Category Archives: Wrist

Benefits of Custom-Made Splints for Hand and Wrist Injuries

November 9, 2022 Teresa Stockton - Blog, Hand, Wrist

The Benefits of Custom-Made Splints for Hand and Wrist Injuries

Hand and wrist injuries can be surprisingly debilitating if it prevents you from doing your job or daily necessary tasks. Hand and wrist injuries have a very broad range, from mild muscle strains to more devastating injuries such as fractures or deep lacerations. Pain and discomfort can push patients to quickly decide the best way to quickly relieve pain. When this is the case, buying an over-the-counter splint at a local store may sound enticing, but did you know that you can have a custom-made splint built specifically to suit your needs?

We asked one of our colleagues at Desert Hand Physical Therapy, Brittney Moya OTR/L CHT, about the benefits of having a custom-made splint for a hand or wrist injury.

Q: What types of conditions or injuries benefit from having a custom-made splint?

Any injuries that involve the elbow or wrist, such as carpal tunnel, cubital tunnel,(typically post-operative they don’t need them because they want them moving for nerve compression) elbow fractures, hand fractures, metacarpal fractures, P1-P2-P3, any and all tendon & artery repairs need one, nerve repairs also need one. There is also specific positioning [that] has to be adjusted over time to manage the protocol directly.

What are P1, P2, and P3?
P1 is the proximal phalange(lower third of a finger), P2 is the middle, and P3 is the distal phalange(the end of the finger).

Q: What makes custom-made splints better than the standard splints that are sold in convenience and big box stores?

Most importantly, they’re individualized. We like to say that over-the-counter splints are really one-size-fits-none! -there’s a small, medium, and large.

The custom splint will [be] individualized for the left or the right hand, where it fits that person specifically and it won’t fit one person to the next. They’re also individualized in care based on protocol and what that patient needs; so, if we’re making one for a CMC(carpometacarpal) joint, for example, some people have very mobile CMC, where we can put in the right position, some people we really have to work our way out into that more functional position- so they can be individualized in that way also.

They are carefully constructed to fit said protocol and/or person so we take a lot of effort to pad bony prominences, protect vulnerable tissue, and manage incisions and wounds, whereas the OTC would be just what it is, the metal is where it is, slight moveable but not really.

Also, they are more effective. There is research to indicate that because they’re fit for that person they’re made and molded specifically for them and they’re monitored. That’s a big thing, we monitor and modify our splints, absolutely throughout treatments, make little changes, and things like that.

Q: What type/(s) of material/(s) is the splint made out of that makes it comfortable to wear?

It is a thermoplastic material and as we’re molding it, it fits that person specifically so that’s what makes it comfortable. So if their wrist is of a specific girth, it fits exactly into that place and that position. We [can also create] “bubble-out areas” because it’s a plastic material, so we can lay down any foam on, for example on an ulnar stylite.

We usually put something on there and lay the splint over top and then remove that pad so that there’s a bubble and that splint material is never physically touching those bony prominences -that’s the other part that makes it comfortable. All splint material is [made of] thermoplastic, some of it has more/less elastic, it just depends on the provider and what they like to use.

Q: What are the risks of ignoring the importance of not wearing a custom-made splint after an injury has happened?

If we’re dealing with specifically a tendon or a nerve repair of some sort, it could rupture the repair or gap the repair -that’s huge. It’s part of the protocol for healing. It’s protecting structures and recently repaired things. The other risk would be for conservative structures or things that could be used for comfort or pain. It would not really change their pain or not progress their therapy protocol overall. They could stay more plateaued with their goals, or they [would] not be able to progress as fast as they would like to if they’re more intermittent with their therapy schedule versus the schedule we recommend.

We also used splints for progression of mobility, so we’ll use some more dynamic components to do this where if we’re trying to get a finger to bend, we may add something to a custom splint to get it to slowly bend, so in that situation, if the person is not with their wear schedule, then again their goals would be really slow to come by and we may get to a point where we have a joint contracture, or we’re really struggling with our manual component of therapy because the splint is supposed to be an add-on to what we’re doing.

Q: What are some things you can do to protect or stabilize an injury after it has occurred before you can get to a clinic?

Typically, you can use things like popsicle sticks, if you need to, for finger fractures. They also have a thing called AlumaFoam, they have aluminum on the outside and blue foam on the inside. Some people just put their finger in that and just get where they need to go. Big bulky ACE wraps(elastic bandage), just wrap up the injury several times over. They could put a thick sock or sleeve on [over the injured arm] and then put a balled-up sock inside of the other to keep their arm open.

Obviously, there are OTC products are there as well. The emergency room will place people in something called Ortho-glass, it’s a fiberglass component on the inside and soft white foam on the outside. They put it under running water wring it out and when they lay it on the patient, it will harden into whatever position it is in. Note, that’s the temporary [solution] otherwise known as, “soft cast” or “half cast” which is usually the gold standard they’ll use, and then they’ll recommend you go to physical therapy as soon as possible.

In Conclusion:

In many cases, a custom-made splint is a great option for patients suffering from both overuse and acute, hand and wrist injuries. Certified Hand Therapy can develop an individualized hand therapy program with a suitable custom-made splint created for your comfort and recovery.

PT News September 2019

September 25, 2019 Teresa Stockton - Blog, Elbow, Hand, Industrial Rehab, PT News, Wrist

This time in PT News we recap what our clinics have been posting throughout September 2019. We are excited to begin a new year of new posts featuring published articles from PTandMe partnering clinics!

1. Carpal Tunnel Syndrome

Written by Spectrum Physical Therapy with three locations in New London County, CT.

Carpal Tunnel Syndrome (CTS) is a type of injury called a peripheral nerve entrapment. What this means is that it is a condition in which the median nerve gets compressed and irritated as it passes through a structure called the carpal tunnel, located on the palm side of your wrist. The carpal tunnel is formed by the carpal (wrist) bones and connective tissue and protects the median nerve and finger flexor tendons as they pass through the wrist. Read more

2. Tommy John Elbow Ligament Injuries in Football Quarterbacks: Why are there significantly fewer injuries than in baseball pitchers?

Written by Mishock Physical Therapy, an outpatient physical therapy practice with locations throughout PA’s Montgomery, Berks, and Chester Counties.

Recently Ben Roethlisberger, quarterback for the Pittsburgh Steelers, sustained an ulnar collateral ligament tear and subsequent surgery, ending his football season. Elbow injuries in football players are uncommon with 92% of the injuries being traumatic (contusions and dislocations), (Ortho J Sports Med 2019). Ulnar collateral ligament injuries in football quarterbacks are even more uncommon. Read more

3. Firefighter and Active Dad Gets Back to Work and Life

Written by ARC Physical Therapy+ an outpatient physical therapy practice with locations across Kansas, Missouri, and Iowa

Marcus Winstead is a firefighter, husband, and father who enjoys leading an active lifestyle with his wife and three children. “I’ve been a firefighter for 13 years”, Marcus explained. “Throughout that time, I’ve been on numerous calls and in very unique and challenging situations. As luck would have it, I was injured during a training exercise. I had two-disc injuries (protrusion and extrusion between L4-L5/L5-S1).” Read more

Find these locations and others to start feeling better today!

Carpal Tunnel Causes, Relief, and Treatment

July 10, 2019 Teresa Stockton - Blog, Hand, Wrist

What is Carpal Tunnel Syndrome and Why Does it Hurt So Much?

The carpal tunnel is a small space at the wrist in which the median nerve and nine tendons pass through. The median nerve travels on top of the tendons through the tunnel. The tunnel itself is made up of your wrist bones and along the top of the tunnel is a thick fibrous ligament called the transverse carpal ligament. If the tendons become swollen (tenosynovitis) or if the tunnel size itself decreases because of injury, compression to the median nerve can occur. Symptoms of Carpal Tunnel Syndrome may include: pain during pinching and gripping, a feeling of clumsiness – the inability to hold things, numbness in the fingers at night, or a radiating pain up the arm.

Risk factors at home and at work

There are many factors that can contribute to pain in the carpal tunnel, but these are some of the most common causes of Carpal Tunnel Syndrome.

Repetition – Overuse can occur with light forces. Irritation of the tendon can be caused by rapid, repetitive activity without a break. Decreased blood flow to the nerves and tendons may be caused by holding or gripping an object without relaxation.
Force – The muscles of the hand and fingers are contracted when gripping or pinching. These contractions place stress on the tendons that go through the carpal tunnel. Higher forces are more likely to expose you to greater risks.
Bending – The tendons in the carpal tunnel can be irritated by bending your hand. Bending your hand up, down, or sideways may inflame the tendons in the carpal tunnel.
Vibration – Nerves are especially susceptible to vibration. Common causes of vibration of the nerves in the carpal tunnel are power tools, steering wheels, or other mechanized equipment.
Impact – Your hand is not a tool. Hitting, moving, or jerking objects may damage the structures of the wrist. Even using a hammer transmits sudden force to these delicate structures.

Practicing prevention

The first line of defense against Carpal Tunnel Syndrome is reducing the risk factors that may lead to CTS. Look carefully at your equipment and tools and try to eliminate the forces that are risk factors. This can include bending, vibration, impact, and repetition.

Tool Handles – A handle should have an optimum grip span of about 2 ¼ inches.
Gripping Surface – Use rubberized coating or tubing on your gripping surface. This will lower the grip strength required to hold onto the tool.
Reduction in vibration – Place a rubber or gel material on the handles or utilize gloves with rubber inserts to reduce vibration.

Home treatment

Ice – Use an ice pack on the palm and wrist area for 10 minutes after intensive hand activities. This can be followed by the wrist stretches.
Rest – Rest your hands after frequent, forceful, or repetitive activities that last 30 – 60 minutes. Try doing a different activity which is not as stressful to your wrist and hand.

If your Carpal Tunnel Syndrome pain does not subside, call your physical therapist to schedule an appointment. Physical therapy may be able to reduce pain and remove the need for surgery.

PT News April 2019

April 24, 2019 Teresa Stockton - Blog, Hand, Shoulder, Wrist

This time in PT News we recap what our clinics have been posting throughout April 2019. We are excited to begin a new year of new posts featuring published articles from PTandMe partnering clinics!

1. The Truth Behind Shoulder Impingement
Written by Spectrum Physical Therapy with 3 physical therapy locations in Connecticut.

Shoulder impingement (Subacromial Impingement Syndrome) is a condition of the shoulder that results in pain felt at the front of the shoulder, under a bone called the acromion process, that is often worse with repetitive or frequent overhead activity. Read more

2. What is Certified Hand Therapy?
Written by the Therapy Team at Momentum Physical Therapy with multiple physical therapy locations throughout Greater San Antonio.

You may have heard of Certified Hand Therapists (CHTs) and wondered if they are the only therapists that can treat hand injuries. You may have also wondered why therapists needed a special certification to treat a specific body part. Read more

3. The Power (and Weakness) of the Wrist
Written by the physical therapy team at Cornerstone Physical Therapy with 5 locations in Ohio.

A wrist fracture has the potential to impact daily life for an extended period of time. Wrist fractures result from falls, sports activities, and improper lifting. Owing to the complex architecture of the bones, muscles, and ligaments in the wrist and hand, healing can take a while. Read more

Common Causes of Carpal Tunnel Syndrome

September 28, 2017 Teresa Stockton - Blog, Wrist

Carpal Tunnel happens when the tendons become swollen (tenosynovitis) or if the tunnel size itself decreases because of injury-causing compression to the median nerve. When compression occurs, a person can experience numbness, tingling, or a dull sensation of the thumb, index, middle and ring fingers. Symptoms may include pain during pinching and gripping, or a feeling of clumsiness and the inability to hold things. The best way to avoid carpal wrist pain is to understand the main causes of carpal tunnel and use that information at work and at home.

WHAT IS THE CARPAL TUNNEL?
The carpal tunnel is a small space at the wrist in which the median nerve and nine tendons pass through. The median nerve travels on top of the tendons through the tunnel. The tunnel itself is made up of your wrist bones and along the top of the tunnel is a thick fibrous ligament called the transverse carpal ligament.

COMMON CAUSES OF CARPAL TUNNEL
Carpal Tunnel is typically not related to a specific injury. Some common causes of carpal tunnel syndrome include:

Genetic Predisposition – Many cases can be a result of physical characteristics of carpal tunnel or medical conditions associated with CTS, which also run in the family.

Repetitive Movements – Certain types of work, leisure, and sports activities require use of the hand and wrist repetitively. Occupations such as manufacturing/assembly line workers, grocery checkers, musicians, carpenters, and many others require the same movements. Common hobbies such as golfing, knitting, and gardening also require repeated movements that cause carpal tunnel syndrome.

Injury or Trauma – Sprain or fracture of the wrist can cause swelling and pressure to the median nerve.

Pregnancy & Menopause – Hormonal fluctuation in women plays a role in CTS. Such fluctuation may cause fluid retention and other changes that cause swelling in the body. Fluid retention frequently occurs during the last trimester of pregnancy and is the reason for CTS.

Medical Conditions – Diabetes, hypothyroidism, lupus, obesity, and rheumatoid arthritis.

ACTIVITIES TO AVOID TO MINIMIZE SYMPTOMS

Avoid keeping your wrists bent in either direction. The best position for the wrist is neutral (straight)
Avoid rapid repetitive forceful or prolonged hand or arm use such as seen with factory work or data entry.
Avoid tight gripping and pinching
Avoid pressure to the palm or wrist
Avoid extreme cold or vibration.

Repetitive Strain Injury (RSI)

May 4, 2017 Teresa Stockton - Blog, Industrial Rehab, Wrist

The Following are Seen as Causes of Repetitive Strain Injury:

The overuse of muscles in our hands, wrists, arms, shoulders, neck and back
The area is affected by repeated actions, which are usually performed on a daily basis over a long period
The repetitive actions are done in a cold place
Forceful movements are involved
Workstations are poorly organized
Equipment is badly designed
The individual commonly adopts an awkward posture
There are not enough rest breaks

Prevention 101: Nine Easy Ways to Reduce Your Risk of Developing Repetitive Strain Injury:

TAKE BREAKS when using your computer. Every hour or so, get up and walk around, get a drink of water, stretch whatever muscles are tight, and look out the window at a far off object (to rest your eyes).
Use good posture. If you can’t hold good posture, it probably means it’s time for you to take a break from typing. If you are perpetually struggling to maintain good posture, you probably need to adjust your workstation or chair, or develop some of the support muscles necessary for good posture.
Use an ergonomically-optimized workstation to reduce strain on your body.
Exercise regularly. Include strengthening, stretching, and aerobic exercises. Yoga and pilates may also be helpful.
Only use the computer as much as you have to. Don’t email people when you could walk down the hall or pick up the phone and talk to them. It’s not only better for your hands – it’s friendlier. Think before you type to avoid unnecessary editing.
Don’t stretch for the hard-to-reach keys, e.g. BACKSPACE, ENTER, SHIFT, and CONTROL… basically everything but the letters. Instead, move your entire hand so that you may press the desired key with ease. This is crucial when you are programming or typing something where non-letter keys are used extensively.
Let your hands float above the keyboard when you type, and move your entire arm when moving your mouse or typing hard-to-reach keys, keeping the wrist joint straight at all times. This lets the big muscles in your arm, shoulder, and back do most of the work, instead of the smaller, weaker, and more vulnerable muscles in your hand and wrist. If you find it difficult to do this, then your shoulder and back muscles are probably too weak. It is OK, and in fact a good idea, to rest your elbows/wrists when you are not typing.
Use two hands to type combination key strokes, such as those involving the SHIFT and CONTROL keys.
When writing, avoid gripping the writing utensil tightly. Someone should be able to easily pull the writing utensil out of your hand when you are writing. If your pen or pencil requires you to press too hard, get a new one (my favorite is Dr. Grip Gel Ink).

Article provided by Fit2WRK. The information noted above is a summary of one of the components of Fit2WRK.