Ortho-Preferred

Hand Splints for Spinal Cord Injury



- Thumb:
    - typical problems: stability and retractability;
    - thumb adduction stop used to gain ROM in first web space;
    - rigid thumb orthosis allows for stabilizing thumb for prehension;

- MP Joints:
    - usually a hand orthosis;
    - with no active extension of the MP joints, use rubber bands with line of pull perpendicular to the shaft of bone;

- Peripheral Neuropathies:
    - Ulnar Nerve at the Wrist:
         - intrinsic muscle paralysis w/ hyperextension of MP joints & flexion of the IP joints "ulnar claw hand;"
         - MP extension stop replaces intrinsic weakness & allows extension of IP joints;
    - Median Nerve Palsy:
         - problem: loss of thumb opposition and sensation;
         - hand orthosis with opponens bar and MP stop;
    - Radial Nerve:
         - loss of extension of wrist and MP joints;
         - need to assist wrist extension - dynamic or static wrist extensors may be used;
         - MP joints should have extension assist;
- Spinal Cord Injuries:
    - C-8 escape:
         - opposition and intrinsic muscle function absent;
         - possible to use static hand orthosis with MP stop;
         - person will use their own natural tenodesis action;
    - C-7 escape:
         - proximal stability present;
         - loss of grasp;
         - wrist extensor present (power source)
         - use wrist driven flexion hinge;
         - persons may use their own natural tenodesis;
    - C-6 escape:
         - proximal stability present;
         - loss of grasp
         - good candidate for flexor hinge hand splint;
    - C-5 escape:
         - proximal stability present
         - no wrist extensors available to power the orthosis;
         - may use external power system, usually electric power with switch control



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 1, 2011 2:06 pm