padding, need to mold with padding in place or build in space for padding.

Case Study – Forearm Burns Dorsal/Ulnar-based static immobilization elbow, wrist brace – Polyform 11-custom

Mechanical Principles & Fit Considerations Reduce pressure by increasing area of application The longer, wider, and more contoured the forearm bar or trough the more comfortable it will be. Length= 1/3 to 2/3 of forearm & not to interfere with elbow flexion Width= ½ to slightly more that circumference of forearm Finger pan width/height= wide enough not to “squish” fingers and long enough to control finger position ) Rounded corners and beveled edges cause less pressure Continuous uniform pressure over a bony prominence is preferred to unequal pressure on the prominence. Wider velcro straps disperse better than narrow straps.

Mechanical Principles & Fit Considerations 2. Provide contour to increase strength 3. Bond to reinforce Eliminate Friction SPLINT TIME!!!!!!!

Splinting Wrist Cock-Up Diagnosis: Treatment: Fabrication:

General Design Principles Consider individual patient factors Consider length of time orthosis is to be used Strive for simplicity and appearance Allow for optimum function of extremity Allow for optimum sensation Allow for efficient construction, fit, & re-adjustments Provide ease of application and removal (dressings) Consider orthosis wearing schedule/exercise regime

Wound Care and Splinting Allow for streamlined dressings to wounds Consider tension on repaired tissue when designing splint Dressings stick to hot thermoplastics (be aware you may have to splint over an undressed wound)

Wounds / Dressings

Wound Care and Splinting

SPLINT TIME

Pediatric Splinting

Peds Splinting

Paeds Splinting Age of child and level of compliance Lever arm on splints, eg short = increased pressure Sensitive skin - vigilance with pressure sores Level of communication, eg explanation of reason for splint, application, voicing areas of pain/irritation Ability to maintain proper positioning, eg may have to splint above elbow Protective vs corrective

Orthosis Materials Categories: Rubber-like Elastics Plastic-rubber

Orthosis Material Con’t… Padding: Open Cell Absorbs water, food, dirt, etc. Closed Cell Does not absorb water, food, etc. can be washed * Critical to build space into orthosis first if you are going to use padding vs. simply adding when there is a pressure point. Adding padding without building space will only increase pressure. *

Orthosis Material Con’t… Pattern Options: Pre-cut orthosis from vender Custom pattern from paper towel Pre-existing pattern Strapping: Velcro hook Velcro loop

Splinting Dorsal Blocking Diagnosis: Treatment: Fabrication:

Splinting Ulnar Gutter Diagnosis: Treatment: Fabrication:

Splinting Hand based Diagnosis: Treatment: Fabrication:

Splinting Short Thumb Spica Diagnosis: Treatment: Fabrication:

Case Studies

Case Studies

Case Study- Challenging cases

Case Study