Hand immobilization splints

Somaya Malkawi, PhD

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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Description of the RHS

Pan

Thumb trough

Forearm trough

C bar

Pre-molded hand splints

Pre-cut splint kit

Customized splints

What are the advantages and disadvantages for each

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

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

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

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 extThumb: 40-45 palmar abduction

Thumb IP: in full extMCPs: 70-90 flex and PIPs and DIPs in full

ext .

Diagnostic indications

Condition Wearing scheduleSplint, wrist position

RAWorn until exacerbation is over.

Wrist: 20-30 ext.MCP: 15-20 flex.Thumb: comfort.

Hand burnsDorsal 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 extThumb: 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

Diagnostic indications

Condition Wearing 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 comfort20 degrees wrist ext, thumb palmar abd, MCP: 70 flex, PIP: 0-10 flex

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