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

2. Case Studies

3. Purpose & Function of Orthosis
Protective
Corrective
Assistive

4. 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

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

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

7. 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?

8. 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

9. 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.

10. 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.

11. 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.

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

13. 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.

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

15. Splinting
Wrist Cock-Up
Diagnosis:
Treatment:
Fabrication:

16. 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

17. 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)

18. Wounds / Dressings

19. Wound Care and Splinting

20. SPLINT TIME

21. Pediatric Splinting

22. Peds Splinting

23. 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

24. Orthosis Materials Categories: Rubber-like Elastics Plastic-rubber

25. 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. *

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

27. Splinting
Dorsal Blocking
Diagnosis:
Treatment:
Fabrication:

28. Splinting
Ulnar Gutter
Diagnosis:
Treatment:
Fabrication:

29. Splinting
Hand based
Diagnosis:
Treatment:
Fabrication:

30. Splinting
Short Thumb Spica
Diagnosis:
Treatment:
Fabrication:

31. Case Studies

32. Case Studies

33. Case Study- Challenging cases

34. Case Study