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Forearm Based Thumb Spica Orthosis

Information

Description of Intervention

The thumb spica splint is used to treat the thumb and wrist together, to help the patient to regain as much functional ability as possible, for rehabilitation from a disease, injury and/or surgical treatment. This splint should be worn for at least 4 weeks. Rigorous activity of the thumb should be avoided for approximately 3 months; this can delay a return to work, depending on the patient’s occupation.1

Common applications for the thumb spica splint include DeQuervain’s disease, thumb basilar joint (CMC) osteoarthritis, Scaphoid fractures, and CMC OA. Some patients with de Quervain’s find that the most positive outcomes are achieved by combining corticosteroid injections with the thumb spica splint. For the corticosteroid injection, 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenderness can be used.2

Indications for Intervention

The thumb spica splint is indicated for patients with DeQuervain’s disease, thumb TMC osteoarthritis, metacarpophalangeal (MCP) joint or collateral ligament healing, scaphoid fracture and acute partial rupture of the thumb ulnar collateral ligament (UCL).

  1. Ask for the patient’s medical history, with a focus on details of any recent injuries. Find out if the patient’s occupation involves close work with the hands, for example carpentry, music or surgery.
  2. Record comorbidities, including diabetes, osteopenia, cardiovascular issues or a history of smoking.
  3. Check active and passive range of motion, in the hand and wrist, including the MCP joints.
  4. Test thumb carpometacarpal (CMC) joint range of motion. Try to place the goniometer arms over the first and second metacarpal, with the axis at the CMC joint.3
  5. Check palmar and lateral pinch strength of the thumb.4
  6. Ask the patient to rate their pain, on the visual analogue scale (VAS) or a similar outcome measure.

Orthoses Guidelines

After the initial examination, the therapist can determine if the patient needs a thumb spica splint. The splint will place the metacarpal in gentle palmar abduction and the MCP joint in slight flexion.3 The interphalangeal (IP) joint should be left free to move, in order to prevent stiffness.

For patients with DeQuervain’s, position the hand at 25° extension and slight radial deviation of the wrist, slight flexion of the first MCP joint, and mid-palmar abduction at the first CMC joint. For patients with MCP collateral ligament healing, place the hand with slight flexion at the MCP joint and correction of lateral deviation.5

Treatment options include static and dynamic splints. For patients with de Quervain’s, the dynamic thumb spica may be easier to use and more effective.4 For thumb osteoarthritis, some patients prefer a static splint to wear at night, and a less restrictive splint to wear during the day to facilitate activities.3

When the splint is ready, the patient should be provided with wear and care instructions. The patient can wear the thumb spica splint throughout the day or only at night. During and after the period of using the splint, the patient should be diligent with stretching and strengthening exercises, as recommended by the therapist. After approximately 3 months of using the splint, a gradual return to more rigorous activities is advised.

Diagnoses Where This Intervention May be Relevant
Comments and Pearls
  • Patients with thumb osteoarthritis should participate in planning their exercise program, as they gradually reduce their use of the thumb spica splint.
  • Some patients with thumb osteoarthritis may be musicians, who might benefit from minor changes in technique along with splinting.5
  • Skin conditions and pallor should be monitored for proper fit and dermatitis cases. Adjustments may be needed as post-injury or post-operative swelling reduces.
References
  1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  2. Mardani-Kivi M, Mobarakeh MK, Bahrami F, et al. Corticosteroid injection with or without thumb spica cast for de Quervain’s tenosynovitis. J Hand Surg 2014 etc. PMID: 24315492
  3. Wietlisbach C. Cooper’s Fundamentals of Hand Therapy. Missouri: Elsevier, 2020.
  4. Nemati Z, Javanshir MA, Saeedi H, et al. The effect of new dynamic splint in pinch strength in De Quervain syndrome: a comparative study. Disabil Rehabil Assist Technol 2017;12(5):457-61. 26886047
  5. Salter M, Cheshire L. Hand Therapy: Principles and Practice. Oxford: Reed Educational and Professional Publishing Ltd, 2000.
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