Transcript chap 8 splints acting on the thumb

Thumb immobilization
splints
Somaya Malkawi, PhD
Introduction
The most common thumb splint is the
thumb palmar abduction immobilization
splint (Thumb Spica, short/long opponens
splint or thumb gauntlet splint)
 The purpose is to immobilize, protect, rest
and position one, two or all of the thumb
CMC, MCP and IP joints while allowing
other digits to be free
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Introduction
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TIS are divided into:
1. Forearm based splints
2. Hand based splints
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Forearms based- and hand splints are
used to help manage different conditions
that affect the thumb
F-TIS: Stabilizing the wrist is beneficial
for a painful wrist as the splint provides
support
Introduction
FTIS  people who have de Quervain’s
tenosynovitis will benefit from it which
provides rest, support, protection of the
tendons across the radial side of the wrist
into the thumb joint
 FTIS  after joint arthrodesis or
dislocation, post surgery RA
 HTIS  Muscle imbalance after median
nerve injury to maintain the web space
 HTIS is also used to position the thumb
before surgery
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Functional and anatomic
considerations for thumb splinting
The thumb is essential for hand
functioning (grip, pinch and fine
manipulation)
 High mobility due to being a saddle joint
 Sensory input of the tip of thumb is
essential
 You have to understand that the most
crucial aspect of the TIS is the CMC joint
(because it allows opposition and
abduction)
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Features of the TIS
TIS prevents motion for one, two or all
thumb joints
 Numerous designs:
 It can be volar, dorsal or radial.. See fig 81, 8-2, 8-3
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Features of the TIS
Usually the C bar and thumb are in some degree
of palmar abduction
 The Thumb post could
immobilize the MP joint alone
or with the IP joint
C bar
 The position of the thumb
Thumb post
varies according to the
diagnosis, (palmar/ radial
Opponens bar
Abduction)
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Features of the TIS
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1.
2.
3.
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The TIS may do one of the following:
Stabilize only the CMC joint
Include the CMC and MP joint
Encompass the CMC MCP and IP joints
The Judgment goes back to you! You should
fabricate a splint which gives the MOST
support with the LEAST movement restriction
IP included: thumb replantation, tendon
transfer, tendon repair
Diagnostic indications
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TIS are prescribed for (but not limited to):
scaphoid fractures of the proximal phalanx
of the 1st MC, tendon transfers, radial or
ulnar collateral ligament strains, repair of
the MCP joint collateral ligaments, RA, OA,
de Quervian’s tenosynovitis, median nerve
injuries, MCP joint dislocations, capsular
tightness of the MCP and IP joints after
trauma, posttraumatic adduction
contracture, extrinsic flexor or extensor
muscle contracture, FPL repair,
uncomplicated EPL repairs, hypertonicity,
and congenital adduction deformity of the
thumb
Splinting for
De Quervain’s Tenosynovitis
It results from repetitive thumb motion
and wrist ulnar deviation
 Affects the AbPL and EPB muscles in the
first dorsal compartment
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Splinting for De Quervain’s
Tenosynovitis
How did this condition develop?
Repeatedly performing wrist deviation and thumb motions
such as grasping, pinching, squeezing, or wringing
(construction: painting, scraping, hammering) may lead
to the inflammation of tenosynovitis.
This inflammation can lead to swelling, which hampers the
smooth gliding action of the tendons within the tunnel.
Arthritic diseases also cause tenosynovitis in the thumb
Forearm based TIS
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Splinting for De Quervain’s
Tenosynovitis
During the acute phase  immobilization of the thumb
and the wrist for symptom control  wrist extension
thumb CMC palmar abduction and MP flexion IS
Wrist in 15 extension
Neutral wrist deviation
40-45 degrees of palmar abduction of the CMC thumb
joint
5- 10 degrees of flexion in the MP joint
IP free, unless patient overuses thumb or fights the
splint
Continuous wearing with removal for hygiene and
exercise within a pain free range
A prefabricated splint is indicated when pain subsides for
sport and work activities
Post surgical management, same splint worn for 7-10
days
Splinting for RA and OA
RA often affects the thumb joints (CMC and MCP)
 splint reduces pain, slows deformity and stabilizes
the joints
 RA involves three stages:
1. The inflammatory stage: splinting is used for
resting the joint and reduce inflammation
2. Disease progression, help the stability of painful
moving joints during activities
3. Grossly deformed splints, aid in putting the hand
in a more functional position
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Splinting for RA and OA
The best splint during the periods on
inflammation is: Forearm based TIS
 immobilizing the thumb in a forearm
based splint, with wrist in 20-30 degrees
of extension, CMC in 45 degrees of palmar
abduction or midway, MCP in 5 flexion
“wrist extension thumb CMC palmar
abduction and MP flexion immobilization
splint!”
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Splinting for RA and OA
You should always fabricate a splint in a
position of comfort
 Use 1.8 mm or less material
 Watch out for bony prominences such as
ulnar head radial styloid, scaphoid and
pisiform bones
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Splinting for RA and OA
CMC OA is a common thumb condition
 Causes subluxation of the joint radially
and dorsally  loss of extension
compensated by adduction
 In this case, splinting is used to manage
pain, provides stability and preservation of
the web space
 Hand based TIS
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Splinting for ulnar collateral
ligament injury
A common injury that occurs at the thumb
 Gamekeepers or skier’s thumb
 The UCL helps stabilize the thumb by
resisting radial stresses across the MCP joint
 The UCL is injured when the thumb is
forcefully abducted or
hyperextended
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Splinting for ulnar collateral
ligament injury
Injuries are classified to I, II, III
 For level I: hand based TIS with the CMC
in 30-40 degrees of palmar abduction with
MCP in neutral or slight flexion (3-4
weeks)
 For level II: same as above but worn for
4-5 weeks
 For level III: requires surgery
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Splinting for scaphoid fractures
Second most common fracture
 Comes from falling on an outstretched
hyperextended/ dorsiflexed hand more 90
degrees
 If a result of a sports injury volar FB-TIS
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Splinting for scaphoid fractures
VF-TIS
 Thumb in palmar abd
 MCP in 0 -10 flex
 Wrist in slight flex and radial dev or
neutral depending on the physician
preference
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Splinting for Hypertonocity
Thumb loop
 Figure of 8 thumb wrap
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