Hand Splint: A Review

Abstract

A splint is a device consisting of bone, wood, metal, polymers, composites, or plaster of Paris that is used to stabilise, join, or protect a damaged body part. It may be movable or immovable. There are numerous methods of rehabilitation currently in use, but we are going to specifically study hand splints with their definition, advantages, disadvantages, uses, etc. in this review paper. We are also going to review the literature that is available in bibliographic databases and compare their findings. The search for these splints was conducted through bibliographic databases and internet searches until May 2022. These searches were also backed by scanning their references one by one, personal reference collections, and talking to physiotherapists. All static splints used in this review paper have been shown to be effective in reducing pain during any motion as well as at rest.

Introduction

I. INTRODUCTION

In stroke, not only are the abilities to stand, balance, and walk affected, but also the ability to use the upper limb and hand in their diversity of functions in everyday life. Loss of upper limb freedom causes significant functional handicap, jeopardising quality of life and independence in "basic" (washing, grooming, feeding, dressing, and so on) and "instrumental" (shopping, home/financial management, and so on) daily activities [1]. The patient's ability to do daily duties may be harmed if he or she suffers a stroke in the dominant hand. In fact, 80% of stroke patients have severe limitations in activities of daily living that require the use of upper limbs [2]. There has been extensive research on the factors that influence QOL in stroke patients. ADL and depression are perhaps the most important factors affecting QOL after a stroke. However, no studies have investigated whether loss of function in the dominant hand affects QOL [3]. Treatment of these patients relies on rehabilitation. The cornerstone of this strategy is helping patients adapt to impairment, while treatments aimed at reducing impairment are less well developed. This will require a better understanding of impairment and, more significantly, recovery mechanisms.

Hand and wrist splints are a common component of occupational therapy programmes for people with strokes. Recent literature suggests splinting has the potential to improve hand function by attempting to support the proximal joints, applying counterbalanced force to deforming joints, and improving biomechanical advantage. Hand splints have both biomechanical and biological rationales for their use and action. However, evidence to support their clinical effectiveness is still emerging [4]. The hand and wrist splints can be used for decreasing soft tissue and joint pain [5], for resting weakened joint structures and decreasing local inflammation [6], for correctly positioning joints [7], for increasing joint stability [8], for increasing hand function (e.g., grasping or pinching) [5], for contributing towards self-management strategies in long-term disease management [9], for minimising joint contractures and hand deformities [10]. In this review paper we are going to identify, describe, and state their limitations.

II. TYPES OF SPLINTS

A. Static Hand Splint

Static resting splints are external devices applied to a body segment, whose aim is to decrease localised pain and inflammation by resting the joint in a correct anatomical position, and realigning drifting metacarpophalangeal [MCP] joints by providing an ulnar border to the splint and restricting carpal movement [11]. It helps maintain a biomechanically functional hand unit [12]. These splints do not permit wrist and hand movement and are recommended to be worn whilst resting and/or during the night. A static hand splint can indeed be recommended to rest an injured and postoperative hand. Resting splints for soft tissue injuries to the hand, like bruises, lacerations, or scars, facilitate the process of healing. Circumferential splinting to maintain postbone fracture reduction is applied to humeral and forearm sites [13].

B. Static Progressive Splint

The employment of inelastic components to provide torque to a joint in order to statically place it as close to the end of this range as possible is known as static progressive splinting. It maximises total end range time, thus increasing passive range of motion. In static progressive splinting torque is applied with accurate position of the joint to create an approach powerful enough to succeed when no other treatment approach does [14]. Static progressive splint applies stress on subjected tissues due to which that tissue gets elongated after that doctor or patient can strengthen the stress for making the subjected tissue more tolerable. Unlike dynamic splinting where load is placed constantly on the tissue, here it is stretched from time to time.

Dynamic splints have an advantage over static progressive splints because dynamic splints have moving parts that allow the individual a range of voluntary controlled movement, which can prevent contractures while allowing resultant muscle force to counter the force of the spastic muscle. Results suggested more normalised muscle activation with the device application. Another study utilising static hand splints found decreased motor activation, which can also contribute towards neglected degeneration in the wrist muscles and misuse of much more distal muscles over time. In contrast, dynamic wrist splints that provide wrist support for more optimal hand function allowed some movement, may not produce this additional strain on proximal muscles [15].

C. Serial Static Splint

A serial static splint aids in tissue elongation by bringing soft tissues to the threshold of their range of motion. Serial splinting has been characterised as a pre-surgical treatment method for contractures. The timing of surgical intervention in post-burn abnormalities is a point of contention. Some authors urge early surgical intervention, while others prefer to wait for the scars to settle for roughly half a year. It has been reported that waiting for some time decreases the risk of postoperative infections [16].

D. Dynamic Hand Splint

A dynamic splint is a splint made of springs or elastic bands that assists in movements initiated by the patient by regulating the plane and range of motion. Tension on joint tissues causes them to react, and an appropriate extension force has been demonstrated to improve flexion contracture [17]. Dynamic splints are most typically used for protection following tendon reattachment (a flexible but inelastic cord of strong fibrous collagen tissue connecting a muscle to a bone). Dynamic splinting provides the advantages of early mobilisation without the hazards of early free active movement, which can result in increased stress, tendon ischaemia, and decreased tensile strength. To encourage compliance, the optimal dynamic extension splint should deliver a continuous and uniform force across its therapeutic range of digit and be simple to apply. Splints on the market now stretch a spring or an elastic band using a stationary outrigger pulley. Dynamic splinting can aid in the treatment of flexion contractures. Some studies argue against using dynamic splints to treat stiff elbows because they produce swelling and pain, causing patients to discontinue use [18].

E. Passive Dynamic Hand Splints

Dynamic hand splints are mechanically responsive orthoses that are traditionally used to recover fingers or the entire hand in accordance with predefined permitted motions. In particular, so-called "passive dynamic hand splints" frequently include elastic bands or springs, which merely exert a passive resistance to voluntary elongations of one or more fingers. These types of orthotic systems allow for the treatment of fingers that can still move independently against the negating elastic component's recovery force. The greatest forces generated by commercial splints for this purpose are typically in the range of 1–10 N. Although such a technique is a relatively simple and effective way to execute basic rehabilitation activities, it is bound by an obvious limitation: the inability to modulate the counteracting action. In fact, the mechanical compliance of the system is pre-defined by the fixed mechanical properties of the adopted elastic component [19].

F. Active Dynamic Hand Splint

Of course, the solely manual restrictions required for passive splints have inherent limits in comparison to the far more helpful electrical restrictions. Such functionality is offered by ‘active dynamic hand splint’. They're designed as orthotic systems with incorporated electromechanical actuation mechanisms, with the goal of allowing electrical control of the system's most important mechanical aspects. Active splints, for example, are designed to provide therapeutic forces that can be accurately and constantly controlled by an electrical input, even in closed-loop systems. As a result, the patient can receive precise rehabilitation programmes by keeping track of the most important rehabilitation criteria. These could include things like the waveform, amplitude, frequency, duration, rising time, and repetition rate of a force signal, among other things. These parameters might be selected from established sets or continuously adjusted during the training phase, depending on the patient's particular response. The choice of actuation technology is critical for the efficacy of the resulting system when developing active orthoses. So far, several electromechanical transduction techniques have been investigated to provide hand systems (not necessarily a splint) with actuation functionalities. These technologies include pneumatic devices [20], electromagnetic motors [21] and shape memory alloys [22]. Additionally, useful means to electrically modulate resistive forces for hand rehabilitation devices have been demonstrated recently by using electrorheological fluids [23]. Given the appealing performance characteristics of all of these actuation methods, these techniques are often characterised by larger, rigid, and bulky devices. They obscure the structure of the orthotic system, making it difficult to wear and transport.

G. Wrist Extension Splint

A wrist splint is a brace that looks like a glove but has no fingers. It keeps your wrist steady while it is straight or slightly inclined. Wrist splints ease pressure on the median curve, provide relaxation from activities that aggravate carpal tunnel syndrome, and can stabilise the wrist in a physiologically beneficial wrist position (10–15 degrees), allowing the extrinsic finger flexors to improve muscular endurance [24]. They are also useful for limiting wrist circumduction and decreasing torque during heavy wrist chores [25]. Wrist extension splints are often prescribed and delivered to stroke patients. Wrist splints, as opposed to static resting splints, are intended to allow the user to continue functioning while reducing discomfort and providing support for the wrist. Normally, patients must wear them during strenuous duties, which might lengthen the time it takes the wearer to complete such tasks. Splints can also become unusable due to dirt. Thus, depending on the sorts of activities that patients engage in, both the wearing duration and the quantity and type of stress on the joints would vary significantly across patients. There are researches that underline the need for standardised wearing time [26]. It is more difficult to standardise the amount of tension applied to the joints.

Commercial wrist extension splints have been demonstrated to increase power grip strength in those who have had a mild to severe stroke. According to the findings of this research, prescribing wrist extension splints is not an easy task. To design the daily wear schedule, the occupational therapist and the patient must collaborate. There is limited data to support the long-term effectiveness of wrist extension splints, and the quality of evidence provided suggests that these splints have moderate clinical effectiveness [27].

H. Finger Splint

Finger splints are devices that keep a damaged finger immobilised and stable. Mallet finger injury, ligamentous sprain and dislocation of the proximal interphalangeal [PIP] joint of fingers, etc., are very common types of simple hand injuries where we can use finger splints. If we protect the injured area and correct the alignment of the joint immediately, we can facilitate early joint movement while maximising functional recovery. There are three simple finger splints to tackle these injuries for quick and effective conservative treatment.

I. Mallet Finger Splint

“Drop finger” and “baseball finger” are other names for mallet finger. Due to extensor tendon mechanism damage, the end of a finger cannot be actively straightened out. Treatment involves at least six weeks of splint use. Surgical fixing is sometimes employed [28]. About half of the cases might be cured or considerably improved by simple splintage. According to the studies, the Stack splint is also chosen for the patient's comfort and convenience [29]. This splint has been shown to be quite effective in both tendon injuries and fracture cases, with no need for open reduction of even substantial fracture fragments without distal phalanx dislocation. Despite the fact that this splint was initially published in 1969, specific results and approaches have not yet been described [30].

J. Buddy Splint

These involve two fingers taped together. When a person has a stretched finger, they use buddy splints. For example, as a result of a jamming (when the tip of the finger is compressed towards the hand) injury. For fractured fingers, this splint is not suggested. The splints are made of rigid material, which optimises the transmission of forces from the uninvolved to the involved digit. The splints are aligned with the anatomic axis of the joints, allowing for finger length discrepancies. The splints distribute the stress over a broader surface area, reducing the amount of strain on the skin. When the buddy splints are utilized on the distal phalanx, the splints do not migrate distally [31].

III. COMPARISON OF LITERATURE AVAILABLE OF SPLINTS

IV. DISCUSSION

While static splinting has been one of the most popular methods of splinting in order to improve hand mobility after a stroke, the evidence backing its efficacy is mixed. Many studies have shown that participants often experience pain or discomfort while wearing the orthosis, limiting its efficacy. Dynamic splints, on the other hand, are generally shown to be effective at improving range of motion, dexterity, and grip and finger strength. Importantly, dynamic splints do not cause as much discomfort as static splints and are generally more affordable. However, the research on dynamic splints and their efficacy is limited.

In this review paper, apart from classifying different types of splints, there is also a collection of data for the effects of splints or orthosis. It has been taken as separating patients into two groups; one is the intervention group, in which orthosis happens, and the control group, which is unexperimented. The analysis is done by different means: Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Action Research Arm Test (ARAT), Visual Analog Scale (VAS), Electromyography (EMG), analysis of variance (ANOVA), etc. Splinting is far more effective in improving and maintaining the patient's functional abilities in hand abnormalities following stroke. The relevance of the Assistive device as a compensation for activity limitations has been highlighted in studies. Functional limits and illness severity have been found for predictive application. Because of the link between particular constraints and the use of adaptive devices, it's possible that assistive device prescriptions should be restricted to patients who have impaired or limited device-related activities now or in the future. For certain stroke patients who can tolerate this low-cost orthosis, a static orthosis can be an effective way to avoid contractures. However, there is a subset of chronic stroke patients who cannot tolerate a static orthosis and require further treatment to avoid contractures in the upper limb. Stepped care can be employed in this group; if static orthoses are not tolerated, another intervention, such as a dynamic orthosis, would be used.

Conclusion

In this review paper we have studied about six broad types of splints and their seven different sub-types collectively. also compared the efficacy of various hand splints. From the above assessment, we can conclude that throughout the years, splinting techniques have advanced exponentially from various static splints to dynamic splints with their extensions. Every splint serves a different purpose, such as static splints are useful for hands which are in rest position, dynamic splints are useful for the patient who requires some amount of motion, wrist splints, as the name suggests, give assistance to the wrist portion with its extensions, finger splints are used for individual fingers, thumbs specifically, and metacarpal ulnar deviation splints for the metacarpophalangeal joints. But with these studies, one thing is clear, which is that it takes a long time to keep it wearing. Hence, there is a lot of scope for developing dynamic hand splints or dynamic hand splints with finger extension to be used for better recovery, less time consumption, and less dependency on others.

References

[1] Hunter S, Crome P. Hand function and stroke. Reviews in Clinical gerontology. 2002;12(1):68-81. [2] Harris JE, Eng JJ. Individuals with the dominant hand affected following stroke demonstrate less impairment than those with the nondominant hand affected. Neurorehabilitation and neural repair. 2006;20(3):380-9. [3] Pyun SB, Kim SH, Hahn MS, Kwon HK, Lee HJ. Quality of Life after Stroke. Journal of the Korean Academy of Rehabilitation Medicine. 1999;23(2):233-9. [4] Adams J, Hammond A, Burridge J, Cooper C. Static orthoses in the prevention of hand dysfunction in rheumatoid arthritis: a review of the literature. Musculoskeletal care. 2005;3(2):85-101. [5] Pagnotta A, Korner-Bitensky N, Mazer B, Baron M, Wood-Dauphinee S. Static wrist splint use in the performance of daily activities by individuals with rheumatoid arthritis. The Journal of Rheumatology. 2005;32(11):2136-43. [6] Janssen M, Phiferons J, van den Velde E. The prevention of hand deformities with resting splints in rheumatoid arthritis patients. A randomized single blind one year follow-up study. Arthritis and Rheumatism. 1990;33:123. [7] Ouellette EA, editor The rheumatoid hand: orthotics as preventative. Seminars in arthritis and rheumatism; 1991: Elsevier. [8] Kjeken I, Møller G, Kvien TK. Use of commercially produced elastic wrist orthoses in chronic arthritis: a controlled study. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1995;8(2):108-13. [9] Hammond A. The use of self-management strategies by people with rheumatoid arthritis. Clinical rehabilitation. 1998;12(1):81-7. [10] McClure PW, Blackburn LG, Dusold C. The use of splints in the treatment of joint stiffness: biologic rationale and an algorithm for making clinical decisions. Physical Therapy. 1994;74(12):1101-7. [11] Biese J. Therapist’s evaluation and conservative management of rheumatoid arthritis in the hand and wrist. Rehabilitation of the hand and upper extremity. 2002;5:1569-81. [12] Bielefeld T, Neumann DA. The unstable metacarpophalangeal joint in rheumatoid arthritis: anatomy, pathomechanics, and physical rehabilitation considerations. Journal of Orthopaedic & Sports Physical Therapy. 2005;35(8):502-20. [13] Rossi J. Concepts and current trends in hand splinting. Occupational Therapy In Health Care. 1988;4(3-4):53-68. [14] Schultz-Johnson K. Static progressive splinting. Journal of Hand Therapy. 2002;15(2):163-78. [15] Reid DT, Sochaniwskyj A. Influences of a hand positioning device on upper-extremity control of children with cerebral palsy. International Journal of Rehabilitation research Internationale Zeitschrift fur Rehabilitationsforschung Revue Internationale de Recherches de Readaptation. 1992;15(1):15-29. [16] Puri V, Khare N, Venkateshwaran N, Bharadwaj S, Choudhary S, Deshpande O, et al. Serial splintage: preoperative treatment of upper limb contracture. Burns. 2013;39(6):1096-100. [17] Srinivasan M, Knowles D, Wood J. The Ossy Splint-A New Design of Dynamic Extension Splint. The British Journal of Hand Therapy. 2000;5(3):72-4. [18] Gallucci GL, Boretto JG, Dávalos MA, Donndorff A, Alfie VA, De Carli P. Dynamic splint for the treatment of stiff elbow. Shoulder & Elbow. 2011;3(1):52-5. [19] Carpi F, Mannini A, De Rossi D. Dynamic splint-like hand orthosis for finger rehabilitation. Biomedical applications of electroactive polymer actuators. 2009:443-61. [20] Noritsugu T, Yamamoto H, Sasakil D, Takaiwa M, editors. Wearable power assist device for hand grasping using pneumatic artificial rubber muscle. SICE 2004 annual conference; 2004: IEEE. [21] Bouzit M, Burdea G, Popescu G, Boian R. The Rutgers Master II-new design force-feedback glove. IEEE/ASME Transactions on mechatronics. 2002;7(2):256-63. [22] Dittmer DK, Buchal RO, MacArthur DE. The SMART wrist-hand orthosis (WHO) for quadriplegic patients. JPO: Journal of Prosthetics and Orthotics. 1993;5(3):73. [23] Khanicheh A, Muto A, Triantafyllou C, Weinberg B, Astrakas L, Tzika A, et al. fMRI-compatible rehabilitation hand device. Journal of neuroengineering and rehabilitation. 2006;3(1):1-11. [24] Stern EB, Ytterberg SR, Krug HE, Mullin GT, Mahowald ML. Immediate and short?term effects of three commercial wrist extensor orthoses on grip strength and function in patients with rheumatoid arthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1996;9(1):42-50. [25] Cordery J, Rocchi M. Joint protection and fatigue management. Rheumatologic rehabilitation. 1998;1:279-322. [26] Haskett S, Backman C, Porter B, Goyert J, Palejko G. A crossover trial of custom?made and commercially available wrist splints in adults with inflammatory arthritis. Arthritis Care & Research: Official Journal of the American College of Rheumatology. 2004;51(5):792-9. [27] Curtin M. Development of a tetraplegic hand assessment and splinting protocol. Spinal Cord. 1994;32(3):159-69. [28] Handoll HH, Vaghela MV. Interventions for treating mallet finger injuries. Cochrane Database of Systematic Reviews. 2004(3). [29] Warren R, Norris S, Ferguson D. Mallet finger: a trial of two splints. Journal of Hand Surgery. 1988;13(2):151-3. [30] Crawford GP. The molded polythene splint for mallet finger deformities. The Journal of hand surgery. 1984;9(2):231-7. [31] Lamey G. Buddy splint. Journal of hand therapy: official journal of the American Society of Hand Therapists. 1994;7(1):30-1. [32] Lannin NA, Cusick A, McCluskey A, Herbert RD. Effects of splinting on wrist contracture after stroke: a randomized controlled trial. Stroke. 2007 Jan 1;38(1):111-6. [33] Fujiwara T, Liu M, Hase K, Tanaka N, Hara Y. Electrophysiological and clinical assessment of a simple wrist-hand splint for patients with chronic spastic hemiparesis secondary to stroke. Electromyography and clinical neurophysiology. 2004 Oct 1;44(7):423-9. [34] Jung YJ, Hong JH, Kwon HG, Song JC, Kim C, Park S, Ki Kim Y, Ahn SH, Jang SH. The effect of a stretching device on hand spasticity in chronic hemiparetic stroke patients. NeuroRehabilitation. 2011 Jan 1;29(1):53-9. [35] Choi JB, Ma SR, Song BK. The effect of resting hand splint on hand pain and edema among patients with stroke. Journal of Ecophysiology and Occupational Health. 2017 Jun 7;16(1-2):37-41. [36] Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial. Archives of physical medicine and rehabilitation. 2008 Oct 1;89(10):1857-62. [37] Kim EH, Jang MC, Seo JP, Jang SH, Song JC, Jo HM. The effect of a hand-stretching device during the management of spasticity in chronic hemiparetic stroke patients. Annals of rehabilitation medicine. 2013 Apr;37(2):235. [38] Andringa A, van de Port I, Meijer JW. Long-term use of a static hand-wrist orthosis in chronic stroke patients: a pilot study. Stroke research and treatment. 2013 Feb 27;2013. [39] Park EH, Kang JY, Chun MH. Effects of resting hand splint in early stroke patients. Journal of the Korean Academy of Rehabilitation Medicine. 2006:261-5. [40] Suat E, ?brahim Engin ?, Nilgün B, Yavuz Y, Fatma U. Short-and long-term effects of an inhibitor hand splint in poststroke patients: a randomized controlled trial. Topics in stroke rehabilitation. 2011 May 1;18(3):231-7. [41] Poole JL, Whitney SL, Hangeland N, Baker C. The effectiveness of inflatable pressure splints on motor function in stroke patients. The Occupational Therapy Journal of Research. 1990 Nov;10(6):360-6. [42] Khallaf ME, Ameer MA, Fayed EE. Effect of task specific training and wrist-fingers extension splint on hand joints range of motion and function after stroke. NeuroRehabilitation. 2017 Jan 1;41(2):437-44. [43] Jang WH, Kwon HC, Yoo KJ, Jang SH. The effect of a wrist-hand stretching device for spasticity in chronic hemiparetic stroke patients. Eur J Phys Rehabil Med. 2016 Feb 1;52(1):65-71. [44] Andringa AS, Van de Port IG, Meijer JW. Tolerance and effectiveness of a new dynamic hand-wrist orthosis in chronic stroke patients. NeuroRehabilitation. 2013 Jan 1;33(2):225-31. [45] Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in poststroke spasticity of the upper limb. Archives of physical medicine and rehabilitation. 2005 Sep 1;86(9):1855-9. [46] Franck JA, Timmermans AA, Seelen HA. Effects of a dynamic hand orthosis for functional use of the impaired upper limb in sub-acute stroke patients: A multiple single case experimental design study. Technology and Disability. 2013 Jan 1;25(3):177-87.

Copyright

Copyright © 2022 Dr. M. Sohail Pervez, Ankit Nagrare. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.