Hand Therapy splints listed by Diagnosis - Complete Guide

Hand Therapy splints listed by Diagnosis – Complete Guide

For a long time, I’ve wanted a list of the most commonly used splints by diagnosis as a quick reference.

In this guide, I’ll list the most commonly used splint for the specific diagnosis first and other splints that may also be used. 

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*Note: Each splint listed below requires guidance from a physician.  Do not use the following splints until first consulting your physician.

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The most common splints used for hand therapy

Here is a list of all the splints listed for hand therapy. 

  • Dynamic extension splint
  • Dynamic flexion splint
  • Hinged elbow brace
  • Long arm splint
  • LMB
  • Radial gutter
  • Sugar tong
  • Thumb spica
  • Tip protector
  • Ulnar gutter
  • Wrist cockup


Splinting terms to know

How to splint without patterns

Amputation (digit)

A tip protector is the most commonly used splint following a digit amputation and the most beneficial to return to work. I prefer these ones with coban, but thermoplastic seems to do the best job.

Reference article

Arthritis 

PIP and DIP (finger)

Silver ring splints are commonly used for patients with arthritis and found to be the most effective for increasing dexterity. 

Reference article

CMC (thumb) arthritis

  • Splinting not effective

Reference article 

Bennet’s fracture (First MP joint fracture)

  • Thumb spica splint

Boutonniere deformity

Boutonniere deformity requires good compliance to the rigid splint wear. Using a splint that can be removed easily will be helpful for blocking exercises at the PIP joint.

Reference article

Carpal tunnel

The wrist cockup is primarily used for carpal tunnel before and after surgery. It has shown to be most effective when used at night to prevent compression at the median nerve.

Conservative treatment

Splint at night x 6 weeks (AMSU)

Post Surgery

Splinting post surgery is not needed but may be beneficial for the first few days. 

Reference article 1

Reference article 2

Cubital Tunnel 

A night splint with 45 degrees of elbow flexion x3 months is the preferred method for conservative management. 

Post Surgery

  • Heelbow 
  • Night splint discontinued

CMC Arthroplasty

Most surgeons today use the tight rope method, but some still do the trapeziectomy. 

Crush injury (digit)

  • Tip protector

A tip protector is the most commonly used splint following a crush injury and the most beneficial to return to work. I prefer these ones with coban, but thermoplastic seems to do the best job.

Bicep tendon repair

Patients are usually placed in a post op molding for two weeks and progressed to a hinge splint for up to 9 weeks.

If a hinged splint is unavailable, use a long arm splint.

There’s a great resource for therapy here

De Quervain’s Tenosynovitis

For conservative management, a forearm-based thumb spica splint is most commonly used to keep the thumb and wrist immobilized. 

Post surgery

  • Splinting may not be necessary
How to splint without patterns

DIP fracture (P3)

A tip protector is the most commonly used splint following a DIP fracture and the most beneficial to return to work. I prefer silicone fingertip protectors, but thermoplastic seems to do the best job.

You may also consider

DIP Arthrodesis

  • DIP extension splint (Preferred)
  • Stacked splint

The preferred method is to keep the DIP immobilized with a DIP extension splint for up to 6 weeks.

Distal radius fracture

Dupuytren’s Release

  • Hand based extension splint

The best splint for duputen’s release is a hand based extension splint with the affected digit in extension with a pad under P3 and a strap under the PIP joint.

Extensor Polices Longus (EPL) repair

Consider keeping the wrist in 20º ext, the thumb halfway between palmar and radial abduction, and the IP in hyperextension.

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Extensor tendon repair

Maintain 15-20º of wrist extension.  Outriggers can be a good way to assist with the dynamic component.  For more info on dynamic extension splinting read my full post here

Flexor tendon repair

  • Dynamic flexion splint

Ganglion cyst removal

  • Wrist cockup 

Following surgery the pt is typically in the post op dressing for the first 3-7 days and in the wrist cockup 7-14 days after surgery.

Guyun’s canal release

  • Wrist cockup

Before surgery a wrist cockup is commonly used to immobilize the wrist and allow digit motion.  A splint is usually not indicated following surgery but may be used if the patient has a “habit of loading the wrist joint.”

Reference

Humerus fracture

Check with your doctor before splinting for a humeral fracture due to a wide variety of protocols. Most humeral fractures don’t need splinting.

Reference


Lateral epicondylitis

According to the resource below, therapy was shown to be more effective than bracing unless the patients were younger. 

Reference

Mallet finger

Splinting for mallet finger can be difficult. The preferred method is using a DIP extension splint.  Preferably with thermoplastic and coban.

Metacarpal fracture

Most injuries are 5th MC fractures and most doctors will request an ulnar gutter splint, but the resource below discusses better outcomes after using a functional metacarpal splint.

Reference

MP RCL/UCL repair

  • Hand based Safe position splint with buddy strap

Fabricate a forearm or hand-based radial/ulnar gutter splint with the wrist in 15-20º of extension, MP joints in 45º of flexion and the IP joints free. 

For the index and long fingers, use a radial gutter splint. For the ring and small fingers, use an ulnar gutter splint. 

Buddy strap the affected digit to the adjacent digit at P1.

How to splint without patterns

Nail bed repair

  • Tip protector

P1 (PIP) fracture

  • Hand based safe position splint 

Fabricate an ulnar gutter (digit 4-5) or radial gutter splint (digit 2-3) with MCP joint at 90 degrees and PIP/DIP in full extension.  Buddy strap as recommended by the MD.

Scaphoid fracture/repair

Stroke (CVA) splinting

  • Limited supportive evidence 

Therapists in the past have used resting hand splints for stroke patients, but there is no current research supporting the effectiveness of this practice. 

Reference

Swan neck deformity

TFCC Debridement/Repair

  • Wrist cockup

For TFCC debridement a wrist cockup is usually worn for 1-2 weeks.  TFCC repairs are usually casted for 6-8 weeks before applying a wrist cockup.

Trigger finger

Studies have shown splinting can reduce pain. Night splinting can also be effective prior to surgery.

Thumb MP UCL repair

Fabricate the splint to allow for IP flex/ext.

Radial nerve palsy (Wrist drop)

If you don’t have a dynamic extension splint, consider a wrist cockup as a temporary solution.  

Wrist arthrodesis

  • Wrist cockup or splinted in 0º of wrist extension

The patient is usually casted for 2 weeks. Avoid wrist motion of any kind.

Reference

Summary

There’s not always one splint the will fix all your problems. Sometimes you may need to assess the nature of the injury or consult with a physician to know what is most appropriate. If you’re new to splinting or looking to increase your splinting skills, definitely check out my book on splinting without patterns.

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