Guest Author - virginia hixson
Although this article primarily examines splints for Carpal Tunnel Syndrome, the principles of splint use are the same for all splints.
Splints and braces used to have some differentiation. Splints covered only part of the limb whereas braces circled the limb. Splints were made of plastic or leather. Braces were made with metal. Braces were made to be used fairly constantly while using the limb. Splints were made to come on and off. Splints were pure supportive devices where braces allowed joint movement.
These differentiations no long hold true. Modern splints often include metal pieces and often circle the affected part. Splints are used both during the night and during the day, may allow joint movement, and can be prescribed for all day or night use – although the type of splint may vary.
Choice of a splint is important. Off– the- shelf splints are usually not the best design or fit. If possible, have a therapist provide and fit the initial splint. It can make a great difference in fit and comfort – and it’s probable you will need one for some time for at least part of the day or at night.
Splints are often prescribed by Doctors and dispensed by occupational, hand, or physical therapists. Sometimes the therapist will do an individual fitting, modifying the splint or will construct one from scratch. These usually supply the best fit and are the most comfortable. A good splint can often be modified to suit your needs as your condition improves.
If you have a repetitive strain injury, it is not uncommon that you will also have a decreased or changed perception of pain and pressure. You may not notice the problem until it is a real problem. If you notice that a splint is rubbing in an uncomfortable way, pinching, or if your skin is red in a particular place, note that place carefully and let your doctor or therapist know immediately. If you can put a mark on the splint at the problematic point, it will be helpful. Your therapist can often make minor adjustments that will improve the fit tremendously.
Night splints are designed to provide the injured body part with the most complete rest possible. Day splints are protective. They prevent you from placing the injured part in a stressful position while you go about your daily life. By forcing rest, they speed healing.
The purpose of a splint is to force your tendons and joints to rest. They do this by constraining movement. The smaller the splint, the freer your movement will be. For De Quervain’s, a hand based thumb splint is the least restrictive while a forearm based splint is most restrictive. Your Therapist or Doctor will suggest the one that they believe will help you the most.
For Carpal tunnel, the night resting splint is generally the most restrictive. This splint holds you in a position where your wrist and fingers cannot move. Comfort in these has improved markedly in the past 10 years, but they are still a pain to wear(not painful, just irritating). Some people wake in the morning to find that in their sleep they have removed the splint and thrown it across the room. Eventually, tolerance builds up and the splints stay on through the night.
Carpal Tunnel day splints come in varied designs. Some are circumferential, some are on the palmar side of the forearm, and some are on the dorsal side (back). Some are short, some are long, reaching further up the arm. Some are very light and serve primarily as position reminders. Others are rigid and totally limit movement in the wrist, keeping it in a ‘cock-up’ position (about 30°). You should carefully describe what you need to do during the day to assist the therapist in choosing the design that will work best for you. However, the movement restrictions you require will be the primary consideration. If you can, try doing the task in the therapy room.
In order to work while wearing most of these splints, you will find yourself holding your elbows and shoulders in strange positions. Be aware of this and try to avoid the most awkward of those positions. Try not to stay in any one of them for an extended period.
Forearm based splints are particularly difficult when using a computer. Since the wrist is immobilized, the elbow and shoulder have to provide position and stabilization. Even reacing the keys on a keyboard is difficult.
You may also find yourself fighting the splint – or levering against the restriction. This indicates that you are not letting the tendon / muscle / joint rest as it should. Try to develop work methods that allow you to accomplish what you need to do without exerting excessive force against the splint. When you notice yourself doing this, stop and take a short break. Then begin again.
Splints are an important part of your recovery plan. Follow your schedule of wear carefully, as prescribed. This will speed healing. If you have concerns, speak with your therapist or doctor.