Purpose of splint/orthosis:
aid in protecting joints or specific body parts with positioning, immobilization, and mobilization
Splint Classifications
Immobilization splints
mobilization splints
restriction splints
Mobilizing splints
serial, static progressive, dynamic
static splints
contain no moving parts and are defined as an immobilization splint--designed to provide protection and stabilization (most common splint)
serial static splint
achieve slow, progressive increases in ROM by repeated remolding of the splint
low load, long duration stretch
Static splint objectives
provide symptom relief
protect/position
aid in functional use
maintain tissue length
protect healing structures
maintain reduction
improve joint alignment
reduce tone in contracted tissue
what principle do static progressive splints use?
stress relaxation: the tissues are stretched and held at a constant length, the stretching force relaxes over time
Stress relaxation theory
relaxation occurs due to realignment of fibers and tissue elongation when tissues are held in a fixed position over time
Static progressive splint
a splint that mobilizes joints or stretches soft tissue.
includes a non-elastic mechanism that adjusts the amount of traction fore and angle acting on the part
ex: turnbuckle splint
Splint classification by design:
single surface design
circumferential design
forearm based
hand based, gutter based
digit based
Dynamic splints:
a static-based splint designed with a mobile, resilient component attached
elastics, rubber bands, and springs that produce motion
Digit based splint
originates from the digits
hand based splint
allows wrist motion
thumb based splint
incorporates one or more joints of the thumb--originates at thenar eminence
forearm based splint:
originating from forearm, allowing full elbow motion
gutter based splint:
includes only the radial or ulnar portion of the body part
Restrictive splint objectives
limit motion after nerve injury, tendon repair, after bone-ligament injury
provide and improve joint mobility
assist in functional use of the hand
single surface design:
supports joint of flaccid muscle (CVA)
effective for outriggers
ideal for post-operative splints
sensory surface exposed (dorsal)
less digital migration
natural padding (skin/muscle with volar)
Circumferential design
Benefits:
covers all surfaces
immobilization of a painful joint
splint for activity (more comfortable)
good design for serial static splint
helps prevent migration of splints
most stable
Disadvantage:
more complex and difficult to don
Clinical assessments for splints:
Moberg
Finklestein's
Froment's
Phalen's
Tinel's
Manual Muscle
Jamar
Semmes-Weinstein
Allen's Test
Dash
Resting hand position
10 degree wrist ext
15 degree MP flexion
10 degree ulnar deviation
Factors involved with splint compliance:
time involved with splint wear
interference with life tasks
inconsistent treating therapists
splint is uncomfortable
poor understanding of purpose
splint is cumbersome
Creases in the hand
distal digital crease
middle digital crease
proximal digital crease
distal palmar crease
thenar crease
distal wrist crease
proximal wrist crease
Radial nerve:
most powerful, digit extension
Median Nerve
FMC and thumb opposition
Ulnar nerve:
intrinsic hand muscles and D4-5
Plasticity
extent that the skin can mold and reshape and retain new length
viscoelasticity
refers to the skin's degree of elasticity which enables the skin to resist stress
Components of pressure and stress on tissue
degree, duration, repetition, direction
three point pressure
system whereby three individual linear forces are directed in an opposite direction from the other two forces
Balance forces so there is no excessive pressure in one area
Benefit of lever systems and splinting
splints serving as levers use a proximal input of force
two movement arms
axis or fulcrum to move a distal output forces
Radial nerve compression points:
elbow: radial tunnel
wrist: dorsal radial snuffbox
Ulnar nerve compression points:
elbow: cubital tunnel
wrist: guyon's canal
Median nerve compression points:
pronator syndrome
carpal tunnel
digital nerve compression points:
lateral borders of digits and thumb
radial nerve dysfunction
wrist drop hyperextended MP
Ulnar nerve dysfunction
flat hand
claw hand
median nerve dysfunction
decreased thumb function, poor opposition (ape hand)