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Soft Ulnar Deviation Splint
PRACTICE FORUM (~_~J
Splinting the Arthritic Hand Edited by Patricia Byron, MA, OTR/L, CHT Editor of Practice Forum Splinting the hand, especially in the rheumatoid population , can be a challenge. Splints aim to protect healing or diseased tissues while allowing maximum function. For the most part, immobilization equals stiffness and subsequent decreased function. The splints described below are lightweight, provide improved joint alignment, and allow maximum available motion .
SOFT ULNAR DEVIATION SPLINT Lori Gilbert-Lenef, OTR William Beaumont Hospital 3601 West Thirteen Mile Road Royal Oak, MI 48073-6769
Purpose: To increase the function of the rheumatoid hand presenting with secondary complications of ulnar deviation and palmar subluxation of the metacarpophalangeal joints (Figs. 1 and 2). Rest, support, and proper po sitioning of th ese structures are vital for decreasing deformity and increasing function. The soft Durable II ulnar deviation splint is designed for da ytime wear. It increase s function by improving alignment, decreasing ulnar deviation, and supporting subluxed metacarpophalangeal joints. The splint is lightweight and provides neutral warmth and a gentle intrinsic stretch . Special Considerations: The soft Durable II ulnar deviation splint is appropriate for patients with significant metacarpophalangeal joint involvement, but inappropriate for individuals with significant wrist instability. Materials: • • • • •
FIGURE 1. Dorsal view of the hands without the splint.
2-in Durable II strapping material l -in Velcro super-stretchy loop, cut in half Self-adhesive hook Velcro Rubatex adhesive R-27708 Needle and thread Fabrication cost is approximately $2.00 per splint. Method of Fabrication (Figs. 3 and 4):
1. Cut a 2-in piece of Durable II strapping material that equals the circumference of the metacarpoThe Pract ice Foru m ed ito r inv ites contribution s of clin ically relevant, timely ideas for th e column . Plea se se nd submissions to Patr icia M. Byron, MA, OTRlL, CHT, Philadelphia Hand Ce n ter, 901 Walnut Stree t, Philadelphia, PA 19107; (215) 829-2325.
FIGURE 2.
Palmar view of the hands without the splint.
phalangeal joints plus 1 inch. Be sure to round the edges. 2. Cut a piece of self-adhesive hook Velcro 2 in long and glue onto on e end of the strapp ing material. Wrap the strapping material around the metacarJanuary-March 1994
29
BUDDY SPLINT Gay Lamey, OTR Senio r Hand Occupational Therapist Physical Medicine Department Parkland Memorial Hospital 5201 Harry Hines Boulevard Dallas, TX 75235
FIGURE 3.
Fabrication of the splint, steps 1, 3 and 3.
Buddy strapping is frequently used as a part of hand therapy in a variety of hand injuries ranging from fractures to staged tendon reconstruction. The experienced clinician is well aware of the deficiencies of conventional buddy strapping. An analysis of buddy strapping reveals some of the following clinical problems (Fig. 7): 1. The material used in commercial buddy straps fre-
quently does not provide adequate force transmission to the involved digit during motion . 2. The flexibility of the material causes the involved digit to lag behind in range, decreasing the potential amount of total proximal interphalangeal and distal interphalangeal flexion and extension.
FIGURE 4.
Fabrication of the splint, steps 4 and 5.
pophalangeal joints to attach on the ulnar side of the hand. Cut a half-moon out just proximal to the index finger at the metacarpal joint to allow full thumb range of motion . 3. Cut two l-in straps of super-stretchy Velcro loop approximately 4 in long. Cut the straps in half so that you have four Y2-in wide straps. Cut three of the straps in Y2-in intervals so that you are left with a 4-in long strap, a 3Y2-in strap, a 3-in strap, and a 21/2-in strap. 4. Place the straps one on top of the other from 4 in to 2 1/2 in long, shortest on top. Sew the straps on the radial side of the splint with the loop facing downward . 5. Cut four 1 em x 1 cm pieces of hook Velcro . Glue the Velcro pieces onto the ends of the Y2-in straps.
Application: Place the splint around the metacarpophalangeal joints with the Velcro closure on the ulnar side of the hand (Figs. 5 and 6). Starting with the first strap on the radial side of the splint, wrap ulnar to radial and bring the index finger toward functional alignment. Attach the strap to the dorsal piece on the radial side of the splint. Continue with each of the fingers in turn . 30
JOURNAL OF HAND THERAPY
FIGURE 5.
Dorsal view of the hands with the splints in place .
FIGURE 6.
Palmar view of the hands with the splints in place.
Splinting the Arthritic Hand Edited by Patricia Byron, MA, OTR/L, CHT Editor of Practice Forum Splinting the hand, especially in the rheumatoid population , can be a challenge. Splints aim to protect healing or diseased tissues while allowing maximum function. For the most part, immobilization equals stiffness and subsequent decreased function. The splints described below are lightweight, provide improved joint alignment, and allow maximum available motion .
SOFT ULNAR DEVIATION SPLINT Lori Gilbert-Lenef, OTR William Beaumont Hospital 3601 West Thirteen Mile Road Royal Oak, MI 48073-6769
Purpose: To increase the function of the rheumatoid hand presenting with secondary complications of ulnar deviation and palmar subluxation of the metacarpophalangeal joints (Figs. 1 and 2). Rest, support, and proper po sitioning of th ese structures are vital for decreasing deformity and increasing function. The soft Durable II ulnar deviation splint is designed for da ytime wear. It increase s function by improving alignment, decreasing ulnar deviation, and supporting subluxed metacarpophalangeal joints. The splint is lightweight and provides neutral warmth and a gentle intrinsic stretch . Special Considerations: The soft Durable II ulnar deviation splint is appropriate for patients with significant metacarpophalangeal joint involvement, but inappropriate for individuals with significant wrist instability. Materials: • • • • •
FIGURE 1. Dorsal view of the hands without the splint.
2-in Durable II strapping material l -in Velcro super-stretchy loop, cut in half Self-adhesive hook Velcro Rubatex adhesive R-27708 Needle and thread Fabrication cost is approximately $2.00 per splint. Method of Fabrication (Figs. 3 and 4):
1. Cut a 2-in piece of Durable II strapping material that equals the circumference of the metacarpoThe Pract ice Foru m ed ito r inv ites contribution s of clin ically relevant, timely ideas for th e column . Plea se se nd submissions to Patr icia M. Byron, MA, OTRlL, CHT, Philadelphia Hand Ce n ter, 901 Walnut Stree t, Philadelphia, PA 19107; (215) 829-2325.
FIGURE 2.
Palmar view of the hands without the splint.
phalangeal joints plus 1 inch. Be sure to round the edges. 2. Cut a piece of self-adhesive hook Velcro 2 in long and glue onto on e end of the strapp ing material. Wrap the strapping material around the metacarJanuary-March 1994
29
BUDDY SPLINT Gay Lamey, OTR Senio r Hand Occupational Therapist Physical Medicine Department Parkland Memorial Hospital 5201 Harry Hines Boulevard Dallas, TX 75235
FIGURE 3.
Fabrication of the splint, steps 1, 3 and 3.
Buddy strapping is frequently used as a part of hand therapy in a variety of hand injuries ranging from fractures to staged tendon reconstruction. The experienced clinician is well aware of the deficiencies of conventional buddy strapping. An analysis of buddy strapping reveals some of the following clinical problems (Fig. 7): 1. The material used in commercial buddy straps fre-
quently does not provide adequate force transmission to the involved digit during motion . 2. The flexibility of the material causes the involved digit to lag behind in range, decreasing the potential amount of total proximal interphalangeal and distal interphalangeal flexion and extension.
FIGURE 4.
Fabrication of the splint, steps 4 and 5.
pophalangeal joints to attach on the ulnar side of the hand. Cut a half-moon out just proximal to the index finger at the metacarpal joint to allow full thumb range of motion . 3. Cut two l-in straps of super-stretchy Velcro loop approximately 4 in long. Cut the straps in half so that you have four Y2-in wide straps. Cut three of the straps in Y2-in intervals so that you are left with a 4-in long strap, a 3Y2-in strap, a 3-in strap, and a 21/2-in strap. 4. Place the straps one on top of the other from 4 in to 2 1/2 in long, shortest on top. Sew the straps on the radial side of the splint with the loop facing downward . 5. Cut four 1 em x 1 cm pieces of hook Velcro . Glue the Velcro pieces onto the ends of the Y2-in straps.
Application: Place the splint around the metacarpophalangeal joints with the Velcro closure on the ulnar side of the hand (Figs. 5 and 6). Starting with the first strap on the radial side of the splint, wrap ulnar to radial and bring the index finger toward functional alignment. Attach the strap to the dorsal piece on the radial side of the splint. Continue with each of the fingers in turn . 30
JOURNAL OF HAND THERAPY
FIGURE 5.
Dorsal view of the hands with the splints in place .
FIGURE 6.
Palmar view of the hands with the splints in place.