Description of Intervention1-5
A resting splint is a type of splint that is used to hold certain joints and muscles of the fingers and/or wrist in a position of rest, also known as a “functional position”. They are frequently prescribed by Physicians based on a request by hand therapists for a variety of diagnoses and are most often custom made by the therapist from a moulded thermoplastic material and fitted with Velcro fastening straps. The purpose of resting splints varies slightly depending on the condition being treated, but in most cases their overall goal is to maintain proper range of motion (ROM) and prevent joint contracture. To achieve a resting position, involved joints are typically placed in a neutral or near-neutral position.
One of the most common applications of resting splints is for rheumatoid arthritis, for which they are worn when a patient experiences a painful flare-up or a period of joint discomfort. These patients may require intervals of rest, which usually involves placing the wrist in slight extension metacarpophalangeal (MP) joints in slight to moderate flexion, and IPs in neutral. For patients recovering from a stroke and other related neurologic conditions, resting splints help to maintain or increase the mobility of the spastic or paretic hand, prevent joint deformities, and reduce muscle hypertonia. In carpal tunnel syndrome, a resting splint is recommended to reduce irritation of nerves and prevent further disease progression. Resting splints are also helpful for alleviating pain and swelling, providing relaxation for the hand and wrist, ensuring proper positioning during sleep, and helping to maintain the length of soft tissues.
Indications for Intervention
A resting splint is indicated for various upper extremity musculoskeletal conditions to hold certain joints of the fingers and/or wrist in a resting position with the goal of maintaining proper ROM of these joints, avoiding joint contracture, and alleviating pain, swelling, and inflammation.
- Ask the patient to describe their medical history, with a focus on any ROM limitations or impairments of the hand or wrist. Ensure that the patient describes their symptoms, the duration of these symptoms, and any inciting injury or event, in detail.
- Ask if the patient has any comorbidities, including diabetes, osteopenia/osteoporosis, cardiovascular issues, or a history of smoking.
- Perform a physical examination of the hand and wrist. If ROM is impaired, measure the active and passive ROM of the joint(s) involved and compare these value(s) with the contralateral side.
- If pain is present, ask the patient to rate their pain on the visual analogue scale (VAS) or a similar pain scale.
- Consider using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, which is used to assess impairment of the upper extremity.
- Other parameters that may be evaluated include task performance with a hand function test, power grip with a hand dynamometer, pinch grip with a hydraulic pinch gauge, and dexterity with a pegboard.6,7
- Assign a diagnosis based on the patient’s history, symptomatology, and examination findings, and prescribe a resting splint if it is likely to benefit the patient.
Orthoses Guidelines4-6,8-10
If the initial evaluation indicates that the patient is a good candidate for a resting splint, you may choose from either a prefabricated, custom-fitted, or custom-fabricated splint:
- Prefabricated splint: these splints are made by a manufacturer and can be purchased over the counter at pharmacies or with a prescription from orthopaedic supply stores; therefore, prefabricated splints are not individualized for the patient and do not require any special fitting services, but patients can make minimal adjustments with Velcro straps to ensure the splint fits properly
- Custom-fitted splint: this is a type of prefabricated splint that requires bending, cutting, or molding the splint to fit the patient’s hand properly; it may be necessary to apply heat to manipulate the splint
- Custom-fabricated splint: these splints are individualized for each patient by taking castings, measurements, tracings, and images of the injured area that are used to create a specialized splint; you will then fabricate the splint by molding, drilling, sewing, or bending the splint material before fitting and applying it to the patient
Custom-fitted and custom-fabricated splints are strongly recommended for most patients, but a prefabricated splint may be sufficient in some cases when the presentation is mild. Resting splints can be constructed with a variety of materials, including plaster, fiberglass, padding, ace wraps, metal, cloth, plastic, or leather. If fitting or fabricating the splint, ensure that it fits comfortably. The splint should also allow for maximal sensory perception, and the pressure of the splint should be distributed equally. It should not challenge the normal contours of the hand and forearm. Pain medications may be needed before and during the splinting process.
The specific positioning of splinted joints depends on the patient’s condition and the therapist’s preference, but examples of splinting protocols for several common conditions are provided below:
- Rheumatoid arthritis: place the forearm in a prone position, the wrist in a neutral position, the MP joints in a maximum of 60° flexion, the interphalangeal (IP) joints in a neutral position, and the thumb in mid-opposition
- Carpal tunnel syndrome: immobilize the wrist in a neutral or slightly extended position (0-20° from neutral), which is intended to reduce pressure within the carpal tunnel. Too much extension may increase the risk of CTS.
- Stroke: place the hand and wrist in a functional resting position, with the wrist in 30° of extension, a normal transverse arch, the thumb in abduction and opposition with the pads of the four fingers, and the MP and proximal IP joints in 45° of flexion
- Metacarpal fracture: place the wrist in extension and the MP joint in 90° flexion
After the splint is applied, provide the patient with wear and care instructions, including cleaning directions, which vary by splint. The frequency of use depends on the type and severity of the condition and the patient’s comfort level. For rheumatoid arthritis, the patient may be advised to wear the splint at night, during rest periods, and especially when their hands are red, warm, swollen, or tender. Consider instructing the patient to wear the splint for a minimum period (e.g., 90 minutes per day) initially and then increasing its usage gradually over time (e.g., by 15 minutes more per day). The duration of use also varies, but usually begins with a period of 4–8 weeks, which may be extended if indicated and tolerated by the patient. When the splint is not worn, encourage patients to continue moving their affected wrist normally to keep muscles flexible and strong.
A resting splint is only one component of a treatment program and should be supplemented with other interventions during and after their use, particularly stretching and strengthening exercises, manual therapy, therapeutic modalities, and functional training.
