Common Indications for a Static 90 degree Elbow Splint

Static 90 degree Elbow Splint • Lateral or medial epicondylitis • Humerus/ foreman fracture • Repair of high median nerve laceration • Anterior transportation of the ulnar nerve • Elbow arthroplasty • Radial nerve repair (proximal to the elbow) • Ulnar nerve transposition • Repair of high ulnar nerve laceration • Elbow flexion contracture release (Often places volarly and increased serially into extension) • Ulnar neuropath • Radial-ulnar dislocation • Post nerve repair • Post trauma • Cubital tunnel release • Tendon transfer • Acute ulnar neuritis These suggestions are not meant to provide an absolute regimen for splinting. Each individual’s condition in unique, and each individual must be evaluated and treated based on his or her medical history and specific current condition.

Common Indications for a Anti- Spasticity Ball Splint

Anti- Spasticity Ball Splint • Upper motor neuron lesions resulting in mild to moderate spasticity Cerebral vascular accident Traumatic brain injury Cerebral Palsy

Common Indications for a Functional Position Splint

Functional Position Splint • Traumatic brain injury • CVA • Acute traumatic hand injury • Spinal cord lesion • Flaccid upper extremity • Brachial plexus injury • Arthritis

Common Indications for a Resting Pan Mitt Splint

Resting Pan Mitt Splint • Edema • CVA • Traumatic brain injury • Arthritis • Burns • Crash injury

Common Indications for Gauntlet Thumb Spica Splint

Gauntlet Thumb Spica Splint • Gamekeepers thumb • Sprain or dislocation • Injury affecting opposition • Degenerative rheumatoid arthritis or the CMC joint • Web spacer • Tenosynovitis

Common Indications for Wrist and Thumb Spica Splint

Wrist and Thumb Spica Splint • Scaphoid fracture • Radial or ulnar collateral ligament strain • Thumb replantation/revascularization • Degenerative rheumatoid arthritis of the joint • Reconstruction of the thumb MP joint • Gamekeeper’s thumb (Chronic ulnar collateral ligament injury) • Skier’s thumb (acute ulnar collateral ligament injury of the thumb MP joint) • Sprain or dislocation of the thumb • Tendon transfer • Trapezial replacement arthroplasty • Painful basilar joint arthritis • Web spacer

Common Indications Dorsal Wrist Cock-Up Splint

Dorsal Wrist Cock-Up Splint • Indications similar to those for volar wrist cock up splint • Patient with wound, graft, or sutures on volar surface • Patient who requires sensory surface free • Base for dynamic splint • C5-6 incomplete cord lesion

Common Indications for Static Splints

Volar Wrist Cock-Up Splint • Carpal Tunnel Syndrome • Synovectomy • Carpal Tunnel arthroplasty • Tensynovitis • Carpal implant arthroplasty • Post fracture • Ganglion cyst • Radial nerve palsy • Non-displaced metacarpal fractures (proximal base) • Post Colles’ fracture (6 weeks) • Post Carpal fracture • Extensor tendinitis • Lateral epicondylitis • Post wrist fusion • Wrist muscle weakness • Arthritis • Wrist sprain

Why Does My Hand Hurt?

Have you ever felt pain when you performed everyday activities such as turning keys or opening car doors? Ever wonder why simple activities such as holding eating utensils or a glass of water too painful to perform? Or have you felt tenderness in the thumb muscle or over the joint and an aching feeling at the base of the thumb following heavy use or with weather changes? One common cause of such pains is osteoarthiritis (OA) of the base of the thumb. This is called the Carpometacarpal (CMC) joint, which is the joint between the base of the thumb and the wrist. OA destroys the cartilage surrounding the join, causing it to become inflamed, resulting in pain and restricting movement of the thumb. The actual degenerative process of CMC osteoarthritis is not completely understood. While is it primarily a “wear and tear” process, there are other factors that play a role in the degenerative arthritis. These include previous trauma or injury, repetitive stress over long periods of time or just the aging process. Muscle imbalance in the thumb may also be a contributing factor to CMC osteoarthritis. An imbalance can lead to poor control over the joint causing it to move at a slightly incorrect angle or rotation. If the joint is not stabilized properly it can rub or glide the wrong way causing the surround tissue to become inflamed which stimulates the degenerative process. An exercise program designed by a certified hand therapist may be helpful in restoring muscle balance of the CMC joint. An osteoarthritis progresses and more joint cartilage is lost, less stress of the thumb is necessary to produce pain. People will often avoid using the thumb for those activities that produce pain and over time this disuse can lead to weakness, muscle loss and tendency to drop things. The pain can be so unbearable that it interferes with one’s quality of life at times. Fortunately, therapy has been an effective treatment for the relief of symptoms of CMC joint pain. Therapy may include ultrasound to reduce inflammation and pain. Patient education about joint protection techniques helps one to resume favorite sports and hobbies. For the acute joint, splints in addition to anti-inflammatory medications may be helpful. Splinting the thumb in a comfortable position can be helpful to put it at rest and alleviate the pain associated with CMC osteoarthritis. Certified hand therapists are trained to assess your hand and determine the most appropriate splint for your particular problem. Although there are several style of commercial designed splints available, they often don’t fit “quite right” and the cost is not usually covered through Extended Health Care Benefits (EHC). A custom splint, fabricated by your certified hand therapist is designed to fit your particular hand, and is reimbursable through EHC. Any additional cost may also be used as an income tax deduction. When these conservative methods of treatment are not longer beneficial to the patient, surgery may be necessary. The most important goal of surgery is to eliminate the pain at the base of the joint of thumb. Surgery may be performed in several ways according to the personal preference of the surgeon. In some instances, surgery is necessary to improve the position of the thumb, range of motion and to improve strength for pinching and grasping. Following surgery, patients are often referred to hand therapy for rehabilitation. Exercises designed to stretch and strengthen structures stabilizing the thumb is considered to be the best approach to treating post surgical pain, swelling, and movement limitations. As these restrictions gradually resolve within three to six months most patients experience complete or near complete pain relief along with recover of range of motion. For more information about osteoarthritis, please contact our one of our clinics, you will find out locations at www.handtherapycentres.com. We will be happy to arrange a clinic tour or to provide you with more information about our services.

Dupuytren’s Contracture

Introduction Dupuytren’s contracture is a thickening of deep tissue (fascia) which passes from the palm into the fingers. Shortening of this tissue causes “bands” which pull the fingers into the palm. The cause of this is unknown but it tends to run in families. The condition is progressive and the only treatment is surgery. If untreated, the fingers will be gradually pulled into the palm. Fasciectomy Your Dupuytren’s contracture will be corrected by removal of the abnormal fascia and relaxation of the overlying skin. The entire wound is stitched up in a zigzag manner which lengthens it but occasionally, a segment of the wound in the palm is not stitched, being left open to heal by itself (open-palm technique). Dermofasciectomy In some situations it is necessary to also remove the overlying skin if it is affected by the disease or previous operation. Amputation Very rare in unoperated cases but may be preferred in a finger in which the bands have returned many times and where there has been previous nerve and vessel damage. Post-Operative Care  Hand elevation is important to prevent swelling and stiffness of the fingers. Remember not to walk with your hand dangling, or to sit with your hand held in your lap.  You will be initially placed in a bulky dressing consisting of gauze, plaster of paris and tensor bandage to rest the hand. The dressing will be removed after 3-5 days and then be left open at this stage, if possible, to allow mobilization of the fingers. The open-palm technique usually requires dressing to be applied to the palm for 2-3 weeks while mobilization is performed in the usual way.  At this time, you will see a hand therapist who will fit you with a splint and give you specific exercises to perform. The splint is to be worn at night for 6-12 weeks to keep the finger straight. During the day, the hand should be exercised and you should perform normal light activities. You may require ongoing therapy for range of motion and strengthening.  Your stitches will be removed one to two weeks after the operation. Following this the scar will be somewhat firm to touch and tender. This can be helped by firmly massaging the area with moisturizing cream. At this stage it is safe to get the hand wet in the bath or shower. The scar and the surrounding skin often become very dry and will be more comfortable if a moisturizer is applied, including the scar itself.  A Hand Therapist will see you for scar management. It is often not possible to fully straighten fingers that are very bent at the time of the operation, particularly if much of the bend occurs in the middle joint of the finger. This can sometimes be improved with splinting and exercise later after the operation. Duputren’s contracture can return either at the site of surgery or else where in the hand.  You can usually drive a car a couple of weeks as long as you are comfortable and have regained good finger movements. Timing of your return to work is variable according to your occupation and this should be discussed. Please call the Office or your Family Doctor if:  The prescribed medication does not provide adequate pain relief  The dressing/cast is too tight or uncomfortable  Numbness persists  You have a fever Risks of Surgery Nerve Damage The nerves running to the fingers can be damaged during the surgery and cause numbness in part of the finger. This complication is unusual in unoperated areas but becomes more common during repeat operations. If this occurs the nerve would be repaired immediately, if possible. Infection Any operation can be followed by redness and tenderness which may indicate infection. Do not apply antiseptics. It would be treated with antibiotics.