By Joe Bullert, MOT, OTR/L
When driving up to the Hand Clinic you may see our sign which declares our aim to “restore abilities from shoulder to fingertips”. This isn’t hyperbole. If a person is having trouble with their arm or hand, it’s very likely we can help them. To do this we have a fully-stocked bag of tools at our…fingertips. One of these is custom splinting.
Custom splinting is the use of temperature-sensitive thermoplastics to either immobilize or mobilize structures to promote healing or function. Hand therapists are experts in fabricating these splints (also known as orthoses) for patients.
So…how is a custom splint made? Well the steps are fairly straightforward, but making the splint takes a lot of skill and practice. Because the splint is fitted to each patient’s particular anatomy, we first create a pattern which is then used to cut out a template from a sheet of hard thermoplastic. This template is then heated to over 160 degrees to cause the temperature-sensitive material to become pliable. After it cools down, the material is placed and molded directly on the patient, providing a fit matching the curves and contours of the client. Splinting is a very effective way to facilitate a patient’s recovery for a variety of conditions.
A common group of diagnoses for which splinting is indicated is repetitive use disorders. These include tennis elbow, golfer’s elbow, DeQuervain’s tenosynovitis, trigger finger, carpal tunnel syndrome, and many others. These type of conditions are caused by overuse of muscles that cross a specific joint or by compression caused by the joint motion itself. Wearing a splint prevents movement of the relevant joint which allows irritated structures to rest, and, along with a therapy program, can resolve symptoms.
We also frequently see people after surgery where positioning of healing structures is critical. A custom splint places the hand or arm in the proper position to protect the integrity of the surgery and allow affected structures to heal properly. An “off the shelf” splint is rarely a good idea after most surgeries as a tailored fit is required to influence very specific joints, accommodate any hardware (e.g. pins), and allow for swelling that often occurs after a surgical procedure. The splint can also be cut down over time to allow more movement as healing progresses.
Another group that benefits from splinting are those with degenerative arthritis. Osteoarthritis often first manifests at the joint at base of the thumb, also known as the carpometacarpal (CMC) joint. The CMC joint gets a lot of use, especially for those that have occupations that require forceful use of the thumb (like hand therapists!). This joint can break down over time, leading to joint instability and painful subluxation. A custom splint provides the external support the thumb needs to compensate for the internal support the joint no longer provides. Patients often realize immediate pain relief with use of a splint and, with accompanying education from the therapist, become more functional with daily activities.
Though splinting can be highly effective for a wide variety of conditions, it is only an adjunct to treatment. Long-term splint wear is rarely indicated and should be weaned based on healing and symptoms. Splint wear without a therapy program can lead to joint stiffness, weakness, and other problems. Splinting can prevent further injury, but does not repair the body. Splinting and a comprehensive therapy program work hand-in-glove to resolve the underlying pathology while preventing further structural damage. At the Hand Clinic, we specialize in treating the upper extremity and splinting is one tool we use to help patient recovery and return to their desired activities.
If you would like to find out if you are a candidate for a custom hand, elbow and shoulder splint (Orthoses), contact our hand clinic at [email protected] or 425-892-2243.