Description of Intervention
A wrist splint is one of the easiest and safest treatments for many musculoskeletal conditions that involve the wrist. The purpose of a splint is to immobilize the wrist to reduce pain and other symptoms and help the patient regain their functional abilities. The two main types of wrist splints are static and dynamic splints. Static splints have no moving parts and provide support and immobilization, while dynamic splints feature traction devices like rubber bands, springs, cords, or Velcro strips to influence the passive range of motion (ROM) of joints.1
The cock-up splint is an extremely popular wrist splint.2 It is a static splint that holds the wrist in extension—usually between 0° to 20° of extension—but does not support the thumb and fingers, which allows the functional use of these digits.3 One of the most common applications of cock-up wrist splints is for patients with carpal tunnel syndrome, in which they reduce pressure upon the median and support the wrist in a neutral position to maximize the carpal tunnel space; however, cock-up wrist splints are also prescribed for many other wrist conditions, including sprains, tendinitis, arthritis, and fracture and surgery recovery.3-5
Cock-up wrist splints are attractive because they protect impaired tissue, relieve pain, stabilize the wrist, correct or prevent deformities, and help patients recover function by minimizing activation of the wrist muscles. Most patients also consider them to be comfortable to wear and convenient to use. Cock-up wrist splints may be worn throughout the day or only at night, since most people move their hands and wrists while sleeping, which can aggravate symptoms.2
Indications for Intervention
The cock-up wrist splint is indicated for patients with mild to moderate carpal tunnel syndrome, as well as many other musculoskeletal involving the wrist, including fractures, sprains, tendinitis, and arthritis. Patients recovering from surgery and transitioning from a cast are also good candidates for cock-up wrist splints.
- Ask the patient to describe their medical history, with a focus on any recent injuries to the wrist or forearm. Be sure the patient describes their symptoms and the duration of these symptoms in detail.
- Ask if the patient has any comorbidities, including diabetes, osteopenia, cardiovascular issues, or being a smoker.
- Perform a physical examination of the wrist and forearm. If ROM is impaired, measure the active and passive ROM of the wrist and compare it to the contralateral side.
- Ask the patient to rate their pain on the visual analogue scale (VAS) or a similar outcome measure.
- Consider using the DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire to evaluate the patient’s subjective 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.1
- Based on the patient’s symptoms and results from the objective assessments, consider the use of a cock-up wrist splint if it is likely to benefit the patient.
Orthoses Guidelines1,3,6,7
If the initial evaluation indicates that the patient is a good candidate for a cock-up wrist splint, you may select 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 orthopedic and medical supply stores; therefore, prefabricated splints are not individualized for the patient and do not require any special fitting services, but you can make minimal adjustments to ensure the splint fits properly
- Custom-fitted splint: this is a type of prefabricated splint that requires you to make adjustments by bending, cutting, or molding the splint to fit the patient’s wrist properly; you may also have to use 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 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 for some patients with only minor symptoms. These are made by Occupational Therapist and Physical Therapists Cock-up wrist 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.
After the splint is prepared, provide the patient with wear and care instructions. This should include cleaning instructions, which vary by splint. The frequency and duration of use depend on the type and severity of the condition and the patient’s comfort level with the splint. You may recommend that the patient either wears the splint overnight only or also during the day (up to 24 hours per day). It may be helpful for the patient to wear the splint during activities that trigger flare-ups in those with carpal tunnel syndrome, but excessive use of the splint can limit ROM and other physical abilities. 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.
Cock-up wrist splints should be supplemented with other interventions during and after their use, particularly stretching and strengthening exercises, manual therapy, therapeutic modalities, and functional training.
