MOBILIZATION SPLINTS • Therapists use dynamic splinting to control motion after the
completion of joint implant arthroplasty and flexor tendon
A. Introduction repairs.
• Functions of dynamic splinting for patients who undergo joint
• Mobilization or dynamic splints have movable parts and are replacement surgery:
designed to apply force across joints. o provide controlled motion and precise alignment of the
• Uses constant or adjustable tension, or both, to achieve one of repaired soft tissue while minimizing soft-tissue deformity
the following goals: o maintains alignment of the joints for the healing structures
o Substitute for loss of muscle function while allowing guarded movement of the joint
o Correct deformities caused by muscle-tendon tightness or • Functions of dynamic splinting for patients who undergo flexor
joint contractures tendon repairs:
o Maintain active or passive range of motion o Provide controlled motion to the healing structures.
o Provide controlled motion after tendon repair or joint
arthroplasty 4. Aid in Fracture Alignment and Wound Healing
o Aid in fracture alignment and wound healing
• Dynamic traction should be used for the treatment of selected
intra-articular fractures of the finger
B. Implications of Mobilization Splints
o A dynamic traction splint involves the use of static tension
while allowing joint movement.
1. Substitution for Loss of Motor Function
• Mobilization splints may also be used following a severe burn to
• The goals of splinting for loss of muscle function are to substitute
assist in wound healing.
for loss of motor use, prevent overstretching of nonfunctioning
o The use of such splinting during wound healing will facilitate
muscles, and prevent joint deformity.
proper collagen alignment and scar formation.
• Both dynamic and static splints can accomplish these goals
• A splint for radial nerve injury C. Biomechanics of Dynamic Splinting
1. Anatomic Considerations
• Application of an external force to healing joint structures raises
the following questions.
o During what stage in the healing process should a splint be
used to apply force?
o How much force should the splint apply?
o Where should the force be applied?
• By applying controlled stress to the tissue over a prolonged
period of time, the therapist can create tension gentle enough to
allow creep without tissue injury.
• A tenodesis splint for persons with spinal cord injury
2. Torque and Mechanical Advantage
• Mechanical advantage involves the consideration of various
forces applied by the splint base and the dynamic portion of the
splint
• Mechanical advantage is determined by the ratio of the lever
arm length (la) of the applied force (Fa) to the lever arm (lr) of
the applied resistance (Fr)
2. Correction of a Joint Deformity
• A person who exhibits limited passive joint motion may be a
candidate for a dynamic splint.
• The best results from dynamic splinting are attained when the
therapist initiates treatment soon after edema and pain are
under control.
• The focus of dynamic splinting should be on increasing the length
of time the splint is worn rather than increasing the force.
• A general goal for a mobilization splint is to increase passive joint
range of motion by 10 degrees per week
• By adjusting the length of the splint base or the length of the
outrigger, the mechanical advantage can be altered
3. Provision of Controlled Motion
• The goal of a splint is to maintain a mechanical advantage of 2. the application of force
between 2/1 and 5/1 • Outrigger
• A splint with a greater mechanical advantage will be more o A projection from the splint base the therapist uses to
comfortable and durable position a mobilizing force.
• Torque is defined as the effect of force on the rotational o The outrigger material depends on the amount and position
movement of a point of the desired force
• The amount of torque is calculated by multiplying the applied o An outrigger can be a high or low profile
force by the length of the moment arm.
• In practical terms, the therapist should place the force as far as
Advantages Disadvantages
possible from the mobilized joint without affecting other joints Low-profile o more o requires
• An exception to placing the force as far from the mobilized joint aesthetically adjustments
as possible occurs when rheumatoid arthritis is involved. pleasing and less more frequently
cumbersome
High-profile o slightly less o Bulky and may
deviation from decrease the
the 90-degree person’s
angle of pull compliance with
wearing the splint
o Materials that can be used for outriggers:
✓ Thermoplastic material
✓ Commercially available low-temperature tubes
✓ ½ inch wire rod
✓ Commercial adjustable wire outriggers
• Application of force
o The therapist can supply force by using:
• If the joint is unstable, a force applied too far from the joint will ✓ rubber bands
result in tilt rather than a gliding motion of the joint - more readily available and easy to adjust
- A long rubber band stretched over the maximum
3. Application of Force length of the splint provides more constant
• When applying force to increase passive joint range of motion, tension than a short rubber band
the therapist must keep the direction of pull at a 90-degree angle ✓ Springs
to the axis of the joint and perpendicular to the axes of rotation - offer more consistent tension throughout the
range
✓ elastic thread
- easiest to apply and adjust
o A nonstretchable string or outrigger line is necessary to
connect the finger loop to the source of the force
o Finger loops from strong pliable material are usually best
because of the increased conformability to the shape of the
finger
• When excessive force is applied to the skin for a prolonged
period, tissue damage can result. The amount of pressure the
skin can tolerate dictates the maximum tolerable force.
• As a general rule, the amount of acceptable pressure or force per
unit area is 50 g/cm2.
• The person should report the sensation of a gentle stretch, not o Static progressive tension
pain. ▪ a static tension splint uses nonelastic tension to
provide a constant force
D. Features of a Mobilization Splint ▪ therapist may use a Velcro tab, turnbuckle, or
• Two features unique to mobilization splinting are: commercially available static progressive components
1. the use of an outrigger to apply the force
• Use a damp paper towel or stockinette when splinting over
bandages or dressing
• Check the line of pull so that a 90-degree angle is present on
finger loops
• All joints should be checked from various angles to ensure proper
positioning
F. Materials and Equipment for a Dynamic Splint
• Thermoplastic material with a high level of self-adhesion
• Finger loops
• Nail hooks, an emery board, and super-glue
• Solvent
• Nonstretchable nylon string (outrigger line)
• An outrigger kit
• A wire rod (1 ⁄8 inch) with tools to bend
• Rubber bands, springs, elastic string, Velcro tabs, turnbuckles, or
commercially available static progressive components
• Safety pins or other material to make a hook
• Pliers, wire bender
G. Precautions for Dynamic Splinting
• The person must be responsible enough to care for the splint and
to follow a guided wearing schedule
• Keep in mind normal functional anatomy and biomechanics of
the extremity.
• Apply minimal force. The amount of force should provide a low-
grade stretch that is tolerable over a long period of time.
• Keep in mind the risks of wearing an ill-fitted splint
• Remember aesthetics
• Monitor and adjust the splint frequently for accurate fit
▪ More tolerable to wear than a dynamic tension splint • Listen to the person.
(since person has more control over the amount of • Use extreme caution when applying an external force to a hand
applied tension) that has decreased sensation
o In determining whether to apply dynamic or static tension, • The altered joint mechanics of a person who has rheumatoid
the therapist must identify the “end feel” of a joint. arthritis make static splinting more appropriate than dynamic
▪ Soft end feel = dynamic or static tension splinting.
▪ Hard end feel = static tension
o Another determinant in selecting the type of tension to be
used with mobilization splinting is the stage of tissue
healing
E. Technical Tips for Dynamic Splinting
• When applying an outrigger to the base, the therapist must
ensure that both surfaces to be bonded are clean.
• If a plastic has a glossy finish, the two surfaces might require light
scratching or a bonding agent to increase self-adherence
H. Fabrication of a Flexor Tendon Splint • This pulley can be created by firmly securing an additional
piece of thermoplastic with eyelets for each finger.
• Goals of post-op flexor tendon repair:
✓ Prevent re-rupture of the healing tendon
✓ Increase tensile strength of the repaired tendon
✓ Limit scar formation that will reduce tendon excursion
• This type of dynamic splint is one of the least complicated to
fabricate because an outrigger is not required.
• However, it is a very demanding splint because initially it must
be worn 24 hours per day (with removal only for therapy).
• Fabrication:
1. Apply the nail hooks to the fingernails
• Explain -> Roughen -> Adjust -> Position -> Glue
2. Construct pattern for a dorsal hand and forearm splint
• Ideal hand position:
• Treatment rationale:
✓ Increase excursion of the tendon
✓ Limit scar formation
✓ Increase tensile strength of the repair
• The therapist may apply a strap to the distal aspect of the
fingers in order to maintain full IP extension
3. Use a heat gun to create a bubble over the radial styloid and
distal ulna to avoid pressure, or pad the bony prominence.
4. Apply straps with hook-and-loop Velcro at the following
locations: across the palmar bar, at the wrist, 3 inches
proximal to the wrist, and across the forearm
J. Fabrication of a Mobilizing PIP Extension Splint
• Process:
1. Fabricate a pattern for a hand-based splint (dorsal) with
MCP joint of the involved finger immobilized into a flexed
position (45 degrees).
o Checklist for splint base:
5. Attach a safety pin to the strap that crosses the wrist
approximately 3 inches proximal to the wrist crease
6. Apply traction using elastic thread attached to the nail
hooks at the distal end and to the safety pin at the proximal
end.
2. Make a small hole in the dorsal ulnar aspect of the splint,
warm the area using a heat gun, then lift with an Allen
wrench.
I. Zone II Flexor Tendon Repairs
• A palmar pulley might provide greater excursion of tendons
from these lesions.
3. Attach the outrigger as follows:
a. Position the outrigger on the splint so that the rod is 1. Fabricate a volar-based wrist immobilization splint with
parallel to and centered on the proximal phalanx. straps. Make sure splint does not limit MCP flexion.
b. With the outrigger in place, mark the splint where the 2. With the splint applied to the person, mark on the distal
ends of the wire are to be attached to the base. palmar bar where the fingers would touch with full
composite finger flexion
4. Remove the splint from the person.
5. Cut a piece of thermoplastic material large enough to
extend beyond the outrigger base by at least ½ inch on each 3. A line guide for the monofilament will be created using a
side metal non rubber-coated paper clip.
6. Heat the outrigger wire over a heat gun, and slightly embed
the wire into the splint base
7. Lightly scratch the surface or apply solvent to the warm
piece of thermoplastic material to increase the bonding
8. Place the warm thermoplastic material over the outrigger
base, and secure the material to the splint base by pressing
the material securely around the outrigger wire.
9. Loosely reattach the extender rod to the outrigger.
10. Apply the splint to the person’s hand.
11. If a prefabricated finger loop is not available, one can be 4. Grasping the bent paper clip with a pair of pliers, hold over
made using soft leather or polyethylene. A sling that is 4 a heat gun for approximately 10 seconds. Carefully insert
inches long and 1-inch-wide will be appropriate for most the metal clip into the rolled aspect of the palmar bar where
adult fingers. Position the extender rod to obtain a 90- previously marked
degree angle of pull.
12. Secure the appropriate rubber band to the nylon string so
that the tension pulls the joint to a well-tolerated end range
5. For each finger to be included in the splint, two finger
sleeves will be required: one for the proximal phalanx and
one for the distal phalanx. Cut two 3 ⁄4-inch by 3-inch pieces
of Velfoam or other similar hook-and-loop material for each
finger
6. On the proximal sleeve, punch four (4) small holes at the
midpoint and on the distal sleeve punch two small holes at
the midpoint.
13. Remove the splint from the person and finish securing the
extender rod.
14. Place a protective rubber cap on the end of the rod.
K. Fabrication of a Composite Finger Flexion Splint with Static
Progressive Tension
7. Secure finger sleeves with Velcro hooks.
8. The long ends of the monofilament are threaded through
the metal line guide.
9. Secure a Velcro hook tab to the end of the monofilament
thread.
10. The person is then asked to secure the Velcro tab at a place
that provides a gentle stretch to the finger(s).
4. Conform the proximal end of the outrigger wire to the splint
base. After forming the outrigger, secure it to the base with
a piece of thermoplastic material prepared with solvent.
L. Fabrication of a Radial Palsy Splint
• Instead of a dynamic force, the splint uses a static line to support
the fingers
• The goal of this splint is to create a limited tenodesis action to
5. Drape an additional piece of thermoplastic material over
allow functional grip
the distal aspect of the outrigger (over the phalanges).
• The splint includes a dorsal base with a low-profile outrigger that
Punch holes directly above each finger
spans from the wrist to the proximal phalanx of each finger
• Fabrication:
1. Draw a pattern that is the circumference and two-thirds the
length of the forearm. Fabricate the splint using a
thermoplastic material that has self-adherence and
drapability properties. Then position the splint on the dorsal
aspect of the forearm.
6. To decrease wear on the cord, metal eyelet reinforcements
may be placed in each hole
7. Form a hook from a paper clip and place it in the middle of
the dorsal forearm splint (Figure 11-30). Apply the hook to
the base with a small piece of thermoplastic material
2. Apply straps to stabilize the splint base during formation of prepared with solvent
the outrigger.
3. Make the outrigger from 1/8-inch wire rod. The outrigger
must be wider than the hand at the level of the MCPs by
approximately 1/2 inch.
8. Place the splint on the person to secure the finger loops and
cord. The length of the cord should allow full finger
extension when the wrist drops to neutral