splinting lecture 2

8/4/2019 Splinting Lecture 2

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Application of Hand Anatomy

Carolyn Podolski M.A. OTR/L


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Repetitive Strain Injuries

Types

Carpal tunnel syndrome (CTS)

Tendonitis

Purposes of splints

Support and immobilization

Promote function


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What is Carpal TunnelSyndrome?


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Carpal Tunnel Syndrome

Conservative protocol Modalities

Heat

Ice Rest Activity modification/education

Functional adaptation

Protective wrist splint Wrist in neutral

Nerve and tendon gliding exercises Prevent adhesions


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Splint for Carpal Tunnel

Syndrome

Splint can be volar or dorsal(Clark, 1998)


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Tendon and Nerve Gliding

Exercises


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CTS: Surgical Protocol

Protective splint

Scar massage

Nerve and Tendon gliding exercises

Active range of motion


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What is tendonitis?


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Tendonitis

Protocol

Modalities

Rest

Activity modification/education

Protective splint

Strengthening


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Splints for Tendonitis

Tennis ElbowBand

Wrist

Immobilization

Splint

Thumb

Immobilization

Splint

(Coppard, 2001)(Coppard, 2001)

http://www.safetyproductsunlimited.com/tenniselbow.html


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Repetitive Strains (continued)

Precautions

Over-aggressive treatment

Under-aggressive treatment


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Tendon Repair

Types

Flexor tendons

Extensor tendons


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Flexor Tendon Zones

Zone 1

Zone 2

Zone 3

Zone 4

Zone 5


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Purpose of Splinting after Tendon

Surgery Purposes of splint

Positioning

Support and protect

Therapeutic purposes


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Tendon Repair (continued)

General Information

Duration varies dependent on medicaltreatments

Compliance


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Flexor protocol (early mobilization)

Splint Dynamic Kleinert splint Protect 3-4 weeks

Passive range of motion (PROM) Prevent adhesions and contractures Protected ROM 0-3 weeks Encourage tenodesis


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Flexor protocol (continued) Place and hold

Isometrics

Status-post 3 weeks

Active range of motion (AROM) 4-6 weeks Gentle range

Resistance Light resistance at 6-8 weeks

Strengthening at 10 weeks


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Kleinert Splint


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Kleinert Splint

(Clark, 1998)


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Precautions

Over-aggressive treatment

Tendon rupture

Under-aggressive

treatment

adhesions poor tendon gliding


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Median, Radial, and Ulnar

Nerves Types

Compression

Laceration

Purposes of splints Protection

Prevent deformity

Promote function


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Degree of Nerve injury


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Neuropraxia

Neuropraxia

Mildest form of nerve injury

Acute insult to nerve resulting ininterruption of impulse transmission

May have motor and sensory involvement

Full recovery with conservative treatmentwith in 21 days


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Axontomesis

Axontomesis

Individual axons severed

Nerve remains intact

Degeneration to axon distal to site of injury

Prognosis depends on degree of lesion

and lesion location


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Neurotomesis

Transection of nerve trunk

Most severe damage

Requires surgical intervention


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Neuropraxia


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Axontomesis


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Neurotomesis


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Surgical procedures

Suturing of epineurium


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Nerve Cuff and Nerve Graft


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Funicular Repair


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Nerves (continued) Common goals

Maintain a balance between musclestructures

Prevent Over-stretching

Joint stiffness

Contractures


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Nerves (continued) Common goals (continued)

Maximize functional use of extremity

Decrease pain and parasthesias

Protect surgical repair

Protect sensation deprived areas


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Median Nerve Injuries


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Median Nerve Injury

Symptoms present (what we look for)

Loss of thumb opposition

Opponens pollicis

Weak abduction APB

Apehand(note thenar atrophy)

(Coppard, 2001)


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Median Nerve (continued)

Protocol (what we do)

Maintain webspace

Prevent contracture

C-Bar Splint

(Coppard, 2001)


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Loss IP thumb flexion FPL

Weak MP thumb flexion Superficial FPB


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ROM

Flexion-assist splint

(Tenney, 1986)


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Additional symptoms (what we look for)

Weak wrist flexion

Weak finger flexion FDS & FDP (radial side)


Treat the symptom

Maximize function

Protect if repaired surgically


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Radial Nerve Injuries


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Radial Nerve (continued)


Loss of wrist extension

ECU, ECRL & ECRB Loss of finger and thumb extension

EDC, EDM, EPB, EPL, & EI

Wrist Drop

(Coppard, 2001)


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Radial Nerve (continued)


PROM

Prevent over-stretching of extensors Maximize functional use of the hand

Splint Static

Dynamic

(Coppard, 2001)


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Ulnar Nerve Injuries


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Ulnar Nerve (continued)


Loss of MP flexion and IP extension of 4thand 5th fingers

Lumbricals

Loss of Finger Ab/Adduction PADS and DABS

Claw Hand(Coppard, 2001)


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PROM

Splint

Lumbrical

BarSplints

(Coppard, 2001) (Tenney, 1986)


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Additional symptoms (what we look for)

Weak wrist flexion

Weak finger flexors

Loss of thumb adduction

Loss of hypothenar musculature


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Treat symptom

Maximize function

Protect if repaired surgically


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Nerve Surgical Repair

Allow 7-9 weeks for surgicalcomponents to heal

Consult with physician

Protect side of nerve repair when

splinting

Scar massage


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Nerves (continued) Precautions

Over-aggressive Increase symptoms

Rupture

Under-aggressive

Contractures

splinting lecture 2

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