Hand splints

orthosis

1. Hand splints
By
Prof Dr. MM Makkawy
Prof. of rheumatology & rehabilitation
Faculty of medicine-Zagazig university

2. Indications:
Support of inflamed joints e.g. RA wrist.
Prevention of deformities before being
formed.
Prevention of contracture e.g. in nerve
injuries
Correction of deformities
Preservation of hand function or
replacement of lost hand function.

3. For the hand to act properly, it needs:
Healthy elbow and shoulders.
Intact steriognosis.
Intact coordination.
Automatism

4. Prehension patterns of hand:
The prehensile
movement of the hand
can be divided into:
Pinch
Grasp
Hook

5. Pinch:
o Fingertip pinch:
Between the tip of fingers and thumb.
It is a weak pinch.
o Palmer pinch:
Between the palmer surface of the fingers and
thumb.
Most functions of the hand are done by this pinch.
It is very strong.

6. o Lateral pinch:
Between the palmer surface of the thumb
and lateral side of index finger, while the
other 3 fingers supports the index finger.
It needs very strong first dorsal interosseous
and opponenus of the thumb.

7. Grasp:
o Spherical grasp: it needs the thumb.
o Longitudinal grasp: no need for the thumb.

8. Hook:
No need for the thumb but the other 4
fingers act as a hook

9. In making or in prescribing a splint for a
patient we have to evaluate all problems
present and the outcome of correcting them
e.g. if a hand has flexion deformity of
fingers associated with weak flexors, it is
better not to correct the deformity as this
may lead to further weakness of hand
flexors, so leave them alone.

10. There are 2 types of splints, according to the
disorders present:
* Functional splints:
* Rest splints

11. Functional splints:
Allowing the hand to function better e.g. wrist
must be splinted in 30-45°as in case of radial
nerve injury cock up splint.

12. Rest splints:
Allowing the best position of rest for joints e.g.
inflamed joints in RA.
Resting position of wrist is 12-20°dorsiflexion
and midposition between supination and
pronation.
MCP, PIP, and DIP of fingers must be in slight
flexion.

13. Thumb must be splinted
in opposition to at least
the index and middle
fingers.
The palm of the hand at
the level of metacarpal
bone is concave (not
flat), so it must be
splinted concave to help
the function of the
thumb.

14. General characters:
The splint must be as light as possible.
It is better to keep the palm and fingers free for
propioceptive functions.

15. Types:
They are either :
Static or
Dynamic (lively) splints.

16. Static splints:
*They allow no movements of the splinted part.
* Used only for support and to prevent contracture
or deformity e.g. in case of wrist drop due to radial
palsy we use cock up splint:
1-It puts the hand in position of function.
2-It prevents flexion contractures of very long
flexors of forearm.
3-It prevents lengthening of extensors, which
usually occurs due to muscle imbalance.

17. Any splint used must be removed once or twice
every day and the joints are moved in full range.

18. In case of ulnar and median nerve injuries, we
have:
o A complete clawing of the hand, in addition to ape
hand deformity (thumb is flat; unable to be
opposed) due to paralysis of thenar muscles.
o Paralysis and later fibrosis of the first dorsal
interosseous loss of web space between thumb
and index fingers.
o MCP are always in extension, this leads to
shortening in the dorsal part of MCP capsules.

19. Most upper extremity splints are based on the
principle of maintaining the thumb in
opposition to at least the index and middle
fingers.
The basic opponens splint is based on these
principles.

20. 1 -Opponens bar:
o Prevents the first MCP
bone from assuming a
position parallel to other
MCP bones i.e. (it puts
the thumb into
opposition).
o It is attached to a dorsal
bar or to the plamer bar
with an angle of 90°.

21. 2-C bar:
o Prevents web space
contracture e.g. in
median, ulnar nerve
injury.
o The splint also serves a
functional purpose by
putting the hand in a
functionally useful
position.

22. 3-MCP extension stop:
o It is used to prevent
keeping MCP joints in
extension in median and
ulnar nerve injuries
(complete clawing) so it
prevents shortening of
dorsal part of MCP
joints,
o It is attached to the
dorsal bar by an
attachment bar.

23. 4-The long opponens splint
Various component parts
can be added to the basic
opponens splint.
o In long opponens splint
there is a forearm bar
connected to the dorsal
bar.
o It supports the wrist
motion and gives more
external power.

24. Dynamic (lively) splints:
Used to exercise the muscles during recovery.
Acts assist extension of IP joints fingers when
there is some action in extensor muscles.
With this type a MCP extension stop is used to
prevent over extension at MCP joints.

25. It is applied to the dorsal surface of proximal
phalanges.
The previous splints are rarely used in a spastic
hand. The most commonly indicated splints in
spastic hand are those which:
Cover the greatest possible area, to avoid high
pressure concentration in certain area.
Are designed to maintain the hand and wrist in
position of function.

26. The volar wrist and hand splints:
Is usually more comfortable tolerated in the
severely spastic hand.

27. The dorsal wrist and hand splints:
This type applies forces in areas where they are
most effective to prevent deformity.
Exposure of the volar aspects of forearm and
palm provides a better friction surface and may
be utilized in gross activities when holding
objects against the body.