HAND SPLINT

PRESENTED BY: DR. PRALOY SAHA

ASSOCIATE PROFESSOR
DEPARTMENT OF OCCUPATIONAL THERAPY
EPCMS & RC
Contents
Definition
Classification
Principles
Materials used in designing and
fabrication
Indications, uses and specific materials
used in fabrication of finger gutter,
volar cock up with thumb, half cock up,
opposition, buddy and flexion strap and
radial nerve splint using extension
outtriger
Definition
Splintsare the external devices which can
be applied for:
a) Maintaining functional position or normal
anatomical position (positioning- volar cock
up splint)

b) Preventing or correcting contractures

(preventive or corrective – finger gutter
splint)

c) Assisting function in presence of weakness

of muscles ( functional – dynamic cock up
splint)
d) Compensating the lost function due
to peripheral nerve injury or
paralysis ( buddy strap)

e) For stabilizing the joints in

presence of ligament laxity or joint
pain ( hallux valgus splint)
 According
to ASHT

Classificati
on of
splints

According Acc. to
to mechanic
materials al splint
used properties
According to American Society
of Hand Therapy

Immobilizat
Mobilization Restrictive
ion
• Mobilizing • Immobilizi • Limit a
primary of ng primary specific
secondary and aspect of
joint secondary range of
joints motion for
primary
joint
 Splint
classification
according to
mechanical
splint
properties

Static dynamic

Static
Serial static
progressive
splint
splint
Static splints
 It has no moving parts.

 It is primarily used to provide

support, stabilization, protection
or immobilization.

 Places tissues in stress free

position to enhance healing
position and minimize friction
Types of static splints
Serial static splint

 Canbe used to lengthen the tissues and regain

range of motion by placing the tissues in the
elongated position for prolonged periods.

 With
this process, the splints are remoulded as the
range of motion increases

 Because immobilization causes unwanted effects

as atrophy and stiffness, a static splint should
never be used longer than physiologically required
and should never unnecessarily include joints other
than those being treated

 Examples – volar cock up splint, finger gutter splint

Static progressive splint
These use non-dynamic components such as
velcro, hinges, screw or turnbuckles, to
create a mobilizing force to regain motion

Thisinelastic traction mobilization offers

benefits not available with serial static or
dynamic splinting because the same splint
can be used without remoulding and
adjustments can be made more easily as
motion improves

Ex- elbow flexion splint, flexion strap

Dynamic splints
 Dynamic splints use moving parts to permit,
control, or restore movement

 Theyare primarily used to apply an

intermittent, gentle force with the goal of
lengthening tissues to restore motion

 Forces may be generated by springs, spring

wires, rubber bands or elastic cords.

 This
type of splinting is known as elastic
mobilization
 With dynamic splinting to increase range of
motion, two concepts are critical

1. The force must be gentle and applied over long

time.
Safe force for the hand is determined to be 100-
300g.
Excessive force results in tissue trauma,
inflammation and necrosis.

2. To be effective and prevent skin problems, the

line of pull must be at a 90 degree angle to the
segment being mobilized.
To ensure this, forces are directed by an
outrigger, a structure extending outward from
the splint.
Outriggers may be high profile or low
profile.

High profile outriggers are inherently more

stable and mechanically more efficient,
require fewer adjustments to maintain 90
degree angle of pull, and require less effort
for the patient to move against the
dynamic force.

Low profile outriggers are less bulky but

require more frequent adjustments and
greater strength to move against the
dynamic force
By allowing motion in the opposite direction,
dynamic splints reduce the risk of joint
stiffness from immobility.

If
successful, an increase in passive joint
mobility can be expected within 2 weeks

Inaddition to gaining motion, dynamic splints

can be used to assist weak or paralyzed
muscles

These dynamic splints may be intrinsically

powered by another body part or by electrical
stimulation of the patient’s muscles.
Extrinsicpower sources,
including gas-operated devices
and battery-powered motors,
have also been used

Inpractice, these externally

powered devices proved to be too
complex and difficult to maintain
causing their use to decline
According to materials
used
Metal
• Corrective
• May or may not
conform correctly with

splint the part splinted

Plasti • Low or high

temperature
c • Protective. Preventive,
corrective when less

splint
pressure is required
• More conformity
Biomechanical
considerations
It includes
The effects of healing tissue on
the biomechanics of hand
Mechanical principles that affect
the design of the splint
Mechanical principles of splint
design
Increase area of force application
Splints apply external force to
the splinted part

Pressure is equal to the amount

of force divided by the area of
force application
Clinical application
Wide long splint is more comfortable
than a narrow short one

Contoured pressure over the bone and

bony prominence is preferable to uneven
or point pressure over the prominence

The therapist must be cautious while

padding the splint because it may
actually increase a point of pressure if
the splint is not well moulded to the area
 Increase the mechanical
advantage to reduce pressure
and increase comfort

The mechanical advantage is the

application of parallel force
systems with the joint as the axis
(A), the distal part splinted as the
resistance (R), and the proximal
part as the force (F), with the
Given a constant resistance, the
amount of force in the lever
system can be decreased by
increasing the length of the force
arm

In case of the wrist support

splint, the forearm trough is the
force arm, and the metacarpal
bar serves as the resistance arm
A longer forearm trough will decrease
any pressure caused by the
transferred weight of the hand

Mech adv= FA divided by RA

Therefore the recommended length

of the forearm trough is usually 2/3rd
of the length of forearm although it
should not impede elbow motion
 Ensure 3 point pressure
The three parallel forces in a first class
lever system such as a splint are in
equilibrium

The splint acts as a counterforce

proximally and distally to the forces of the
forearm, arm and hand

The strap securing the splint at the axis

position provides a reciprocal middle force
These parallel reciprocal forces
create the three points of
pressure

This concept guides splint design

and directs the placement of
straps for proper force application
 Add strength through contouring
When a force is applied to a flat piece
of material, the material bends

Ifthe same material is moulded into a

curve, the material can withstand the
force more effectively

Contour mechanically increases the

materials strength
 Thesplint should follow the contour and
extend midway around the part being splinted
for maximum comfort and strength

 In
addition, rounded edges are more
comfortable and increase the splints durability

 Curved and contoured edges are preferable to

angled or square edges to conform to the
finger lengths, which form a curve and the
other curves throughout the hand, wrist and
forearm
 Perpendicular traction for dynamic or static progressive
splinting
 To mobilize a joint through dynamic or static progressive
splinting, the line of pull must be perpendicular to the long
axis of the bone being mobilized

 Whether using finger loops with an extension outrigger or

nail hooks with a flexion pulley, the therapist must maintain
a 90degree angle of pull to provide the most effective
application of the force

 The perpendicular force application prevents shearing

stress and unwanted traction on the joint

 As mobility improves, the therapist must make changes in

the outrigger to maintain the 90 degree angle of pull
 Acceptable pressure for dynamic splinting
 Forces in dynamic splinting may be applied with
rubber bands, elastic threads or springs

 The force must not exceed the acceptable limits

 Low load forces of 100-300 g are recommended

for dynamic splinting of fingers

 Therapists may use lighter forces for the acute

stages and heavier forces for treatment of
chronic joint contractures
 The therapist must consider the patient’s size,
condition and stage of recovery when
determining the proper force application

 The length and width of rubber band determine

the force of tension

 Effective
dynamic splinting of a contracture
produces a gain of only 10 degrees per week

 If dynamic Splinting is not enough to remodel

tissues or if greater pressure is required, serial
casting may be preferable
 High vs low profile outriggers
 Both are similar in their effects

 However, as improvement occurs high profile

outriggers generally require fewer adjustments to
maintain the 90 degree angle of pull

 However,a high profile outrigger may be

cumbersome to the user

 Ifa patient has adequate strength of the

opposing muscles and is seen on op basis, low
profile outrigger may be preferable
Principles of design
Consider individual patient factors
Easy donning and doffing
Consider the length of time, patient
is wearing the splint
Allow optimity
It should be low cost and light weight
Identify key points
Purpose should be clear (preventive,
protective etc)
Consider diminished area of
sensitivity
Identify whether to apply static
or dynamic splint
Identify anatomical variables
Principles of construction
Itincludes concepts related to
durability, aesthetics and comfort
Careful adherance to principles
provides a well finished, wearable
product that will withstand the daily
use
Choose appropriate equipment,
method and materials for the
construction of splints
Safety precautions should be observed
for self and patient protection
Splint edges should be
smoothened (grinding process)
Corners should be rounded
Rivets or fastening devices
should be finished, eliminating
points or surfaces that might
inadvertently cause injury or
catch on clothing
Ventilation is provided as
necessary (porous and non-
Padding should be secured
without surface overlap or
wrinkles
Straps should be secured in one
place for proper fit
Principles of fit
The basic design concepts and
fabrication techniques may be rendered
useless if a splint is not well fitted
In this final phase all the principles
come together
Mechanical principles play an important
role during fitting of the splint
Contiguous fit of the splint to the
extremity reduces pressure on bony
prominences as well as soft tissue
Optimal, 90 degree rotational
forces prevent migration of the
splint and associated
components ex finger cuffs
Careful alignment of the splint
articulations with anatomic joint
axes eliminates friction, and use
of optimal leverage increases
comfort and durabilty
Anatomical considerations for
splinting
Hand creases
The creases of the hand provide
landmarks for splint fabrication
These creases identify the axis of
motion for the corresponding
joint
The distal edge of the splint must
not extend beyond a crease if
motion at that joint is desired
Bony prominences
Bony prominences of the hand
and wrist can create pressure
points if the splint does not
adequately conform to the areas
Potential pressure points are
common on the dorsum of the
hand and wrist
Arches of the hand
Distal transverse (metacarpal)
arch, the proximal transverse
arch (carpal), and the longitudinal
arch ensure optimal hand
function
The splints must conform to
these arches to support the
functional position of the hand
Functional position of the hand

15-20 degrees of wrist dorsiflexion,

Neutral to slight ulnar deviation
15-20 degrees of metacarpophalangeal
flexion
10 degrees of flexion at the proximal
interphalangeal (PIP) and distal
interphalangeal joint (DIP)
Palmar abduction of the thumb
Extension of the metacarpophalangeal
(MP) and interphalangeal (IP) joints of the
thumb
This position places the muscles, tendons
and ligaments at a resting length and in
position of grasp and prehension

Thewebspace of the thumb allows

maximal abduction of the thumb for grasp

Every effort is made to preserve the

maximum web space because the size of
the object that can be grasped depends on
the mobility of thumb web space
Dual obliquity

 The fingers vary in length and height with

the fingers on the radial side being longer
than those on the ulnar side of the hand
when the hand is open
 The MP joints on the radial side are higher
than those on the ulnar side of the hand
when the hand is closed.
 This principle is very useful in splinting
 The splint must be longer and higher on the
radial side of the hand
The therapist should evaluate
sensibility, mobility, motor
function, edema and tone prior to
splint design and construction
Sensory deficit in the hand
Patient may not be able to feel
pressure points or areas of
irritation from the splints, which
can lead to skin breakdown or
injury

i/c/o hypersensitivity the use of

the splint can protect the finger
tip or hand from unpleasant
Edema
Indicates the need for close
monitoring for fit and comfort
As edema decreases, splint may
require modification or remolding
to maintain proper fit
Deficitsin mobility may change during
the course of splinting , so modification
required

Weakness indicates a need for dynamic

assist splint, which needs modification as
muscle strength improves

Increased or decreased tone may indicate

the need for splinting to maintain muscle
balance and prevent contracture
Indesigning a splint, the therapist must
be aware of the neutral posture of the
hand that affect function

When the hand is held in supination, the

wrist is held in neutral to slight radial
deviation; in pronation, the wrist
assumes a more ulnarly deviated posture

This information is required for proper

splint fit
Other considerations
Effectiveness of a splint depends on two
other factors – compliance and
education

Compliance
◦ Compliance can have a profound influence
on the effectiveness of intervention
◦ Comfort is important to increase the
compliance of the splint
◦ The therapist must be attentive to the
patients needs and requests while designing
the splint
◦ These considerations should be
combined with the therapists
knowledge of the optimal design
◦ It is helpful to collaborate with the
patient to identify effective options
that are acceptable to the patient
Strategies to increase splint
wear compliance
 Offer splint options to the patient if possible
 Teach the patient about the benefits of splint
wear
 Provide for easy application and removal of
the splint
 Make the splint comfortable
 Use a lightweight material if possible
 Immobilize only the joints being treated
 Make the splint cosmetically pleasing to the
patient
 If feasible, collaborate with the patient on a
wearing schedule
Education
◦ The therapist must provide adequate
instruction to the patient regarding
wear and care to ensure proper use
of the splint
◦ Patients should be taught the goal
and purpose of splinting
◦ It may be helpful to inform the
patients of the consequences of
failing to comply with splint wear
◦ If patient is a child, inform the
Splint design
 Selecting a splint design
◦ How many joints must be immobilized or
mobilized?
◦ What is the best application? Volar or dorsal;
ulnar, radial or circumferencial ; static, static
progressive or dynamic
◦ Should the splint be based on the forearm, hand,
finger or thumb to provide the necessary support
for the splinted part?
◦ Will the patient be able to apply and wear the
splint as recommended?
◦ Which material is best to achieve the purpose of
the splint? Does the material affect the design of
the splint?
Splint checkout
Review the splint using these
questions as guidelines
◦ Does the splint achieve the purpose?
◦ Does the splint maintain the proper
position of the joints?
◦ Check the angles with a goniometer if
necessary?
◦ Does the splint fit the contours of the
hand, the arches and the bony
prominences?
◦ Does the splint restrict or immobilize any
joint unnecessarily?
◦ Is the splint long enough to support the
splinted part?
◦ Are all edges smooth and all possible
pressure points relieved?
◦ Does the splint allow functional use of the
hand if allowed?
◦ Can the patient apply and remove the
splint?
◦ Does the patient understand wear and
care instructions?
◦ Is the splint cosmetically acceptable to
the patient?
 Materials used in
design and fabrication
of splints
Classification of splint
materials
Splint
Harnessing
fabrication
materials
materials

Reinforcem
Padding
ent
materials
materials

Adhesive
materials
Splint fabrication
materials
• Generally used by orthopedicians
Plaster of • Non removable
paris • Not remouldable

• Used by orthoticians and occupational

Wood or therapists
• Usually correctable splints
metal • Adjustable splint

Thermoplasti • Use d by orthoticians and

occupational therapists
cs
Thermoplastic material
High temperature Low temperature
 PVC (poly vinyl  Aquaplast,
chloride), poly polyflex,
ethelene, plastazote orthoplast, PCL
(poly capro
 Splint
made on the lacron)
negative cast
 Splintmade on
 Cannotbe
the affected part
remoulded once
made
 Can be remoulded
Harnessing material
Rivets Nails Screw

Nut
Newar
Islets and
strap
bolt
Press
Hooks Velcro
buttons

D-ring
Reinforcement materials

Aluminiu
m strip

Hinge
Padding materials
Leather Rexin Velvet

CLP
(crossed
Foam Hilton
linked
polymer)

Felt Dunlop Blanket

Ethaflex
Adhesive material

Fevicol Gum

Dendri
Speb
te
Practical time......