Upper Quarter: Splints

Currently I am completing the upper quarter module at the Harris Health System orthopedic residency. After covering the shoulder and elbow, we spend the final 2-3 weeks reviewing wrist and hand conditions and management. This section of the module is taught by certified hand therapists and occupational therapists because they see the majority of distal upper extremity injuries at my clinic. During last Monday mornings lab we covered splint making.     

In this post I will cover the various splints we made with indications of when to utilize each splint. One key piece of information regarding splinting: splint as little as possible to maximize ROM at surrounding joints. Generally, only splint one joint proximal and one joint distal. 

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Name: Dorsal Blocking Splint
Indication: Flexor Tendon Injury
Additional Information: With this splint, the wrist should be placed in 20 degrees flexion, MPs in 70 degrees flexion, and IPs in full extension. As with all splints that cross the wrist, make a space for the radial styloid.

Name: Ulnar/ Radial Gutter Splint
Indication: P1 Fracture (proximal phalanx shaft fracture)
Additional Information: Keep the IP joints in extension and let the wrist move freely. 

Ulnar Gutter Splint

Radial Gutter Splint

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Name: Clamshell Splint
Indication: P2 fracture (middle phalanx) or trigger finger 
Additional Information: This small splint does not cover the MP joint and is made for a single finger injury. It is easy to make and requires very little material.

Name: Wrist Cock-up Splint
Indication: Distal radius fractures 
Additional Information: Be sure to not block the thenar eminence. The distal hand crease needs to be free as well to allow for normal MP flexion. Many times a pre-fabricated splint (OTC) splint will also work.

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Name: Thumb Spica Splint
Indication: CMC OA, DeQuervain's Syndrome, Scaphoid fracture (generally would cover the wrist as well) 
Additional Information: Keep the IP joint of the thumb free. The purpose of this splint is to prevent the "swivel" movement that occurs at the CMC joint. This splint is worn for pain and is not needed 24/7. 

Name: Anti-claw Splint
Indication: Ulnar nerve injury (if both median and ulnar are affected, a full lumbrical bar splint can be fabricated in similar fashion but covering all fingers) 
Additional Information: In the presence of an ulnar nerve injury, the patient cannot extend their IP joints of the 4th and 5th digits. This splint blocks MP hyperextension and promotes IP extension.  

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Splint making is not difficult, but like any other skill it does take practice. When making splints, focus on the diagnosis at hand and the specific impairments of the patient. As stated early, limit as little movement as possible. Hand-land can seem like a scary place at times, but with a little practice and anatomical review, you will find that treatment is similar to many other joints of the body.  

-Jim