Orthotic Splinting Instructional videos

The anti-spasticity splint prevents contracture by encouraging extension of the wrist and digits. For use with patients with increased tone in wrist, hand, or fingers. See written instructions below. 

Clinical Examples

• In-patient
• Post-CVA
• Coma
• This can be worn all day or at night, with
  proper monitoring of the skin

Positioning the body

The client should be seated and upright, if possible. Supine or side lying may be preferred if the patient has decreased tone in this position. The elbow is stabilized on a table with forearm placed in neutral, wrist placed in neutral (extension will encourage flexion of finger joints), separate the fingers (to discourage finger flexion), little finger in MP extension, thumb in radial or palmar abduction whichever decreases tone. A towel or pad under the elbow can decrease pressure on the ulnar nerve and tone.

Contraindications/Precautions

If increased muscle tone prevents fabrication of this splint, it can be made on a person of comparable size. Frequent skin checks are needed to monitor for pressure.

Instructions

1. Carry heated thermoplastic on a towel to the client to prevent stretching or leaving fingerprints on the
   materials, and to remove hot water.
2. Spread the fingers and place thermoplastic between each finger.
3. Hold the thumb in abduction.
4. Ensure that the wrist is in neutral.
5. Stroke the material. Keep the arm, wrist, and hand in the correct position while the splint hardens.

Final Check

Check for clearance of radial and ulnar styloid processes, thumb, and finger MCP joints. The splint should not create any areas of pressure for the client, observed as blanched or red skin. If areas are identified, the splint should be spot heated and stretched to eliminate the pressure. Observe the patient donning and doffing the splint correctly. Provide written wear/care instructions.

Adding Straps

This splint requires a strap that wraps in a spiral distally to proximally.

Materials

• 1” adhesive-back hook Velcro: 3” x4
• 2” loop Velcro or strapping: 42” (or enough to go around the entire orthosis)

Instructions

1. Remove the paper from adhesive back hooks and stick on a towel.
2. Starting distally, place adhesive-back hooks at the PIP joints, proximal to the wrist crease, middle of the forearm, and one inch before the edge of the splint.
3. Starting at the PIP joints join the strapping to the hook Velcro and wrap around the dorsum of the fingers.
4. Continue to spiral the strap over the dorsum of the hand and ensure that there is no pressure over the
   venous return.
5. Continue to spiral the strap attaching it to the hook Velcro until the end.
6. Trim off the excess strap, creating a rounded edge increases the stability of the strap.

Final check

The straps should not cause any areas of pressure or block venous return in the dorsum of the hand. Observe the caregiver applying the splint correctly. Provide written splint instructions for wear, care and precautions.

Dorsal wrist orthosis immobilizes the wrist without requiring a wrist strap. Can be used for conditions including carpal tunnel syndrome, rheumatoid arthritis, or radial tunnel syndrome. See written instructions below.

Clinical Examples

• Rheumatoid Arthritis
• Carpal Tunnel Syndrome
• Radial Tunnel Syndrome

Positioning the body

The client is seated and upright when possible. The elbow is stabilized on a table with forearm placed in neutral, wrist 15-20° of extension, fingers flexed 45- 90° at the MCP joint, and thumb in palmar abduction. Place a towel or pad under the elbow to decrease pressure on the ulnar nerve. If carpal tunnel syndrome is present, the wrist is placed in neutral.

Contraindications/Precautions

Hand edema or potential for edema following surgery or trauma as the hand portion of the splint is circumferential. Proximal forearm strap should not compromise circulation.

Instructions

1. Carry heated thermoplastic on a towel to the client to prevent stretching or fingerprints on the material and to remove hot water.
2. Position thermoplastic on dorsum of involved hand and wrist with the distal material edge proximal to the MP joints.
3. Insert fingers through distal opening, slide thermoplastic material to the palmar crease. Flip the palmar bar placing the straight edge at the palmar crease.
4. Request the client to touch their middle finger to the thumb. This position supports the palmar arches of the hand and places the thumb in functional palmar opposition.
5. Fold the two lateral edges down at the hand/wrist area.
6. Continue to stroke the material with the forearm, wrist, and hand supported in position until the splint cools and hardens (up to 5 minutes).
7. The splint should extend 2/3 up the forearm; trim with scissors if needed, creating smooth edges.

Final Check

Check for clearance of radial and ulnar styloid processes, thumb, and finger MCP joints. The splint should not create any areas of pressure for the client; remove splint, look for areas of blanched or red skin. Spot heat pressure areas, stretch, recheck for pressure.

Attaching straps

One proximal forearm strap is sufficient, which is useful for one who needs to wash their hands frequently. The 2” loop used with 1” hook allows easier grasp of the loop strap for removal.

Materials

• 1” adhesive-back hook Velcro: 3” piece
• 2” loop Velcro or strapping
• 12” piece (or enough to go around)

Instructions

1. Place the adhesive-back hook Velcro on the proximal, volar forearm of the splint. The center placement of a single piece of adhesive hook increases the longevity of the adhesive.
2. Place loop strap around forearm following the contour of the arm, meet ends in the center of the hook Velcro.

Final Check

Ask client to shake their arm, the splint should not move. Observe the client correctly donning and doffing the splint. Provide written wear/care instructions and precautions.

Various hand-based and forearm-based orthoses to support the thumb MP and CMC joints. See written instructions below.

Clinical Examples

• Provides some support to the MP joint
• Provides some support to the CMC joint but not total protection

Positioning the body

The client should be seated and upright. The elbow is stabilized on a table with forearm placed in neutral, wrist placed in 15-20° of extension, fingers flexed to 90° at the MCP joint, and thumb in palmar abduction. A towel or pad under the elbow can decrease pressure on the ulnar nerve.

Contraindications/Precautions

The thermal plastic should not be bonded circumferentially around the thumb if edema or potential for edema is present.

Instructions

1. Carry heated thermoplastic on a towel to the client to prevent stretching and leaving fingerprints on the materials, it also removes hot water.
2. Place the curved edge around the thumb at the IP joint.
3. The two outside straight pieces should meet together at the dorsum of the thumb.
4. To ensure that the thenar eminence has enough room for full thumb opposition ask the client to touch their middle finger to the thumb, keeping the thumb in palmar abduction.
5. Run a paperclip around the inside of the thumbhole to prevent an hourglass effect over the shaft of the thumb, this makes it easier to don and doff the splint.
6. IF the client has swelling or the potential for swelling crack the tab open and connect with a strap instead of keeping it circumferential.6.Trim with curved scissors to fit. Pay particular attention to creating smooth edges to prevent skin irritation.

Final Check

Check for clearance of the thumb and finger MCP joints. The splint should not create any areas of pressure for the client; removing the splint and looking for areas of blanched skin can check this. When these areas are identified the splint should be stretched enough to eliminate the pressure.

Adding Straps

Only one strap is needed across the dorsum of the hand.

Materials

• 1” adhesive-back hook Velcro: 1” x2
• 1” loop Velcro or strapping: 10” (or enough to go across the dorsum of the hand)

Instructions

A. Place an adhesive-back hook Velcro to the radial side of the orthosis, right at the edge.
B. Place an adhesive-back hook Velcro to the ulnar side of the orthosis, ½ inch from the edge.
C. Wrap the loop Velcro across the dorsum of the hand, ensure that there is minimal tension across the dorsum of the hand to allow for sufficient return circulation. If there is a lot of swelling a 2” strap can be used and trimmed down to fit the contour of the hand.

Final check

The straps should not cause any areas of pressure or block venous return in the dorsum of the hand. Observe the patient donning and doffing the splint correctly. Provide written instructions for splint wear, care, and precautions.

Thumb hole wrist orthosis immobilizes the wrist and has a built-in thumbhole. May not be appropriate for those with hand edema. Can be used for conditions including rheumatoid arthritis, total wrist fusion, partial wrist fusion, TFCC injury, and carpal tunnel syndrome. See written instructions below. 

Clinical Examples

• Rheumatoid Arthritis
• Carpal Tunnel Syndrome
• Total Wrist Fusion
• Partial Wrist Fusion
• TFCC Injury

Positioning the body

The client should be seated and upright.  The elbow is stabilized on a table with forearm placed in neutral, wrist placed in 15-20° of extension, fingers flexed to 45-90° at the MCP joint, and thumb facing the client for a forearm neutral position (thumb will be later placed in palmar abduction).  A towel or pad under the elbow can decrease pressure on the ulnar nerve.  If carpal tunnel syndrome is present, the wrist should be placed in neutral.

Contraindications/Precautions

Not meant for people with hand edema, particularly the MCP joints or thumb, as a circumferential splint may create pressure.

Instructions

1. Carry heated thermoplastic on a towel to the client to prevent stretching or leaving fingerprints on the materials, and to remove hot water.
2. The thumbhole is stretched and given one fold for comfort and to add strength to the thermoplastic.
3. Place the thermoplastic over the thumb.
4. To ensure the thenar eminence has room for full thumb opposition and to support the palmar arches, have the client to touch their middle finger to thumb, keep the thumb in palmar abduction.
5. The MCP joint of the little finger needs full flexion for functional hand use. The thermoplastic must remain below the palmar crease.
6. Stroke the material. Keep the arm, wrist, and hand in the correct position while the splint hardens
7. The splint should extend 2/3 up the forearm;trim with curved scissors to fit.  Pay particular attention to creating smooth edges to prevent skin irritation.

Final Check

Check for clearance of radial and ulnar styloid processes, thumb, and finger MCP joints. The splint should not create any areas of pressure for the client, observed as blanched or red skin. If areas are identified, the splint should be spot heated and stretched to eliminate the pressure. Observe the patient donning and doffing the splint correctly.  Provide written wear/care instructions.

Attaching Straps

This splint requires three straps for optimal distribution of pressure and security.

Materials

• 1” adhesive-back hook Velcro: 3” x3•
• 1” loop Velcro or strapping: 8” (or enough to go across the dorsum of the hand)•2” loop Velcro or strapping: 8”, 10” (or enough to go around the distal and proximal forearm)

Instructions

A. The 8” distal strap covers the dorsum of the hand and attaches to the middle of 3” hook on the palmar crease of the splint, this makes doffing easier and increases the longevity. A slit can be cut to accommodate the palmar arches1.  Ensure that there is minimal tension across the dorsum of the hand to allow for sufficient return circulation. If there is a lot of swelling a 2” strap can be used and trimmed down to fit the contour of the hand.

B. The 8” middle strap is placed proximally to wrist crease on dorsal side of the forearm and attaches to the middle of 3” hook on the volar side of the splint.  It should follow the contour of the arm.

C. The 12” proximal strap is placed an inch or two from the end of the splint and attaches to the middle of 3” hook on the volar side of the splint. It should follow the contour of the arm.

Final Check

The straps should not cause any areas of pressure or block venous return in the dorsum of the hand.

Radial bar wrist orthosis immobilizes the wrist. Can be used for conditions such as rheumatoid arthritis, carpal tunnel syndrome, radial tunnel syndrome, total wrist arthroplasty, and ulnar styloid fracture. See written instructions below.

Clinical Examples

• Rheumatoid Arthritis
• Carpal Tunnel Syndrome
• Radial Tunnel Syndrome
• Total Wrist Arthroplasty
• Ulnar Styloid Fracture
• Radial Nerve Repair

Positioning the body

The client should be seated and upright. The elbow is stabilized on a table with forearm placed in neutral, wrist placed in 15-20° of extension, fingers flexed 45- 90° at the MCP joint, and thumb in palmar abduction. A towel or pad under the elbow can decrease pressure on the ulnar nerve. If carpal tunnel syndrome is present, the wrist should be placed in neutral.

Contraindications/Precautions

The splint and straps should not restrict circulation or produce pain or skin discoloration.

Instruction

1. Carry heated thermoplastic on a towel to the client to prevent stretching or leaving fingerprints on the materials, and to remove hot water.
2. Position thermoplastic on palmar side of hand just proximal to MP joints palmar crease.
3. Place radial bar between thumb and index finger along dorsal surface of the hand, proximal to MP joint.
4. Smooth and flare thumb arc to thenar crease to provide clearance for thumb opposition. Mold material to support arches of hand while having the thumb opposed to the middle finger tip. Allow gravity to assist in forming material around the forearm. Flare borders as needed.
5. Stroke the material and keep the arm, wrist, and hand in the correct position while the splint cools and hardens.
6. The splint should extend 2/3 up the forearm; trim to fit with curved scissors. Pay particular attention in creating smooth edges to prevent skin irritation.

Final Check

Check for clearance of radial and ulnar styloid processes, thumb, and finger MCP joints. The splint should not create any areas of pressure for the client, observed as blanched or red skin. If areas are identified, the splint should be spot heated and stretched to eliminate the pressure. Observe the patient donning and doffing the splint correctly. Provide written wear/care instructions.

Adding Straps

This splint requires three circumferential straps for optimal distribution of pressure and security.

Materials

• 1” adhesive-back hook Velcro: 3” x2, 2” x3
• 1” loop Velcro: 2”, 8” (or enough to go across the dorsum of the hand)
• 2” loop Velcro/strapping: 8”, 12” (or enough to go around the distal and proximal forearm)

Instructions

1. Remove the paper from adhesive back hooks and stick on a towel.
2. Starting distally, place adhesive-back hooks at the PIP joints, proximal to the wrist crease, middle of the forearm, and one inch before the edge of the splint.
3. Starting at the PIP joints join the strapping to the hook Velcro and wrap around the dorsum of the fingers.
4. Continue to spiral the strap over the dorsum of the hand and ensure that there is no pressure over the venous return.
5. Continue to spiral the strap attaching it to the hook Velcro until the end.
6. Trim off the excess strap, creating a rounded edge increases the stability of the strap.

Final Check

The straps should not cause any areas of pressure or block venous return in the dorsum of the hand. Provide written wear/care instructions. Observe the patient donning and doffing the splint correctly.

Full-arm radial bar orthosis immobilizes the elbow in 90 degrees and the wrist. Can be used to protect fractures or tendon repairs. See written instructions below.

Clinical Examples

• Fractures
• Tendon repair

Positioning the body

The client should be seated and upright in a chair that allows you to comfortably move from front to back. The arm should be in 180° of abduction, elbow in 90° of flexion, forearm in neutral, wrist in 15-20° of
extension with the thumb pointing towards the ground. Alternative position in supine: Arm in 0° flexion + 90° internal rotation, forearm in neutral, wrist in 15-20° extension, and thumb pointing towards the head.

Contraindications/Precautions

This splint may take two therapists to fabricate. Do not use elastic wraps to secure the splint during fabrication due to the risk of creating pressure points over boney prominences.

Instruction (for seated client)

1. Carry heated thermoplastic on a towel to the client to prevent stretching or leaving fingerprints on the materials, and to remove hot water.
2. Lay the thermoplastic over the client starting distally at the hand.
3. Position the distal portion of the material at the palmar crease, gently fold down to create a smooth surface for comfort and to increase the strength of the thermoplastic.
4. Forming the elbow is difficult and can be done without creases by stretching the thermoplastic over the elbow and around the arm, touch the two sides together lightly as this ensures that the material will
   comfortably surround the arm. Ruffles created in this process will be trimmed away.
5. Stroke the material. Keep the arm, wrist, and hand in the correct position while the splint hardens.
6. The splint should extend 2/3 up the arm and the client should be able to IR 90° without impairment, if it’s too long the proximal edge can be trimmed with curved scissors. Cut away the excess thermoplastic
   around the elbow. Cut smooth edges preventing skin irritation.

Final Check

Check for clearance of elbow, radial and ulnar styloid processes, thumb, and finger MCP joints. The splint should not create any areas of pressure for the client, observed as blanched or red skin. If areas are
identified, the splint should be spot heated and stretched to eliminate the pressure. Observe the patient donning and doffing the splint correctly. Provide written wear/care instructions.

Adding Straps

This splint requires five circumferential straps, or two distal circumferential straps and a proximal Figure 8 strap (about 36”). These instructions are for the circumferential straps.

Materials

• 1” adhesive-back hook Velcro: 1” x2, 3” x4
• 1” loop Velcro or strapping: 1”, 8” (or enough to go across the dorsum of the hand)
• 2” loop Velcro or strapping: 12” x4 (or enough to go around the forearm and arm)

Instructions

A. The 8” distal strap traverses from distal ulnar border to radial bar across the dorsum of the hand. The strap adheres to a tab on the radial bar and 2” hook on the ulnar side of the palmar crease. Tab1: 2” of 1” loop Velcro beneath the radial bar with 2” of 1” hook over the top. Ensure minimal tension across the dorsum of the hand to allow sufficient return circulation by passing the little finger beneath the strap. B/C/D/E. The forearm and arm straps are placed proximally to the wrist crease, proximal forearm, distal arm above the bend in the elbow, and proximal arm on the dorsal side of the orthosis. Straps should follow the contour of the arm.

Final Check

The straps should not cause any areas of pressure or block venous return in the dorsum of the hand. Provide written instructions for wear/care. Observe proper donning and doffing of the splint.

The mallet finger orthosis immobilizes the DIP joint to treat a mallet finger injury. Video outlines both the sugar tong and free tip versions. See written instructions below.

Mallet “Sugar Tong” Orthosis

Clinical Examples

Good splint for sleeping as it doesn’t fall off. The slits on the side allow for nerves and vessels to remain uncompressed.

Positioning the body

There are no specifics for positioning a client to make this splint. This splint can also be made on the opposite hand, same finger.

Contraindications/Precautions

Open wounds should be bandaged.

Instruction

1. Place thermoplastic on volar side of the finger.
2. Ensure that there is barely enough space for PIP flexion.
3. Hyperextend the DIP joint and wrap the thermoplastic over the finger tip and onto the dorsal surface to the PIP joint.
4. Hold in place until cool.

Final Check

There should not be any excess pressure on the finger, check for blanched skin, redness or “dusky” appearance due to too tight strapping and decreased circulation.

Adding Straps

This splint requires a strap that wraps in a spiral distally to proximally.

Materials

• ½” adhesive-back hook Velcro: 1” piece
• ½” loop Velcro or strapping: 3” piece

Instructions

1. Place the adhesive-back hook Velcro on dorsum of proximal phalanx.
2. Wrap loop Velcro or strapping around the splint and trim the excess.
3. Ask client to shake their hand, the splint should not move.

Final Check

The straps should not cause any areas of pressure or block venous return in the dorsum of the hand. Observe the caregiver applying the splint correctly. Provide written splint instructions for wear, care and precautions.

Mallet “Free Tip” Finger Orthosis

Clinical Examples

Better for typing and function, clients will still have sensation in their fingertips. Does not require straps.

Positioning the body

There are no specifics for positioning a client to make this orthosis. This orthosis can be made on the opposite hand.

Contraindications/Precautions

This splint may not withstand shaking and may slide off while the patient sleeps.

Instruction

1. Hyperextend the DIP
2. Wrap the H straps around the finger and hold until hardened.

Final Check

There should not be any excess pressure on the finger, check for blanched skin or redness. Provide written instructions. Observe the patient donning and doffing the splint correctly without allowing the fingertip to come out of hyperextension.

Functional safe position (resting hand) orthosis places hand and forearm into functional position and prevents deformity. Can be used after metacarpal joint arthroplasty, rheumatoid arthritis, hand trauma, and other conditions. See written instructions below.

Clinical Examples

• Burns
• Spinal cord or nerve injury
• Post MP joint
• arthroplasties
• Hand trauma
• Rheumatoid arthritis night resting orthosis

Positioning the body

The client should be seated and upright. The elbow is stabilized on a table with forearm placed in neutral, wrist placed in 15-20° of extension, fingers flexed to 90° at the MCP joint, fingers in full extension at PIP

joints, and thumb in palmar abduction. A towel or pad under the elbow can decrease pressure on the ulnar nerve. If carpal tunnel syndrome is present, the wrist should be placed in neutral.

Contraindications/Precautions

Open, volar hand wounds require dressings to prevent skin maceration.

Instruction

1. Carry heated thermoplastic on a towel to the client to prevent stretching or leaving fingerprints on the materials, and to remove hot water.
2. Place the thermoplastic on the volar side of the forearm; material extends past the fingertips.
3. A C-shape should be made with the thermoplastic to allow thumb palmar abduction.
4. Gently roll the material at the base of the thumb, this creates a smooth surface for comfort and also increases the strength of the thermoplastic.
5. Support the palmar arches by placing your thumb or several fingers into the space as it cools, this increases comfort, strength, and maintains hand function.
6. Stroke the material proximal to distal. Keep the arm, wrist, and hand in the correct position while the splint hardens. This prevents creating divets and extra texture along the length of the splint.
7. The splint should extend 2/3 up the forearm; if too long, trim with curved scissors. Pay particular attention to creating smooth edges, sharp edges can irritate skin.

Final Check

Check for clearance of radial and ulnar styloid processes, thumb, and finger MCP joints. The splint should not create any areas of pressure for the client, observed as blanched or red skin. If areas are identified, the splint should be spot heated and stretched to eliminate the pressure. Observe the patient donning and doffing the splint correctly. Provide written wear/care instructions.

Adding Straps

This splint requires three straps for optimal distribution of pressure and security.

Materials

• 1” adhesive-back hook Velcro: 3” x3
• 1” loop Velcro or strapping: 8” (or enough to go across the dorsum of the hand)
• 2” loop Velcro or strapping: 8”, 10” (or enough to go around the distal and proximal forearm)

Instructions

1. The 8” distal strap covers the dorsum of the hand and attaches to the middle of 3” hook on the palmar crease of the splint, this makes doffing easier and increases the longevity. A slit can be cut to accommodate the palmar arches. Ensure that there is minimal tension across the dorsum of the hand to allow for sufficient return circulation.
2. The 8” middle strap is placed proximally to wrist crease on dorsal side of the forearm and attaches to the middle of 3” hook on the volar side of the splint. It should follow the contour of the arm.
3. The 12” proximal strap is placed an inch or two from the end of the splint and attaches to the middle of 3” hook on the volar side of the splint. It should follow the contour of the arm.

Final Check

The straps should not cause any areas of pressure or block venous return in the dorsum of the hand.