Overview of Wrist Splint
The wrist is a rather intricate joint, consisting of the ends of the radius and ulna bones (two long bones in your forearm), as well as eight smaller bones known as carpals. Between the rows of carpals and the ulna bone, there’s a soft, tough tissue referred to as the fibrocartilaginous complex. Each of these wrist components can potentially get injured, either through a fall, during sports activities, or from doing repetitive movements.
Currently, wrist splints have become an essential tool in treating various wrist injuries. Wrist splints serve to hold or ‘immobilize’ the wrist in a certain position to aid healing, reducing swelling and lessening pain. There’s a vast range of materials used for splints and many pre-made splints available in the market, each meant to serve a specific purpose.
Wrist splints are often used by individuals suffering from carpal tunnel syndrome or osteoarthritis (a disease causing the breakdown of joints). These splints are typically worn at night, but they can also be used during the day to alleviate the disease’s symptoms. Studies have shown that wearing a wrist splint for carpal tunnel syndrome can help reduce symptoms in just a few weeks, while in osteoarthritis, using a wrist splint at night resulted in reduced joint pain after half a year. Wrist splints can also complement physical therapy, leading to increased improvement of symptoms.
Additionally, wrist splints can be beneficial in correcting minor issues with bone alignment by holding the wrist still. These custom-designed splints temporarily align the wrist and allow any swelling to decrease before a cast is applied. There’s a range of splint materials and sizes, which varies based on availability, costs, and personal preferences. Some common types of splints include volar, dorsal, radial gutter (thumb spica), ulnar gutter, and sugar tong.
After surgery, wrist splints are often used to reduce pain, promote proper healing, and ensure that any surgical hardware or treated joint remains stable. It’s worth noting that wearing a splint for a prolonged time might cause the joint to become stiff, a condition sometimes called a frozen joint. Therefore, it’s advised that those who’ve worn a wrist splint for extensive periods do exercises to restore movement and strength to the region. But remember, anyone with a post-surgery splint should consult their doctor before starting any exercise regimen.
Lastly, research hasn’t shown that one type of wrist splint is superior to another. The choice of splint usually depends on availability, costs, and personal preference.
Anatomy and Physiology of Wrist Splint
The wrist is a complicated structure made up of many different parts, including bones, ligaments (the tissues that connect bones to other bones), tendons (the tissues that connect muscle to bone), and cartilage (a flexible tissue in joints). The wrist contains eight small bones called the carpal bones. Their names are scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate, and hamate. Your wrist bends and moves where these carpal bones meet up with the bones in your arm, the radius, and ulna.
The lunate bone is often the one that gets knocked out of place, while the scaphoid bone is the one that tends to get fractured or broken most often. You can feel your scaphoid bone in what is known as the “anatomical snuffbox,” which is a small triangle-shaped area at the back of your hand, surrounded by thumb tendons.
There is also an important ligament, known as the triangular fibrocartilage complex (TFCC), which helps keep your wrist stable when you rotate your arm. Given how complex the wrist is, all of these parts can get injured, which is why wrist splints are commonly used to treat wrist injuries.
Why do People Need Wrist Splint
Wearing wrist splints can be essential or optional, depending on the situation. For example, a person might have to wear a wrist splint after having surgery or after having a bone reset. This allows the area to stay in the right position and heals correctly. Athletes might also wear wrist splints to protect their wrists while they continue to play sports and as they heal from an injury.
On the other hand, if a person has a sprain, strain, or a condition like carpal tunnel syndrome or osteoarthritis, wearing a wrist splint can be beneficial. The splint limits movement in the wrist, reducing pain and helping the injury heal more quickly.
There are three main types of custom-made wrist splints for different types of wrist injuries or pain: The volar splint, thumb spica, and sugar tong. The volar splint is used for injuries of the small wrist bones (excluding two specific bones: the scaphoid and the trapezium) and soft tissue injuries of the wrist. The thumb spica is used for suspected injuries to the scaphoid bone, a specific tissue inflammation called de Quervain tenosynovitis, as well as injuries or pain in the thumb. It’s important to use a thumb spica for both confirmed and suspected scaphoid fractures because these fractures can lead to a lack of blood supply to the bone, causing major complications. Anyone with confirmed or suspected scaphoid fractures should also be monitored by an orthopedic doctor for further treatment. The sugar tong splint is used for acute injuries of the two forearm bones, the radius and ulna. This splint gives support to the front and back of the forearm and limits turning movements.
When a Person Should Avoid Wrist Splint
Deciding whether to use a wrist splint often depends on weighing the potential benefits against the risks, and it can vary from person to person. Sometimes other treatments might be better, from not using a splint at all to performing surgery right away. Few scenarios where a different approach might be needed can be:
1. If the arm or hand is very swollen, a wrist splint might not be the right choice.
2. If there are burns on top of the fracture that needs regular dressing changes, a splint may interfere with this process.
3. If a person has medical equipment under their skin that often needs to be accessed – like a dialysis catheter (a tube for cleaning the blood in people with kidney problems), or a PICC line (a long, thin tube that’s inserted through a vein in your arm and passed through to the larger veins near your heart to give certain medicines) – a splint might make it harder for doctors to reach these.
4. An open fracture, which is when the broken bone has gone through the skin, might need different treatment.
Equipment used for Wrist Splint
To apply a cast or splint, certain materials are necessary. These include the material for the cast (which could be fiberglass or plaster), a ‘web roll’ (which is about 2 to 4 inches wide and is used to wrap around the cast), an elastic wrap (3 inches wide), and possibly a ‘stockinette’ (a type of knitted tube that can provide extra comfort). You’ll also need shears or large scissors, sheets or pads to cover the area, and a sling if applying a specific type of splint called ‘sugar tong splint’. Lastly, you’ll need a table or stand to keep all these items handy.
If the area where the splint is being applied doesn’t have a sink nearby, you’ll need a bucket or a big basin. This is because the plaster and a specific type of fiberglass called ‘Ortho-Glass™’ react with water and generate heat (a reaction known as ‘exothermic’). If you soak them in hot water they will harden quicker, while if you use cold water they will take more time. However, using warm water is recommended as it gives a sufficient amount of time (about 10 minutes) to mold the splint and doesn’t take too long to harden.
Who is needed to perform Wrist Splint?
A single person, usually a healthcare provider, can put a splint on your wrist. But getting some help from another person to hold the wrist in place might make the job easier. The person helping doesn’t need to be a medically trained individual; their primary role will be to keep the wrist steady.
Preparing for Wrist Splint
Like any job that needs to be done well, getting ready is the most important part. Here’s a basic guide on how a wrist splint is made. First, all necessary tools and materials are gathered. If there’s no sink where the splint is being made, a bucket or basin is filled with warm water. Then, a sheet or absorbent pad is placed on the floor and under the arm that’s going to be treated to keep things clean.
A type of medical tape, called a web roll, is used to measure the length of the needed splint. For plaster splints, three extra layers of web roll are added for padding. If the splint is made of pre-padded cast material with fiberglass, it’s cut according to the measured length with scissors. If the splint is made of plaster, eight strips of equal length are layered on top of each other.
Next, the exposed material at one end of the splint is pulled back a little bit to make sure it doesn’t cause discomfort or injury when it hardens. Then, the medical tape is wrapped around the arm, paying extra attention to areas like the wrist and elbow. The cast material is then soaked in water to activate it, and the extra water is squeezed out. The prepared splint material is placed between two layers of padding and then applied to the arm.
In essence, the doctor is creating a custom bandage that not only protects the injured area but also keeps it in place so it can heal properly. A wrist splint is carefully designed and constructed to ensure comfort and recovery for the patient.
How is Wrist Splint performed
A volar splint is applied to the front of the forearm. It should cover from an inch above the fold of the palm to the upper part of your forearm. The splint is then moulded to fit your arm with your wrist slightly elevated. An elastic wrap is used to hold the splint in place, but it should not be stretched too much. After putting on the splint, it’s important to make sure the fingers can still move properly, the blood flow is not hindered (this can be checked through what’s called capillary refill), and there are no changes in feeling or sensation. This is done to avoid any risks that can affect the nerves and blood vessels.
A thumb spica splint is applied to the thumb side of your forearm which encases your thumb. It should cover from slightly beyond the joint in the thumb to the upper part of the forearm. Once the splint is on, it is moulded such that your thumb is in a position as if you were holding a soda can, and your wrist is extended 20 to 30 degrees. An elastic wrap is used to keep the splint in place. Once again, it’s essential to make sure that your fingers can move, your blood flow is fine, and your sensation is unchanged after the splint is applied. These checks are to make sure no nerve or blood vessel damage has occurred during application.
A sugar tong splint is a bit different. Here, your forearm would be placed in a flat level position. If you have someone helping you, you can rest your elbow on a table with your forearm lifted. If you’re applying the splint by yourself, you can just rest the side of your forearm on a table. Once applied, the splint should start from the line where your palm starts, wrap around your elbow, and extend to the back of the joints in your hand. After applying the splint, an elastic wrap is used to keep it intact and your wrist slightly elevated with no overstretching. Then, the same checks are carried out to ensure proper finger movement, adequate blood flow, and normal sensation.
For pre-made splints, like those for carpal tunnel syndrome or arthritis (commonly known as OA), you just follow the instructions provided in their packaging to use them correctly. You need to make sure the splint is secure on your arm, but it should not be too tight. And as always, it’s crucial to check for normal finger movement, proper blood flow, and unchanged sensation after the splint is worn to avoid any possible harm to your nerves or blood vessels.
Possible Complications of Wrist Splint
It’s crucial to understand that sometimes problems can happen with wrist splinting as well as from the injury itself. One serious problem that might occur is called ‘compartment syndrome’. This happens when pressure within the layers of tissue (or ‘fascial planes’) around the wrist increases. This pressure can stop the normal flow of blood and lymph fluid, usually because of swelling or because the cast or splint is too tight. This is a medical emergency, and it’s very important that patients are aware of the six warning signs: severe pain, a tingling sensation, changes in temperature, muscle weakness, paleness, and loss of pulse. These last three signs are usually late symptoms.
If compartment syndrome is caused by internal pressure, it needs to be treated immediately with a surgery called a ‘fasciotomy’. If it’s caused by a cast or splint being too tight, the pressure needs to be reduced by cutting the cast or loosening the splint or wrap.
If the splint isn’t positioned correctly, is made incorrectly, or if there’s a lack of padding, other conditions can occur like pressure sores, cuts, increased pain/swelling and even rupture of a tendon. Also, if a broken bone doesn’t align properly, it might not heal well, which could mean more surgery is needed to fix the problem. Finally, too much pressure on the inner part of the wrist can cause ‘acute carpal tunnel syndrome’, a condition that causes pain, numbness and tingling in the hand and arm.
What Else Should I Know About Wrist Splint?
Splints are a common tool doctors use to aid in the healing of both fresh and longstanding bone and joint issues. When applied correctly, a splint can help decrease pain, increase the flow of blood and lymphatic fluid, and keep the affected area in the correct position to heal properly.
