1. Hand immobilization splints Somaya Malkawi, PhD

2. Hand immobilization splints Also called resting hand splints (RHS) It immobilizes fingers and wrist Thumb may or may not be included Purpose: 1.Immobilize 2.Position in functional alignment 3.Retard further deformity 4.Maintains balance between extrinsic and intrinsic muscles of hand 5.Provide localized rest to the tissues of wrist, thumb, fingers

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6. Description of the RHS Pan Thumb trough Forearm trough C bar

7. Pre-molded hand splints Pre-cut splint kit Customized splints What are the advantages and disadvantages for each

8. Hand immobilization splints Volar based resting hand splint is better used when you require a great amount of forearm support Dorsally based RHS is used when there is sutures, sores, rashes, or intravenous needles. Also used for someone who has hypertonicity

9. Hand immobilization splints Two types of positions are accomplished by this splint depending on diagnostic indication 1.Functional position 2.Anti-deformity (intrinsic-plus) position

10. Functional position The resting splint is positioned in resting or mid-joint position Place the wrist in 20-30 degrees of extension Thumb CMC in 45 degrees of palmar abduction Fingers MCP joints 35-45 degrees of flexion PIP and DIP of fingers joints in slight flexion

11. Anti deformity position Often used to place the hand to maintain tension/distraction of anatomic structure To avoid contractures and promote function Wrist: 30-40 ext Thumb: 40-45 palmar abduction Thumb IP: in full ext MCPs: 70-90 flex and PIPs and DIPs in full ext.

12. Diagnostic indications ConditionWearing scheduleSplint, wrist position RAWorn until exacerbation is over. Wrist: 20-30 ext. MCP: 15-20 flex. Thumb: comfort. Hand burns Dorsal or volar Continuously worn until healing begin, removed for dressing changes, therapy, and hygiene. Wrist: (V) 30-40 ext. Wrist: (D) 0 ext. MCP: 70-90 flex. PIP, DIP full ext Thumb: palmar abd & ext. Burn acute phase Worn all time except for therapy. As ROM improves decrease wearing time. Same as above. Burn: Skin graft Worn all times for 5 days!Antideformity. 12

13. Diagnostic indications ConditionWearing scheduleSplint, wrist position Burn: rehab phase.Only at night time.Antideformity. Dupuytren’sAfter surgery, worn at night times, removed for hygiene and exercise. Wrist: neutral or slight extension. MCPs, PIPs, & DIPs: full extension. Crush injuries of the hand At night, or periods of pain Wrist: 0-30 ext. MCP: 60-80 flex. Thumb: palmar abduction & extension. CRPSAll times, removal for hygiene and ADL. Weaned with decreseaed pain and improved function considering comfort 20 degrees wrist ext, thumb palmar abd, MCP: 70 flex, PIP: 0- 10 flex 13