Overview of Forearm Splinting
Splinting is a method used in many areas of medicine including emergency care, bone and joint care, everyday healthcare, and foot and ankle care. The primary purpose of splinting is to keep a joint or limb from moving. This can help with pain relief, keeping an injury stable, and allowing for the body’s tissues to heal.
In situations where someone is hurt suddenly (like during sports), a splint can be used temporarily to treat injuries such as sprains (stretching or tearing of ligaments), strains (injury to muscle or tendons), dislocations (when a bone slips out of a joint), fractures (broken bones), and cuts on the skin.
For long-term illnesses, splinting is mainly used to reduce inflammation. The primary aim of splinting the forearm (part of the arm from the elbow to the wrist) is to stop the entire forearm from twisting. This method would be particularly useful when there are injuries to any part of the two bones in the forearm (radius and/or ulna) or the soft structures within the forearm.
Anatomy and Physiology of Forearm Splinting
The forearm is made up of several key components: bones, muscles, nerves, and blood vessels.
The bones in your forearm are the radius and the ulna. The radius is a bit curved, something like a half-circle, while the ulna is a straight bone. This curve in the radius lets the bone rotate around the unmoving ulna, which helps with the turning motion of your forearm—imagine twisting your wrist to turn a doorknob or screw in a light bulb. This rotation is medically referred to as pronation and supination. Both the radius and ulna have several contact, or articulation, points with other bones, which form your joints. They also have areas called tuberosities, where muscles such as the biceps attach.
The muscles on your forearm fall into two main categories: the anterior and posterior compartments. The anterior compartment is home to your flexor muscles. As the name suggests, these muscles help bend your wrist and fingers. An example of using these muscles might be curling your fingers to make a fist. The posterior compartment houses your extensor muscles. These muscles help stretch out your wrist and fingers. An example of using these muscles might be flaring your fingers out wide.
The nerves located in your forearm—called the median, radial, ulnar and musculocutaneous nerves—all come from the brachial plexus, which is a complicated network of nerves in your neck, shoulder, and arm. These nerves control the motor function—in other words, movement—for muscles in your forearm. Some of them also provide sensations like touch or pain to the skin on your forearm and wrist.
Lastly, your forearm contains various blood vessels, the main ones being the radial and ulnar arteries, which come from the brachial artery in your upper arm. They run along the length of your forearm and work to form the deep and superficial palmar arch in your hand, supplying it with blood.
Why do People Need Forearm Splinting
Forearm splinting, which means putting a supportive brace on your forearm, aims to prevent the turning or twisting of your forearm. There are many situations where a forearm splint might be needed. These include muscle or ligament sprains (stretching or tearing of ligaments), broken bones, bones shifting out of their normal position (dislocated joints), cut tendons and nerve compression (pressure on a nerve causing pain or damage).
The main goals of using a forearm splint are managing pain, preventing further harm, and helping the healing process. In urgent health scenarios, a splint is often used for broken lower arm bones, cut tendons in the forearm, and a condition called radial nerve palsy, which can cause a limp wrist. For ongoing issues, a splint can be helpful for conditions like De Quervain’s tenosynovitis (a painful condition affecting the tendons on the thumb side of your wrist), inflammation of the bony bump at your elbow joint (medial and lateral epicondylitis), and any nerve compression syndromes in the forearm.
When a Person Should Avoid Forearm Splinting
While there are no clear-cut reasons not to use a splint, it’s important to consider the patient’s overall condition before deciding on this treatment, primarily in urgent situations. Care should be taken when the patient has burn injuries due to heat or electricity, exposed broken bones, deep wounds that have a lot of dirt or bacteria, and major swelling of their skin or flesh. As a rule, a splint can be used as long as any other injuries are treated before applying the splint.
In cases where there’s a lot of swelling, using a splint is preferred to a cast. Unlike a cast that encircles the entire injured area, a splint only covers one side and doesn’t squeeze the injured area. This means it can be loosened or removed more easily if needed.
Equipment used for Forearm Splinting
Here are some items that doctors usually need to apply a cast or a splint:
* Stockinet: This is a type of fabric sleeve that goes on your arm or leg before the cast or splint. It’s like a long, snug sock.
* Webril/cast padding: This is soft and protective material that goes over the top of the stockinet. It prevents the hard outer layer of the cast from causing any discomfort or injury to your skin.
* Plaster or prefabricated splinting material: These are what form the hard, supportive layer of the cast or splint. Plaster is a traditional material that needs to be moistened and then it hardens as it dries. Prefabricated splinting material is ready-made and simply needs to be fitted and secured on your limb.
* Water: Water is needed to moisten the plaster so it can harden into a supportive structure. The temperature of the water will affect how quickly this happens. Cold water makes the process longer, so there’s plenty of time to shape the cast or splint perfectly. Warm water will make it harden quickly.
* Elastic bandages: These are used to hold the layers of the cast or splint together until the hardening process is completed.
* Scissors: These are needed for cutting the materials to the correct size and for adjusting the fit of the splint or cast as needed.
Who is needed to perform Forearm Splinting?
If you need to have your forearm put in a splint, sometimes it can be done by a doctor or nurse without any additional help. However, this would require you to follow their instructions carefully. If you’re unable to do this, due perhaps to feeling unwell or having been given medication that makes you sleepy, then another person will be needed to help hold your forearm steady during the procedure.
Preparing for Forearm Splinting
Before setting a splint, it’s crucial to identify the specific injury that needs treatment. Once the injury has been determined, the doctor can decide which type of splint is best. The ‘sugar-tong’ splint is often used for forearm injuries. Other kinds of forearm splints include a ‘sugar-tong with a posterior mold’ and a ‘volar-forearm splint’. The particular splint dictates how much material is used. For the sugar-tong splint, the forearm should be positioned neutrally, and the elbow bent at a 90-degree angle.
This splint starts at the base of your palm and wraps around your bent elbow, ending at the back of your knuckles. If an additional layer is needed, it starts just beyond the wrist on the side of the forearm that’s nearest to the body and ends just before the elbow. It provides support that restricts the flexing and extending of the elbow. The other commonly used splint, the volar-forearm one, starts at the base of your palm and end just before the inner part of your elbow. This still lets your elbow bend and your forearm turn somewhat in each direction.
Whether made from plaster or a ready-made material, the length used aligns with the patient’s own measurements, estimated using a sheet of soft cotton padding used in casting. The splinting material is cut according to this and if made from plaster, should be neither too thin (less than 8 sheets) or too thick (more than 12 sheets). This is because plaster generates heat as it hardens, so it’s important to balance strength and safety to avoid thermal injury, or burns.
A stretchy fabric tube, called a stockinette, is cut so that some extra material hangs off each end. This extra fabric will cover the edges of the plaster, creating a soft border at each end of the splint for the patient’s comfort. The forearm is then wrapped in soft cotton padding over the stockinette before the wet, wrung-out plaster is applied. Some additional padding can be added over the plaster before the whole splint is wrapped with an elastic bandage. At the right time, the splint can be shaped and adjusted to fit well and support the injury properly.
How is Forearm Splinting performed
In your treatment, we must apply a specific type of cast, known as a sugar tong splint, to your arm. This special cast is designed to protect and support your injured limb while it heals. Below is an easy-to-understand breakdown of steps we’re going to follow:
1. Determination of the need for a sugar tong splint, precisely fit for your arm.
2. We’ll ensure that your forearm is in a comfortable position, with your elbow bent at 90 degrees throughout the process.
3. We will precisely measure a piece of plaster that is 8 to 12 layers thick. The length of this plaster will span from the fold of your palm, wrap around your bent elbow, and end at the back of your hand.
4. Next, we will measure, cut, and place a soft material called stockinet on your forearm. This also covers your thumb through a specially created opening. We’ll make sure that this stockinet extends a bit beyond the palm of your hand and up to the middle of your upper arm.
5. We will then wrap your forearm with a cotton type of padding. The padding will start at the fold of your palm and end just short of the middle of your upper arm. We’ll ensure that every layer overlaps the next by 50%, and apply at least 2 layers for comfort. Plus, any bony or pointy parts of your arm will be well padded. It’s important to have no creases or bunching in the padding for your comfort.
6. Next, we’ll dip the plaster piece into water to make sure it is thoroughly wet.
7. We’ll squeeze excess water from the plaster until it bonds together between the fingers.
After that, the wet plaster will be laid over the cotton padding on your forearm. It will start at the fold of your palm, wrap around your elbow, and end at the back of your hand. Then we’ll apply one layer of cotton padding over the plaster to prevent it from sticking to the bandage that will wrap it. We’ll fold over any excess stockinet at the ends of the splint to form a cuff. The whole splint will then be lightly wrapped with a stretchy bandage. We’ll shape it a bit whilst the plaster hardens, but make sure not to put the splint on a pillow or a blanket during this stage, as it can slow the hardening process. Once the plaster is fully set, we’ll check to make sure that the blood is circulating well in your hand and fingers.
And there you have it! This is a simple and clear explanation that you need, to understand how we are going to apply a sugar tong splint to your arm.
Possible Complications of Forearm Splinting
Some issues that may arise from having a forearm splint include skin damage due to pressure, which can start just 2 hours after the splint is put on. If the splint is wrapped too tightly, it can cause ‘compartment syndrome’, a painful condition where there’s too much pressure in an arm or leg. Wrapping a plaster cast too thickly can cause burn-like injuries. Besides, the splint could lead to stiffness in the joints of the fingers if it extends beyond the base of your hand. It’s important your health professional is careful with these points to avoid these problems when applying your forearm splint.
What Else Should I Know About Forearm Splinting?
If you’ve hurt your forearm, a doctor might use what’s called a forearm splint to provide support, reduce your pain, and help to heal. The splint does its job by keeping your forearm steady and secure to prevent further harm to your bones, muscles, nerves, and arteries. It also reduces the risk of a simple break in the bone getting worse and possibly opening the skin. Unlike a full cast, a splint covers only part of your arm. This makes it easier for any swelling to go down and allows healthcare providers to check any wounds under it.
After getting a forearm splint, you need to look after it properly. It’s important to keep it clean and dry. If the splint gets wet, it can weaken and cause the skin underneath to become soggy and damaged. This is especially dangerous if there’s an open wound under the splint, which could become infected. If your splint gets wet, you should go back to where it was put on – usually a hospital or clinic.
You should avoid taking off the splint yourself, especially if it was put on because of a broken or dislocated bone. Removing it could shift the injury out of place again. You should go back to the hospital or clinic if you start to feel numb or a pins-and-needles sensation in your hand or fingers. Try lifting your arm above your heart; if that doesn’t help, you need to get medical attention.
