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Thumb immobilization splints

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)

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Thumb immobilization splints

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  1. Thumb immobilization splints Somaya Malkawi, PhD

  2. 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

  3. Introduction • TIS are divided into: • Forearm based splints • Hand based splints • 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

  4. 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

  5. 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)

  6. 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 8-1, 8-2, 8-3

  7. 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 • The position of the thumb varies according to the diagnosis, (palmar/ radial Abduction) C bar Thumb post Opponens bar

  8. Features of the TIS • 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

  9. Diagnostic indications • 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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!”

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. Splinting for Hypertonocity Thumb loop Figure of 8 thumb wrap

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