Thumb HoleWrist Orthosis
Clinical Examples Rheumatoid Arthritis Carpal Tunnel Syndrome Total Wrist Fusion TFCC Injury
Positioning the body The client should be seated and upright. The elbow is stabilized on a table with forearm placed in neutral, wrist placed in 15-20° of extension, fingers flexed to 45-90° at the MCP joint, and thumb facing the client for a forearm neutral position (thumb will be later placed in palmar abduction)). A towel or pad under the elbow can decrease pressure on the ulnar nerve. If carpal tunnel syndrome is present, the wrist should be placed in neutral.
Contraindications/Precautions Not meant for people with hand edema, particularly the MCP joints or thumb, as a circumferential splint may create pressure.
Instruction 1. Carry heated thermoplastic on a towel to the client to prevent stretching or leaving fingerprints on the materials, and to remove hot water. 2. The thumbhole is stretched and given one fold for comfort and to add strength to the thermoplastic. 3. Place the thermoplastic over the thumb. 4. To ensure the thenar eminence has room for full thumb opposition and to support the palmar arches, have the client to touch their middle finger to thumb, keep the thumb in palmar abduction. 5. The MCP joint of the little finger needs full flexion for functional hand use. The thermoplastic must remain below the palmar crease. 6. Stroke the material. Keep the arm, wrist, and hand in the correct position while the splint hardens. 7. The splint should extend 2/3 up the forearm; trim with curved scissors to fit. Pay particular attention to creating smooth edges to prevent skin irritation.
Final Check Check for clearance of radial and ulnar styloid processes, thumb, and finger MCP joints. The splint should not create any areas of pressure for the client, observed as blanched or red skin. If areas are
Division of Occupational Therapy
1959 NE Pacific Street OFFICE 206.598.5764 Box 356490 FAX 206.685.3240 Seattle, WA 98195-6490 WEB rehab.washington.edu/education/degree/ot/
identified, the splint should be spot heated and stretched to eliminate the pressure. Observe the patient donning and doffing the splint correctly. Provide written wear/care instructions.
Adding Straps This splint requires three straps for optimal distribution of pressure and security.
Materials 1” adhesive-back hook Velcro: 3” piece 1” loop Velcro or strapping: 8” (or enough to go across the dorsum of the hand) 2” loop Velcro or strapping: 8”, 10” (or enough to go around the distal and proximal forearm)
Instructions A. The 8” distal strap covers the dorsum of the hand and attaches to the middle of 3” hook on the palmar crease of the splint, this makes doffing easier and increases the longevity. A slit can be cut to accommodate the palmar arches1. Ensure that there is minimal tension across the dorsum of the hand to allow for sufficient return circulation. If there is a lot of swelling a 2” strap can be used and trimmed down to fit the contour of the hand. B. The 8” middle strap is placed proximally to wrist crease on dorsal side of the forearm and attaches to the middle of 3” hook on the volar side of the splint. It should follow the contour of the arm. C. The 12” proximal strap is placed an inch or two from the end of the splint and attaches to the middle of 3” hook on the volar side of the splint. It should follow the contour of the arm.
Final Check The straps should not cause any areas of pressure or block venous return in the dorsum of the hand.
Division of Occupational Therapy
1959 NE Pacific Street OFFICE 206.598.5764 Box 356490 FAX 206.685.3240 Seattle, WA 98195-6490 WEB rehab.washington.edu/education/degree/ot/