Some of the purposes for Resting Hand Splints are listed here. Usually this splint is used to control the Wrist-Hand-Finger assembly, counteracting contracture, wrist drop, etc.
Purposes of the Resting Hand Splint
Immobilizes wrist, fingers, and thumb. Immobilizes in “functional hand position” or “intrinsic plus position”. Prevents deformity.
Functional Hand Position: Wrist in 20° -30° of extension (neutral if inflammation due to exacerbation of rheumatoid arthritis). Thumb abducted (palmar abduction) .Metacarpophalangeal joints in 15° -20° of flexion. Interphalangeal joints in slight flexion.
Intrinsic Plus Position Wrist position varies: Palmar burn – 30° -40° extension; Dorsal burn – neutral; Crushing injury – 0° -30° extension; Metacarpophalangeal joints Burn – 70° -90° flexion; Crushing injury – 60° -80° flexion; Interphalangeal joints of fingers and thumb extended.
Thumb abducted
Diagnoses that may require a Resting Hand Splint: Rheumatoid Arthritis during periods of acute exacerbation; Nighttime wear: Trauma Crush injuries; Rest and support to injured tissues; Reduce pain and edema; Dorsal or Volar hand burns; Prevent contractures; Aid in tissue healing. Day and Night wear: Remove for dressing changes and cleaning; Spasticity due to upper motor neuron lesions; Other splint designs or serial casting may work better; Prevent contractures; Lengthen shortened finger flexors; However, monitor thumb position and potential for increased spasticity; carefully Remove splint to encourage functional use of hand.
For Proper FitWiden trough for forearm proximally to accommodate “fleshier” part of forearm. Choose a material that has strength, rigidity and memory. Avoid wrist ulnar or radial deviation .Take care that the cut for the thumb trough does not go more proximal than the first CMC joint (wrist would loose stability). Make sure thumb trough is long enough. Maintain arches of the hand. Maintain wide 1st web space. Splint should not limit elbow range of motion. Straps Proximal to PIP joints. Proximal to thumb IP joint. Distal forearm Proximal forearm. Sometimes crossing forearm straps provides more comfort
PrecautionsMonitor areas of pressure (redness should disappear after 20 minutes). Avoid pressure over bony prominences. Make frequent adjustments. “Bubble out” rather than cut or pad pressure areas. Keep splint -making supplies clean and hygienic. Especially in cases of wounds, keep splint clean. A person with rheumatoid arthritis may benefit from a lighter weight or thinner splinting materials.
ADL Considerations: Rheumatoid Arthritis; Light weight tools; Large handles; Velcro Fasteners; Burns; Perform ADLs as soon as possible making use of full range of motion.
References
Coppared, B.M., & Lohman, H. (2001). Introduction to splinting: A critical-reasoning and problem solving approach (2nd ed.). St. Louis, MO: Mosby.
Pedretti, L. M.. & Early, M.B. (Eds.). (2001). Occupational therapy practice skills for physical dysfunction (5th ed.). St. Louis, MO: Mosby.
Trombly, C. A. & Radomski, M.V. (2002). Occupational therapy for physical dysfunction ( 5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.