Thumb Spica Splinting is often effective as a short-lived immobilization measure and provides adequate protection from further soft tissue injury secondary to the structural support when the technique is performed correctly. Acute injuries are well-suited to splinting as splinting accommodates for anticipated swelling, whereas casting doesn’t. This activity describes the indications, contraindications, and techniques involved in placing thumb spica splints, and highlights the role of the healthcare professional in the management of hand injuries.
Anatomy
The PCL originates from the dorsal third of the metacarpal head and inserts on the volar aspect of the proximal phalanx. The ACL originates from the palmar to the PCL and runs continuously through the PCL to insert on the volar plate. The PCL function is taut in flexion, while the ACL is taut in extension. Both ligaments ensure the ulnar stability of the metacarpophalangeal joint. The Adductor pollicis inserts on the proximal phalanx, work as a dynamic stabilizer of the MCP joint. It lies superficial to the ulnar collateral ligament.[rx]
The ulnar collateral ligament is formed from two parts, the right collateral ligament (PCL) and therefore the accessory collateral ligament (ACL). The PCL has its origin proximal to the bottom of the top of the MCP-1 joint and its insertion on the volar side of the proximal phalanx. The ACL has its origin just palmar of the PCL and runs parallel to the PCL to its insertion on the proximal phalanx. Together they make sure the ulnar and volar stability of the bottom of the thumb. However, there are other components that also participate in creating stability within the joint. they will be divided into static and dynamic components. Next to the PCL and ACL, the form of the joint, the dorsal capsule, and therefore the volar plate structure the static components.
The most important dynamic component is the adductor pollicis muscle. This muscle has its insertion onto the proximal phalanx partly superficial to and partly deeper than the UCL. This relationship is crucial to understanding how a Stener lesion can occur. Most of the time, the distal end of the UCL ruptures.
The PCL originates from the dorsal third of the metacarpal bone’s head and inserts on the volar aspect of the proximal phalanx. The ACL originates palmar to the PCL and runs continuously with the PCL to insert on the volar plate. The PCL is taut in flexion, while the ACL is taut in extension. Both ligaments ensure the ulnar stability of the MCP joint. The radial and ulnar collateral ligaments are the primary stabilizers to varus and valgus stress on this joint.
Hand and wrist injuries afflict a good range of adult and pediatric general population groups. Further, they will potentially impact patients of all ages and activity levels. Thus, not only do these injuries occur in high-level, professional athletes, but they will occur secondary to low-energy trauma (e.g., ground-level falls within the elderly) during normal daily activities.
Splinting about the wrist, generally, serves a possible role within the initial (or definitive) stabilization of the wrist and periarticular joint injuries. Splinting is often effective as a short-lived immobilization measure and provides adequate protection from further soft tissue injury secondary to the structural support when the technique is performed correctly. Acute injuries are like this modality as splinting (as against casting) accommodates for the anticipation of swelling.
Thumb spica splinting is a crucial technique for clinicians and healthcare providers in the least levels and specialties given the potential utility it can have for the temporary or definitive immobilization counting on the precise sort of injury into account.
Anatomy and Physiology
The wrist also mentioned because the wrist may be a condyloid articulatio synovialis of the distal upper limb that connects and is a transition point between the forearm and hand. A condyloid joint may be a modified ball and socket joint that permits flexion, extension, abduction, and adduction movements. The joint itself is made through the articulations between the distal radius and therefore the scaphoid, lunate, and triquetrum.
The proximal articulation forms a concavity composed of a mixture between the distal end of the radius and the articular disk. The distal articulation is convex, consisting of the scaphoid, lunate, and triquetrum bones of the proximal hand. Note that the ulna isn’t a part of the wrist itself, because it articulates distally via the distal radioulnar joint (DRUJ).
The radiocarpal ligament is large, present on the dorsal and palmar surfaces of the wrist, and further connects the radius to distal carpal bones. The distal ulna, however, doesn’t are available contact with carpal bones and is attached to the radius via the radio-ulnar joint. Finally, dense fibrous animal tissue crammed with synovia wraps the whole joint itself.
Scaphoid considerations
The position of the scaphoid in regard to the wrist, carpus, and distal articulations is exclusive compared to its counterpart carpal bones. Serving because the radial border of the proximal carpal row, the scaphoid is nearly entirely covered by articular cartilage which allows it to act as an osseous bridge connecting the proximal and distal carpal row articulations. Its blood supply coming from the arteria radialis is provided during a retrograde fashion, leaving the proximal portion of the scaphoid most vulnerable to ischemia and avascular necrosis following injury.
Indications
The thumb spica splint is indicated in radially-based hand and wrist injuries. samples of these injuries include but aren’t limited
- Various sorts of soft tissue and/or osseous injuries along the thumb/first ray
- These injuries include osseous injuries (e.g., phalangeal or metacarpal fractures) or soft-tissue based injuries (e.g., thumb ulnar collateral ligament (UCL) injuries)
- Other injuries include first metacarpal base injuries (i.e., Bennett and Rolando fractures)
- Degenerative conditions of the thumb (e.g., carpometacarpal thumb osteoarthritis, also commonly mentioned as basal joint arthritis)
- Fractures of the carpus
- Scaphoid fractures
- Lunate fractures
- De Quervain tenosynovitis
- Carpal tunnel syndrome, Not considered standard of care within the management of CTS
- Cock-up wrist splints are often effective as night-splinting modalities; however, the utilization of splinting measures within the management of CTS remains controversial
Although controversial, some studies report improvement in symptoms within the short-term management of symptoms – some studies have demonstrated a possible clinical benefit within the use of splinting measures for patients with primarily nocturnal symptoms
Contraindications
There are not any specific contraindications to thumb spica splinting.
Equipment
Thumb spica splints are often prefabricated or fiberglass.[8] Pre-fabricated splints are able to use immediately and wish only minor adjustments via velcro straps. For fiberglass splints, necessary materials include:
- Plaster or padded fiberglass
- Plaster wool
- Bucket of water
- Scissors
- Crepe bandage
Personnel
- Thumb spica splinting is often wiped out in any traumatic, medical care, or emergency setting by a physician, nurse, or technician. the method is performable by one operator.
Preparation
Thumb spica splints can extend from the thumb to mid-forearm or from the thumb to above the elbow. within the setting of a scaphoid fracture, the utilization of a long-arm thumb spica splint may cause shorter unions times within the first 4 to six weeks and diminish the shearing forces from the radius and ulna on the scaphoid. However, by the top of splinting treatment, both long and short thumb spica splints will have equal efficacy in treating a scaphoid fracture an easy short-arm thumb spica splint is acceptable and effective for patients with De Quervain’s tenosynovitis and first metacarpal fractures (Bennet and Rolando fractures).
It is vital that the splint allows for balanced function and maximal mobility of the unaffected areas like the fingers, upper arm, and shoulder. The splint should also leave maximal sensory perception, and therefore the pressure of the splint should be distributed equally. The splint shouldn’t challenge the traditional contours of the hand and forearm. If needed, the patient should have adequate analgesia before and alongside the splinting process.
Technique
- Perform a comprehensive physical examination before splinting
- Have the patient rest his or her elbow on a table, and therefore the forearm should be during a neutral position
- The thumb should be within the normal resting anatomic position
- Measure a 4-inch wide, eight layers thick plaster measured from the tip of the thumb to the proximal forearm
- Soak plaster in lukewarm water
- Apply plaster to the radial side of the forearm and thumb in order that this area is shielded from the thumb tip to the mid-to distal-third of the forearm (depending on the precise injury)
- Ensure no ridges or indentations are created
- Cover the plaster with a one-layer soft wrap material to interpose between the plaster and therefore the overlying most superficial wrap (e.g., ace wrap)
- Recheck and document neurovascular exam
References
