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Fabric Lined Splint

 

The Fabric lined splint is a very useful splint for those fragile, sore or swollen hands. Here I have used some soft strapping - Durawrap/Mafra, which conforms well around the hand and also helps reduce any swelling. Over the wrist I have used Microgrip, which is an elastic, soft strapping, which would be confortably for the client to wear.

 

Here is a tutorial on how to make this splint, as presented at the New Zealand Hand Therapy Conference 2015.

 

 

Circumferential Wrist Support

When you are making a circumferential splint, you do not need to use a thick thermoplastic. For this splint I have used a 1.6mm thick microperforated Turbocast. I like the different colours it comes in and as it has a coating on it, it does not tend to get as hot as the more shiny thermoplastics. Saying that, I commonly also use Orfit Classic for this design.

As this splint is for a child, I would definately not go any thicker than 1.6mm and I would stay at this thickness for many adults too. For larger hands I would go up to 2mm thickness and maybe 2.6 for a very large, strong hand.

To start off, I measure how long the splint needs to be (roughly) and cut out a square. I then prepare the patient and make sure I pad the ulnar styloid, to avoid any uncomfortable rubbing in from the splint.

 

 

Once I have prepared the patient, I cut the thermoplastic into a slight cone shape, a bit off centre, and cut small hole about 3 cm below the tip of the cone. Don't make the hole too big as it will stretch! I made this one approximately 2cm. For an adult you may want to up to 3 cm in diameter. Place the thermoplastic in the water to heat up, remove from the water and fold the edges around the thumb and distal ends. Put back in the bath to reaheat and take back up. 

 

 

Now place the thermoplastic on to the hand and give it a slight stretch around the forearm. Pinch the edges together and mould the palm until set.

Once set, undo the pinched area and take off the splint. If you are using a sticky thermoplastic (Orfit Classic or Aquaplast), make sure not to pinch any larger area than you need to as you may find it hard to undo! 

Cut the edges; On one side, cut the edge where to fold is, on the other side, leave approximately 5mm of the folded edge. These edges will be dipped into the water and be folded back. Cutting it this way will leave a little bit of a gap, which will give the splint a nice, snug fit. You may also want to dip in the proximal end of the splint and just flare out the edge to prevent any cutting on. 

 

 

Now you have the splint made. Now on to the velcro. With Turbocast, you have a little bit of extra work to put on the velcro, due to the "fluffy" surface. For other thermoplastics you may just need to dryheat the plastic and press on the velcro. 

Here is how to do it for Turbocast:

 

 

For the hook velcro, fold in approximately 2mm of one side, dryheat the thermoplastic suface where the folded side is going to be (without over heating it! A smaller heatgut is easier!).  The key is to give it a short spurt and stay close to the thermoplastic, to avoid heating up a too large of an area. Now work the hooks in very well into the thermoplastic, using your thumb nails. You want the hooks to kind of mound in with the thermoplastic.

 

 

For the loop part, this is what you do:

 

 

Cut three pieces of loop veclro and attach it to the hook. Place the splint on the patient and mark out where the velco will attach. This way you will get the right angle of the loop straps and it will fit nicely. Take the splint off the patient.

 

 

Now dry heat the area where the loop is going to be attached. Again, work it in well with your thumb nails. To reinforce the loops I like to dry heat a strip of Turbocast and place it on top of the ends. Again - work it in! Put the splint back on the patient and cut straps to fit.

Done!

 

Carpal Tunnel Night Splint

 

 

 

 

 

 

 

 

 

 

 

Splinting Carpal Tunnel Syndrome at night is an effective way of trying to reduce symptoms. Here is a tutorial on how to make a night splint, using Orfit Classic, as we use the fact that it is sticky when warmed up. This makes it stick to the stoking which helps conforming the splint nicely around the client's contours while moulding it.

You will need:

  • Scissors
  • 1.6 or 2mm Orfit Classic
  • Pattern (download here and adjust according to hand size)
  • Water bath and heat gun
  • Stocking - I used green Tubifast
  • Velcro - self adhesive hook (3cm) and loop 3cm + 5cm)

First, trace the pattern on to the thermoplastic and cut it out. Heat the thermoplastic up in waterbath. Ensure it doens't fold on to itself as it will stick!

While the thermoplastic is heating up, prepare the client. Place a tight stocking on the hand. A loose stocking will cause creases and will not allow the plastic to mould around the contours of the hand.

Bring the thermoplastic onto a tea towel and dry it gently. Fold the edge on top and on thethumb side. Leave the ulnar side for now. Put the thermoplastic back in the bath briefly to ensure the themoplastic is heated through. Bring it back up, dry it and place on the client's hand.

Ensure that the wrist is being kept in a neutral postion, holding is still while moulding. Mould the arches of the hand and once the thermoplastic is starting to set some, rotate the arm at the same time as you are rotating the stocking, so the hand and splint move towards pronation simultaniously.

Cut off any access plastic and heat the ulnar side of the splint and fold that edge. 

 

Flare the proximal edge to avoid any cutting in to the forearm. Once you are happy with the fit, attach the self adhesive velcro. To make it stick on better, heat it briefly using the heatgun, spot heating the plastic and the glue. Work in the velcro with your fingers. Add loop velcro next. Wide strap over the wrist, as this is where most of the pressure will be.

 

If the client would like to wear a stocking underneath when wearing the splint, ensure it is a loose fitting one (and not the one you used to mould the splint), so it doesn't compromise circulation. Also ensure that the straps are not applied too tightly, as the hand may swell at night.

 

Make a Resting Splint

 

There are couple of options of patterns when it comes to making resting splints, but I prefer the "paddle" as I find it gives the thumb a better postion and it tends to be a bit stronger.

 

So this is a step by step guide on how to make a resting splint. This works on children and adults alike. How you postion the hand will depend on what you are trying to achieve. We will not go though the different options but will talk about splinting techniques rather than treatment options.

 

I will say though, that the strapping option will be as crucial as the postion of the joints. In general, wider straps are safer than skinny ones. 

 

You will need:

  • Thermoplastic
  • Paper towel
  • Pen
  • Scissors
  • Electric frying pan/water bath
  • Heat gun
  • (Tea) towels 
  • Self adhesive hook Velcro
  • Strapping

First, start off with tracing the pattern of the hand on to a paper towel or such. I like to use paper towels but you can also use plastic bags or normal paper. The reason I like to use paper towels is that they are easy accessible, strong and conforms well around the hand.

 

 

After you have drawn around the hand and forearm, add about 10mm on the side of the fingers and thumb, and about 2-3cm around the forearm, gradually increasing the added amount as you move proximally up the forearm, allowing for the bulk muscles of the forearm. So if you have a client with a larger forearm, you need to add more material. In general, you want to go up 2/3 of the forearm. If you make it too short, it will be uncomfortable. If you make it too long, you will block supination/pronation (which you may or may not want).

 

Once you have made the pattern, try the paper pattern on the client, to make sure it has a good fit. Adjust accordningly. 

Trace the pattern onto the thermoplastic. Here we used Orfit Eco, but other thermoplastics with some memory may work just as well, eg Taylor splint.

 

If you have smaller hand, you do not need a thick thermoplastic, and for larger hands you want to go thicker. Here we used a 1.6mm thick material as it is for a child. For an adult I would use 2.0mm up to 3.0mm thickness, depending on arm size.

 

 

Cut down the thermoplastic small enough to fit in your water bath. Once heated and softened, cut out the splint. If you cut the thermoplastic while soft, you will have nicer, smoother edges.

 

 

While the thermoplastic is still in the water bath, prepare the client. Place a stockinette/Tubifast stocking over arm (tight enough not to cause wrinkles on the splint). Ask the client to keep palm up (if possible) when the thermoplastic is taken out, to make it easier to place it on to the hand. Make sure the thermoplastic is not too hot before you place it on the client. Wrap the splint on using a an elastic bandage, from the wrist, up towards the elbow, but finish just before the end of the splint, not to cause the edge from digging in to the forearm. 

 

 

Once the elastic bandage is on, you can rotate the splint and forearm (simultaniously) to allow the splint to cool in natural postion. If you leave the hand supinated, the splint will only fit well with the hand in supination!

 

While the thermoplstic is still soft, place the hand in the postion you want it in and do not let go, especially of the wrist position, until set. At the same time, make sure to not hold your fingers still on the thermoplastic, as this will leave dents that will be uncomfortable for the client, and will be ugly! The trick is to keep one of your fingers on the dorsal aspect of the client's wrist, while your thumb constantly is moving on the volar aspect of the splint, helping to shape the arches.

 

 

Once the splint is set, mark out any areas that need adjusting. Avoid cutting it cold, but heat it in the water bath or with the heat gun. Finish off by heating the proxinal edge of the splint and flare it out. This will prevent this edge from cutting in and leaving marks.

 

 

Once you are happy with the fit, attach the hook velcro. I prefer to use longer strips as this stays on better.

 

 

Now to the important straps. You ALWAYS want to use wide strap over the wrist for any volar splint!!!! If there is an issue with swelling, you want to cover as much surface as possibl, so go wide all the way and go ELASTIC! I love using Microgrip, Fabrifoam and Durawrap/Mafra. Ensure that elastic straps are not too tight as that may compromise the circulation.

You may want to provide the client with a loose fitting stockinette to wear under the splint for comfort and to protect the skin.

Any resting splint needs to be monitored by a qualified therapist.

 

 

 

Finger Flexion Glove

Stiff fingers can be very tricky to treat. Here is a simple but effective splint for patients with general stiffness of all finger joints. 

You want to block any flexion of joints what already has good flexion eg, if there are no issues with the MCP joints, you want to block the MCP joints to the flextion force will be transferred to the IP joints. If the MCP joints are stiff as well, you will include them in the pull. Hope that makes sense.

You will need:

  • A well fitting off the shelf wrist brace
  • Cotton glove (sold at many pharmacies or even dollar shops
  • Sports tape 
  • Elastic thread (sold by eg Ofit and at craft stores)
  • Off cut of Orfit Classic or other sticky thermoplastic if you want to block the MCPs (Needs to be sticky to stick on to the brace)
  • Safety pins (some cheap safety pins will bend so invest in some good quality ones)

For tools you need scissors, a heat gun if you want to add thermoplastic,  and a hole punch.

1. Place glove on patients hand and tape each tip with the sports tape. This is to reinforce the fabric as this will be your anchor.

2. Pull the tips away from the patient's hand and hole punch through the tape and glove fabric.

3. Fold the elastic in half and feed the folded part through each hole. Feed the two cut ends through the loop and pull to tighten. The threads will now stay put.

4. Place wrist brace on top of the glove and add the first safety pin. The postion of this will depend on the flexion deficiency. 

5. Place the second safely pin at the bottom of the brace. You now want to adjust the tension of the elastic thread according to deformity of each finger. This is a good knot that will not slide: Loop both end bits around your finger and feed through the hole - easy.

 

If you want to block the MCP joints you add a thermoplastic piece. I find dry heating eg Orfit classic works well as it sticks on to the brace well. It still needs to be worked in with your finger tips for a solid attachment. You may also want to pad the inside for extra comfort. Here is one made earlier, which is blocking the MCPs. This one might be good if you want to emphasise on the PIP joints.

If the fingers are very stiff you may want to consider making a small "cushion" for the fingers to rest on (not too big so it restricts the pull). Putting a bit of wadding inside some Tubifast is one idea....

It would be insteresting to hear what you think about this one and if anyone have used something similar. It is a cost effective and easy splint to make, and it seem to be well excepted by many patients. They key is not to pull too hard, but to be patient and go for a gradual increase of tension.

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