Forearm/wrist orthoses are volar or dorsal and either gutter-based or circumferential. Ideally, the wrist should be positioned in 15-30° of dorsiflexion (wrist extension), except in carpal tunnel syndrome (CTS), when the wrist should be maintained at neutral to minimize median nerve compression.
* The volar type should allow for metacarpophalangeal (MP) flexion by ending before the distal palmar crease.
* Examples of forearm-wrist orthoses include the following:
o Wrist cock-up splint
o Wrist extension splint
o Ulnar gutter splint
* These types of orthoses are used for immobilization in patients with lateral or medial epicondylitis, wrist sprain, wrist or forearm fractures, postoperative wrist fusions, and arthritic conditions.
Forearm-wrist-thumb Orthoses
Long opponens thumb spica splint
* The splint covers two thirds of the distal radial forearm up to the interphalangeal (IP) joint of the thumb.
* The wrist should be placed in 15-30° of dorsiflexion while maintaining motion of digits 2-5.
* The thumb should be maintained in an abducted position to achieve a 3-point jaw chuck prehension.
* Indications
o Used for maintaining the thumb ROM in patients who have had burns
o Used to restrict motion in patients with arthritis
o Used for serial static stretching, such as in contractures and burns
o Used to stabilize the thumb in opposition for 3-point chuck pinch in patients with peripheral nerve, cerebrovascular diseases, C5 level of SCI, and other upper motor neuron lesions
o Used in patients who have had tendon transfers/repairs, arthroplasty, and De Quervain tenosynovitis
Forearm-wrist-hand Orthoses
The basic type of forearm-wrist-hand orthoses includes the resting hand splint, functional resting splint, and static hand splint.
* Placement may be dorsal, volar, or circumferential and extends from the tips of the fingers to two thirds of the distal forearm. The dorsal type of splint is particularly useful in patients who demonstrate palmar hypersensitivity and grasp reflex.
* The position of the wrist is neutral or in slight dorsiflexion.
* Functions of the forearm-wrist-hand orthoses include the following:
o Immobilization in patients with hand flexor and extensor tendinitis, or who are undergoing tendon, nerve, or fracture repair
o Maintenance of passive ROM in patients with upper motor neuron lesions, burns, and contractures
* More specific types of forearm-wrist-hand orthoses include the following:
o Functional resting splint
o Static hand splint
o Burn splint
o Weight-bearing splint
o Resting hand splint
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