Hand and Upper Extremity Splinting. Principles & Methods

718 Pages·2005·39.861 MB·English

by  Elaine Ewing Fess, MS, OTR, FAOTA, CHT, Karan S. Gettle, MBA, OTR, CHT, Cynthia A. Philips, MA, OTR/L, CHT, and J. Robin Janson, MS, OTR, CHT (Eds.)

FM.qxd 7/20/04 4:19PM Pagevii
Contributors
Joni Armstrong, OTR, CHT
Hand Therapist, Consultant, North Country Peak Performance
Bemidji, Minnesota
University of North Dakota School of Medicine and Health Sciences
Grand Forks, North Dakota
Judith Bell Krotoski, OTR, CHT, FAOTA;
CAPTAIN, USPHS (Ret.)
Private Teaching and Consulting, Hand Therapy Research
Baton Rouge, Louisiana
Former Chief Hand and OT/Clinical Research Therapist
USPHS National Hansen’s Disease Programs
Baton Rouge, Louisiana
Alexander D. Mih, MD
Hand Surgeon, The Indiana Hand Center
Indianapolis, Indiana
James W. Strickland, MD
Clinical Professor, Indiana University School of Medicine
Indianapolis, Indiana
Past President, American Academy of Orthopaedic Surgeons
Past President, American Society for Surgery of the Hand
vii
FM.qxd 7/20/04 4:19PM Pageix
Foreword
to First Edition
T he emergence of hand surgery as a specialty therapist know the hazards that can turn a good pre-
and the advances in the science and art of hand scription into a harmful application. In this situation,
surgery since World War II have been truly phe- Elaine Fess, Karan Gettle, and James Strickland have
nomenal. Societies for surgery of the hand have put their own experience down on paper and made it
attracted some of the most skillful and dedicated sur- available to all of us. It is obvious that they have a
geons and have served as a forum for discussion and great deal of experience. It is also clear that they
criticism, new concepts, and the testing and trial of have gone far beyond the “cookbook” stage of previ-
competing ideas. ous splinting manuals. They have researched and
At first, this exciting advance in hand surgery was studied their subject thoroughly, and we are fortunate
not accompanied by a parallel advance in techniques indeed to have the result of that study presented so
of conservative and nonoperative management of the clearly and illustrated so well.
hand. Not only has this led to a tendency to operate What pleases me most about this book is that it
on patients who might have been better treated con- deals first with principles and only then with specific
servatively, but many patients who have rightly and design. It begins with an emphasis on anatomy and
properly been operated on have failed to obtain the topography and then with mechanical principles; after
best results of their surgery because of inadequate chapters on principles of design and fit and construc-
or poorly planned preoperative and postoperative tion, the authors discuss specific splints. In addition,
management. there is a good chapter on specific problems and how
It is encouraging to note that just in the last decade to handle them.
interest has surged in what is being called “hand It is a measure of how far we still have to go in the
rehabilitation.” This term is used to cover the whole science of splinting that the authors do not feel able
range of conservative management of the hand. It rep- to recommend actual specific forces by numbers to
resents an area in which the surgeon and therapist use in dynamic splints. My own feeling is that the
work closely together, with each bringing their special boundary between art and science is numbers. Even
experience and expertise to the common problem. in hand surgery we are not yet able to say that a spe-
Hand rehabilitation centers are multiplying, and a new cific tendon should be attached with a tension of 200
group, the Society of Hand Therapists, has been grams, so why should we expect a therapist to fix a
formed in association with the American Society for rubber band at a specific level of tension? One day we
Surgery of the Hand to bring together those physical will take these extra steps toward precision. When
therapists and occupational therapists who specialize data are available, Elaine Fess, Karan Gettle, and
in the hand. James Strickland will be the first to put it into their
Pioneers in the new movement are Elaine Fess, next book. They have jumped into a clear position of
Karan Gettle, and James Strickland, and their work leadership with this book. I am sure they will stay
has concentrated on the neglected field of hand splint- ahead of each new advance as it comes along.
ing. Little research has been done on the actual effect
of externally applied forces on joints and tissues of Paul W. Brand, F.R.C.S.*
the hand. Experienced surgeons and therapists have
Clinical Professor of Surgery and Orthopaedics
developed an intuitive “feel” for what can be accom- Louisiana State University; Chief, Rehabilitation Branch
plished, but there is little in the literature to assist the United States Public Health Service Hospital
young surgeon in what to prescribe or to help a young Carville, Louisiana
*Deceased.
ix
FM.qxd 7/20/04 4:19PM Pagexi
Foreword
T he opportunity to write the Foreword to this almost every splint I wanted made for the wide variety
the third edition of Hand Splinting: Principles of patients and conditions that I was seeing in my
and Methods has special significance to me. fledgling practice. She wanted to understand the
Having modestly participated in the writing of the first underlying biological and biomechanical effects of
volume in 1981, I am awestruck by the science and splints and was particularly inquisitive about the
sophistication of today’s splinting techniques and repercussions of applying varying amounts of stress to
applications. Much like hand surgery itself, splinting injured tissues. She challenged the way splints were
and hand rehabilitation have progressed from very made and the angles of approach and forces generated
unscientific, “trial and error” methods to thoughtfully by the mobilization slings and rubber bands we were
considered, evidence-based techniques for matching using. She continually questioned existing concepts
the fundamental concepts of anatomy, kinesiology, about moving stiffened joints and repaired tendons.
and biomechanics with the ever increasing body of Although initially somewhat annoyed by her constant
knowledge on wound healing, tissue remodeling, and quest for knowledge and frequent need to dispute and
adhesion control. revise the established splinting dictums of the time, I
I am old enough to reflect back on my days as an came to appreciate her scientific curiosity. That ther-
eager orthopaedic resident in the early 1960s. When apist was Elaine Ewing Fess, OTR, the author of all
told by a respected attending physician to splint the three volumes of Hand Splinting: Principles and
hand of an injured patient, I asked, “What kind of Methods, and, in my view, one of the most thoughtful
splint should I use?” The immediate reply was to ask and dedicated students and teachers of hand and
the therapist to make a “long opponens hand splint upper extremity splinting of our time.
with a lumbrical bar,” a splint that had been a work- From those modest beginnings, and because of
horse for orthopaedists during the polio days when her insatiable curiosity, Elaine Ewing Fess went on to
intrinsic muscle paralysis was common. In retrospect, become a brilliant and respected hand therapist,
that splint had little practical application to the trau- researcher, and teacher. Understandably, she has
matically altered anatomy of my patient, but I didn’t taught her students to challenge commonly used tech-
hesitate to request the long opponens splint as I was niques that lack scientific support and look for better,
told. Several days later I had a very different patient evidence-based methods. Together with her long-time
with a radial nerve paralysis and queried a different colleague Karan Gettle and myself, Elaine authored
attending physician about the appropriate splinting. the first truly science-based text on hand splinting,
He also responded with the same answer: “long oppo- Hand Splinting: Principles and Methods,in 1981. An
nens hand splint with a lumbrical bar.” Over the updated second edition written with noted co-author,
ensuing weeks I noticed that that splint seemed to be Cynthia Philips, was published in 1987.
the stock answer regardless of the clinical condition. It is no surprise, then, that Elaine Fess, OTR, and
Like a good resident I just accepted the fact that the Karan Gettle, OTR, together with their outstanding
long opponens splint seemed to be used for almost all co-authors Cynthia Philips, OTR, and Robin Janson,
hand conditions. It wasn’t until my fellowship in hand OTR, have now produced a beautifully updated and
surgery that I began to learn that different conditions markedly expanded third edition that is a true mas-
demanded different splints, but even then our scien- terpiece. Together with a formidable cadre of distin-
tific rationale and fabrication techniques were primi- guished contributors, the authors have extensively
tive when compared to the technical erudition so revised and supplemented all of the comprehensive
eloquently described in this edition. sections of the third edition and, even more impres-
Early in my hand surgical practice I had the con- sively, they have exhaustively described all splints
summate good fortune to hire an extremely bright according to the expanded American Society of Hand
young therapist who questioned the reasoning behind Therapists (ASHT) Splint Classification System. In
xi
FM.qxd 7/20/04 4:19PM Pagexii
xii F O R E W O R D
doing so, they have provided clinicians and therapists genitally deformed, and surgically repaired hands and
worldwide with a system that accurately describes upper extremities.
almost all known splints and categorizes those splints The authors have taken us a very long way since
into a sort-and-search tracking engine, the Splint the “long opponens hand splint with a lumbrical bar”
Sequence Ranking Database Index©(SSRDI). In doing and our patients are much better off because of their
so, they have given us the first orderly tool for easily dedicated efforts.
accessing information about design configuration and
clinical application of upper extremity splints. James W. Strickland, MD
In my mind, this new work represents the “Bible of
Clinical Professor of Orthopaedic Surgery,
Hand Splinting” and should be read, re-read and thor- Indiana University School of Medicine
oughly understood by all therapists and physicians Indianapolis, Indiana
engaged in the management of injured, diseased, con-
FM.qxd 7/20/04 4:19PM Pagexiii
Preface
O ur decision to describe all splints illustrated in Perplexingly, as the numbers of unnamed splints
this third edition according to the American slowly mounted, it became increasingly apparent that
Society of Hand Therapists (ASHT) Splint the majority of these splints were simple in design and
Classification System (SCS) has profoundly influenced many fell into a group colloquially dubbed “exercise
our own understanding of splinting concepts and sub- splints.” It was one of those middle-of-the night reve-
sequently defined the essence of Hand and Upper lations that finally identified the problem. This group
Extremity Splinting Principles and Methods, third of splints belonged to a heretofore-unidentified fourth
edition. Both the original SCS and its updated version, purpose category: torque transmission. A trial period
the expanded SCS (ESCS), revolutionize splinting con- was initiated during which we tested this new cate-
cepts by providing a sophisticated, methodical, and gory and much to our relief the problem of the non-
effective language for describing and classifying splints. conforming splints was solved. We thank bioengineer
From the outset, the original SCS provided a solid David Giurintano, MSME,* for confirming the exis-
basis for naming the substantial number of splint tence of this fourth splint purpose category and for his
photographs earmarked for the third edition. The assistance in defining its technical designation, as we
opportunity to compare and contrast this vast array had originally incorrectly labeled it force transmis-
of photographs confirmed and honed our expertise in sion. Some 135 torque transmission splints are illus-
using the SCS. However, as our learning curve trated in this third edition. Ironically, the lowly
advanced, several critical issues became apparent. “buddy strap” was one of the splints that gave us the
The first involved our ability to revisit and assess our most trouble until we added the torque transmission
earlier assigned SCS designations, a key factor to category!
improving our accuracy in naming splints. Tracking A true classification system is not stagnant. Its use
nearly 1200 splint illustrations, all of which would begets revision and refinement, allowing the system to
eventually have technical ESCS monikers, was rapidly grow and evolve. Although not as noteworthy as the
becoming a logistical nightmare. In response, we addition of a fourth purpose category, other additions,
devised a rudimentary database that over time adaptations, and subtleties were incorporated as
became increasingly complex as the tasks of making needed, and we eventually arrived at the current
information accessible and manageable became more ESCS used in this third edition. For example, the orig-
sophisticated and challenging. What we originally inal SCS does not address multipurpose designations,
created as a simple tracking device has evolved into a and yet we identified numerous photos in which the
comprehensive, dual-function, sort-and-search engine splints depicted had two and even three purposes.
that automatically rank-orders splints according to With identification of SCS deficiencies came the
their ESCS names and identifies single- or multiple- responsibility and challenges of creating the associ-
splint photographs depending on specific input crite- ated representational patterns that would translate
ria. This sort-and-search engine, the Splint Sequence our revisions into workable ESCS format.
Ranking Database Index© (SSRDI©) is pivotal to the The ESCS is a technical language by which splints
organization of this book and to its associated inter- and splint-like devices are classified according to func-
active website. tion, not form. Each splint is defined by a mandatory
The second major issue involved a number of six-section sentence and, as with other languages,
splints that resisted categorization into one or more section sequence, section connectors, and punctua-
of the three purpose categories (immobilization, tion are fundamental elements to sentence structure.
mobilization, and restriction) defined in the original Careful definition of minute details and consistent
SCS. Naming certain splints was a struggle, and our
periodic reassessment of their previously assigned *Chief, Rehabilitation Research, Paul Brand Biomechanics Labora-
SCS designations revealed serious inconsistencies. tory, Baton Rouge, Louisiana.
xiii
FM.qxd 7/20/04 4:19PM Pagexiv
xiv P R E F A C E
implementation of their use was, and continues to be, the ESCS name indicates whether normal joints are
mandatory for the evolving classification system to included to improve mechanical effect of the splint. In
work properly, especially in database format. For the case of the torque transmission splint, one joint
example, we had to create rules for using “or,” “and,” level—the wrist—is included secondarily (type 1)
and the backslash ( / ) as connectors between multi- whereas no secondary joint levels (type 0) are
purpose or multidirectional ESCS sentence compo- included when the wrist is the primary focus joint.
nents. Another example, a colon ( : ) indicates a shift Detailed information provided by ESCS names
in direction for reciprocal action torque transmission renders retention of colloquial terms (e.g., the “cock-
splints such as the design that occasionally is used up” splint) woefully inadequate. For even in what
to improve hand function in radial nerve palsies. In should be a difficult challenge, that of differentiating
these splints, the task of the “driver” joint alternates identical-configuration splints, ESCS designations
between the wrist and finger metacarpophalangeal clearly identify distinguishing characteristics of the
(MP) joints with wrist flexion producing finger MP splints involved. There are many instances through-
extension and finger MP flexion producing wrist exten- out this book that parallel this paradigm where same-
sion. A different reciprocal splint design is used to configuration splints have different ESCS names. It is
maximize tenodesis hand function of spinal cord all about function, not form.
injury patients. All reciprocal splints, regardless of In truth, we could not have anticipated the inte-
their anatomical location, are identified by the pres- grated precision, flexibility, and power of the ESCS
ence of a colon in their ESCS names. Uniformity of when it is used in conjunction with its sort-and-search
ESCS sentence pattern structure is key to sorting, engine, the SSRDI©. Until we began to see large
searching, and grouping splints in the database. To numbers of splints sorted into their respective cate-
this end, we developed and put into operation critical gories, we did not realize that we were dealing with an
structural adjustments and refinements to standard- incredibly effective tool with enormous potential. One
ize ESCS sentence format. has only to peruse the Splint Index at the back of this
One new change to this edition is the use of spacing book to recognize the underlying logic and order that
between the individual parts in a given figure. As many these systems working in tandem impart to the splint-
of the figures consist of several parts, it became nec- ing knowledge base. The number and kind of splints
essary to differentiate multiple views of one splint that may be classified is unlimited. To date, we have
from completely different splints that make up a not encountered a splint that cannot be classified
figure. Different views of the same splint are grouped according to the ESCS. In addition to having positive
closely together in the layout for ease of the reader. effects on future patient treatment, research, and
Photos of different splints are spaced farther apart professional communication, the near-mathematical
from one another. precision afforded by the ESCS/SSRDI© makes it an
Why go to all this trouble? Because for the first time intuitively obvious basis for reimbursement coding
in the history of splinting endeavors, we have a system and billing. Other nomenclature systems cannot
that accurately describes splints. The ESCS incorpo- match the precision of the ESCS. Our attempts in
rates all design configurations by addressing splint earlier editions to organize and name splints now
function, a feat accomplished by no other system. An seem primitive in comparison to the preeminence of
ESCS name tells everyone involved the “what, where, the ESCS.
and why” of a splint without getting bogged down in We thank Jean Casanova, OTR, and Janet Bailey,
trivial design details. Take for example the ubiquitous OTR, for their insight and vision in bringing together
“cock-up” splint. Noting in a chart that a patient was members of the ASHT Splint Nomenclature Task
fitted with a wrist cock-up splint indicates only that a Force for one weekend in 1991 with the directive of
splint was applied to the wrist, nothing more. In con- putting an end to the entrenched disorder of splinting
trast, an ESCS name defines whether the wrist was nomenclature; it was this group of nine therapists who
immobilized, mobilized, restricted, or whether the created the original SCS and wrote the manual, Splint
splint was applied to transmit torque to the finger Classification System* (see Chapter 1, A History of
joints through secondary control of the wrist. In the Splinting). Three of the four authors of this third
torque transmission example, the primary focus joints edition had the honor of participating on this 1991
are the twelve finger joints. This is a very different sce- Task Force, and although we knew the SCS was im-
nario from immobilizing, mobilizing, or restricting portant, at the time we did not really understand its
the wrist as a single primary focus joint. Likewise, the potential magnitude.
purposes of wrist immobilization, mobilization, and
restriction differ significantly from each other. In addi-
tion to defining splint primary joints and purposes, *©American Society of Hand Therapists, 1992.
FM.qxd 7/20/04 4:19 PM Page xv
P R E F A C E xv
The ESCS provides the conceptual framework for research, writing, and editing, some 10,000 total hours
this third edition, setting the organizational composi- to date, a family member quietly picked up the slack
tion of chapters and content. For quick reference, so that our family lives continued to run smoothly.
ESCS names of illustrated splints are printed in blue Special mention goes to Steve Fess who, as Fess
ink at the beginning of the figure captions. Addition- Express (self-dubbed), maintained supplies, shuttled
ally, a comprehensive Splint Index lists all illustrated reports and items that could not be e-mailed back and
splints by ESCS designation, in SSRDI©order, starting forth, ran library searches, and catered our frequent 6
with articular shoulder splints and ending with nonar- to 10 hour work sessions with carry-in meals. We also
ticular phalangeal splints. Associated figure numbers thank our many friends who understood and offered
are included in the Index to facilitate location of the their help when we were distracted, late with commit-
illustrations in the chapters. With the exceptions of ments, and just plain grumpy. Of particular note,
Chapters 17, Splinting for Work, Sports, and Perform- Sherran Schmalfeldt launched our work of revising
ing Arts; 18, Splinting the Pediatric Patient; and 19, chapters by typing all of the chapters from the second
Splinting for Patients with Upper Extremity Spastic- edition onto computer disks. Sherran’s generosity and
ity, colloquial splint expressions are not included with exceptional typing skills allowed us to completely
ESCS designations. Because the above-referenced update these chapters instead of just patching them.
chapters do include both ESCS and colloquial nomen- Family and friends are our unsung heroes to whom we
clature, they serve as user-friendly learning bridges for owe so much. We also have strengthened our own long-
readers who are unfamiliar with the ESCS. Abbrevia- term friendships, and our continuing capacity to work
tions used throughout this text are listed on the inside as an integrated team is especially rewarding. In addi-
back cover. tion to the pressures of writing this book, we have sur-
In addition to extensive updating of existing vived numerous other professional commitments,
chapter content and references, this third edition of changing work situations, a Master’s thesis, the birth of
Hand and Upper Extremity Splinting: Principles & a child, children in school, two household moves,
Methodsincludes six new chapters: Chapter 1, History comings and goings of beloved pets, a husband, chil-
of Splinting; Chapter 14, Splints Acting on the Elbow dren and grandchildren leaving and returning from
and Shoulder; Chapter 17, Splinting for Work, Sports, overseas mission work, long-term parent illnesses, and
and Performing Arts; Chapter 18, Splinting the Pedi- the deaths of three parents. Friendship and commit-
atric Patient, by Joni Armstrong, OTR, CHT; Chapter ment to a common goal are compelling, enduring
19, Splinting for Patients with Upper Extremity bonds that are inextricable.
Spasticity; and Chapter 23, Cast, Splint, and Design Adding the most essential element of this third
Prostheses for Patients with Total or Partial Hand edition are the 121 individuals and corporations who
Amputations, by Judith Bell Krotoski, OTR, CHT, kindly shared their photographs of splints, or the
FAOTA. We are especially pleased that five of these splints themselves, with us. Without the marvelous
new chapters provide valuable clinical information generosity of these individuals and groups from
about the use of splints in specialized fields. Impor- around the world there would be no 3rd edition of this
tant new sections are also added to existing classic book. Further, it was the sheer numbers and great
chapters. Chapter 2, Anatomy of the Hand, Wrist, and range of submitted splint photographs that allowed us
Forearm, by James W. Strickland, MD, is expanded to to develop the ESCS and SSRDI©. It is a privilege to
include a new section, Anatomy of the Elbow and include splint photographs from these international
Shoulder, by Alexander Mih, MD; and Chapter 3, Bio- leaders in splint technology in this book. We encour-
logic Basis for Hand and Upper Extremity Splinting, age these individuals, corporations, and others to
by Dr. Strickland, includes a new section, Biome- submit new splint photographs to the website
chanics, Splinting, and Tissue Remodeling, by Judith (http://evolve.elsevier.com/Fess/) so that we, and
Bell Krotoski, OTR, CHT, FAOTA; and a second new others, may continue to learn from their skills and
section, Soft Tissue Remodeling, that reviews research talents.
studies addressing cellular-level mechanical, physio- Published works reflect the expertise of the profes-
logical, and chemical mechanisms of soft tissue sional editorial staff with whom the publications are
responses to stress. associated. We are fortunate to have Kathy Falk and
Writing a book is a team effort. The contributions of her associate, Melissa Kuster, as our editors for this
many individuals who are not listed as authors are as book. As often happens in life, events have a way of
important as the contributions made by the authors of coming around full circle. Kathy Falk, as a C. V. Mosby
this work. We are especially grateful to our families, representative attending an early Philadelphia Hand
who have generously supported us in the preparation Symposium, initiated the idea of Fess, Gettle, and
of this third edition. For every hour we spent in Strickland writing a new splinting book. She subse-
FM.qxd 7/20/04 4:19PM Pagexvi
xvi P R E F A C E
quently became primary editor for the project and for all three editions of this book. He openly and hon-
the first edition of Hand Splinting Principles and estly shared his considerable knowledge of splinting
Methods was published in 1981. We were thrilled and materials without, even once, touting his own line of
relieved to have Kathy return as primary editor for materials. Thank you, John, for your wisdom and pro-
this third edition. With so many illustrations and asso- fessionalism over these many years. We are grateful to
ciated ESCS names involved, the technical challenges the many individuals who provided important bits and
of putting together a book of this scope have been pieces of information that helped us verify, document,
daunting to say the least. Both Kathy and Melissa and track text references, splinting resources, and
played pivotal roles in this third edition. They literally individuals who had submitted photographs to earlier
restructured and hand-pasted numerous chapters editions. An example of the kindness and profession-
where layout was especially difficult. Were it not for alism of these individuals is Barbara Lewis, OTR, CHT,
their timely and expert intervention, this book would who took time out of her busy schedule to assist us in
be hopelessly unwieldy for readers. Thank you, Kathy finding a talented contributor to the second edition
and Melissa, for your dedication, support, and unflap- who we were unable to locate.
pable good humor throughout this project. Addition- As science and the understanding of its principles
ally, we are grateful to Diane Schindler who efficiently are an ever-changing landscape, we enthusiastically
ensured that all the copyright permissions are in good encourage dialogue, criticism, additions, and updates
order. to this work by all of our colleagues for the advance-
We also thank medical illustrators Craig Gosling, ment of our common base of knowledge!
Chris Brown, Marty Williams, and Gary Schnitz, and
photographers Rick Beets and David Jaynes, who E. E. F.
employed their considerable artistic talents to make K. S. G.
learning easier and more enjoyable for others through C. A. P.
their excellent drawings, photographs, and cartoons. J. R. J.
John Kirk* has served as our trusted materials expert
*WFR Corporation, Wyckoff, NJ.
FM.qxd 7/20/04 4:19PM Pagexvii
Acknowledgments
We thank the following individuals and companies for generously contributing photographs, splints, materials, equipment,
and ideas:
3-Point Products, Inc. Jill Francisco, OTR, CHT Donna Reist-Kolumbus, OTR, CHT
Aircast Steven Z. Glickel, MD Joyce Roalef, OTR/L, CHT
Cheri Alexy, OTR, CHT Lynnlee Fullenwider, OTR, CHT Jill Robinson, PT, CHT
Jean-Christophe Arias Karen E. Gable, EdD Jean Claude Rouzaud, PT
Joni Armstrong, OTR, CHT Susan Glaser-Butler, OTR/L, CHT Sammons Preston Rolyan
Norma Arras, MA, OTR, CHT Patricia Hall, MS, OTR, ATP Kathryn Schultz, OTR, CHT
Sandra Artzberger, MS, OTR, CHT Christine Heaney, BSc, OT Karen Schultz-Johnson, MS, OTR, CHT,
Janet Bailey, OTR/L, CHT Carol Hierman, OTR, CHT FAOTA
Rebecca Banks, OTR, CHT, MHS Brenda Hilfrank, PT, CHT Kimiko Shiina, PhD, OTR/L
Jane Bear-Lehman, PhD, OTR, FAOTA Renske Houck-Romkes, OT Linda Shuttleton, OTR
Judith Bell Krotoski, OTR, FAOTA, CHT JACE Systems Silver Ring Splint Company
Rivka Ben-Porath, OT Jewish Hospital Terri Skirven, OTR, CHT
Lin Beribak, OTR/L, CHT Caryl Johnson, OTR, CHT Barbara Allen Smith, OTR
Theresa Bielawski, OT (C) Joint Active Systems, Inc. Smith Nephew Rolyan
Bledsoe Brace Systems Joanne Kassimir, OTR, CHT Barbara Sopp, MS, OTR, CHT
Christopher Bochenek, OTR/L, CHT Damon Kirk Donna Breger Stanton, MA, OTR, CHT
Suzanne Brand, OTR, CHT Kleinert Institute Hand Therapy Center Maureen Stark, OTR
Kay Colello-Abraham, OTR, CHT Jennifer Koryta, OTR Elizabeth Spencer Steffa, OTR/L, CHT
Diane Collins, MEd, PT, CHT Cheryl Kunkle, OTR, CHT Erica Stern, PhD, OTR, FAOTA
Ruth Coopee, MOT, OTR, CHT Elaine LaCroix, MHSM, OTR, CHT James W. Strickland, MD
Lawrence Czap, OTR Karen Lauckhardt, MA, PT, CHT Dominique Thomas, RPT, MCMK
Darcelle Decker, OTR, CHT Janet Kinnunen Lopez, OTR, CHT David E. Thompson, Ph.D.
Carolina deLeeuw, MA, OTR Daniel Lupo, OTR, CHT Sandra Townsend, OTR, CHT
Shelli Dellinger, OTR, CHT K. P. MacBain, OT Linda Tresley, OTR
Lori Klerekoper DeMott, OTR, CHT March of Dimes Stancie Trueman, OT (C)
Elisha Denny, OTA, PTA Helen Marx, OTR, CHT Regina Roseman Tune, MS, OTR
Lisa Dennys, BSc (OT), DCM, Dac Karen Mathewson, OTR, CHT Ultraflex Systems, Inc.
DeRoyal/LMB Gretchen Maurer, OTR, CHT Paul Van Lede, OT, MS
dj Orthopedics Esther May, PhD, OT Griet Van Veldhoven, OT, Orthop. E.
Rebecca Duncan, PT Laura McCarrick, OTR Nelson Vazquez, OTR, CHT
Dynasplint Systems, Inc. Conor McCullough, OTR Kilulu Von Prince, OTR
Rachel Dyrud Ferguson, OTR, CHT Peggy McLaughlin, OTR, CHT Allyssa Wagner, MS, OTR
Jolene Eastburn, OTR Robin Miller, OTR, CHT Sheila Wallen, OTR/L, MOT
Susan Emerson, MEd, OTR, CHT Bobbie-Ann Neel, OTR Watts Medical
EMPI Jerilyn Nolan, MA, OTR, CHT WFR Corporation
Roslyn Evans, OTR, CHT North Coast Medical Jill White, MA, OTR
Expansao Orfit Industries Diana Williams, MBA, OTR, CHT
Joan Farrell, OTR, CHT Margareta Persson, PT G. Roger Williams, OTR
Bonnie Ferhing, LPT Sally Poole, MA, OTR, CHT Jason Willoughby, OTR
Sharon Flinn, MEd, OTR/L, CHT Karen Priest-Barrett, OTR, CHT Theresa Wollenschlaeger, OTR, CHT
Kenneth Flowers, PT, CHT Barbara Raff, OTR/L, CHT
xvii
ch01.qxd 7/21/04 2:42 PM Page 3
C H A P T E R 1
A History of Splinting
Chapter Outline
Section 1: A History of Splinting: To Understand the Advances in Basic Science
Present, View the Past Soft Tissue Remodeling
DEFINITION AND PURPOSES OF SPLINTING Digital Joint Anatomy and Biomechanics
GENERAL HISTORICAL OVERVIEW Mechanical Systems of Splints
THE DEVELOPMENT OF SPLINTING PRACTICE IN THE Agencies
20TH CENTURY Hand Centers
Disease and Epidemiology Knowledge Dissemination and Organizational
Infection Leadership
Poliomyelitis Seminars and Educational Courses
Political Conflict and War Professional Organizations
Medical Advances Relating to Splinting Publications
Technologic Advances Relating to Splinting SUMMARY
Commercial Products Section 2: Lessons from Hot Feet: A Note on Tissue
Surgical Advances Remodeling
Section 1 clinicians often are not aware of splinting history
beyond their own experiences. Delving into the past
A History of Splinting:
strengthens the foundation of clinical practice by
To Understand the Present,
identifying themes that have persisted over time and
View the Past* by expanding crucial knowledge of the field. It also
imparts a heightened appreciation for current
ELAINE EWING FESS, MS, OTR, FAOTA, CHT
methods by providing new insights into the pivotal
The splinting of extremities rendered dysfunctional events that contributed to the development of modern
by injury or disease is not a new concept, and yet splinting theory and technique.
Those who ignore the past inevitably recreate it.*
*This section originally was published as an article in the Journal Both novice and experienced clinicians alike have
of Hand Therapy (JHT), vol 15:2, 2002, with the understanding that
“invented” revolutionary new splint designs, only to
it would later appear in Chapter 1 of this third edition of Hand and
discover later that their highly touted creations have
Upper Extremity Splinting: Principles and Methods. Since the JHT
publication of this chapter, additional references have been added
and some splint nomenclature has changed in response to the
expansion and refinement of the ASHT Splint Classification System Additional information and resources are openly sought so that this
by the authors of this book. initial study may continue to grow.
The perception of history is ever changing, and its documenta- *Cf. “Those who cannot remember the past are condemned to
tion is dependent on the information available at the time. repeat it.” George Santayana (1863-1952).
3