Chapter 18: Orthotic Intervention for Peripheral Neuropathy

Objectives

On completion of this chapter, the student/practitioner will be able to:

• List the indications for use of a splint in individuals with peripheral nerve injury.

• Describe the differences between static and dynamic splinting.

• Discuss common orthoses prescribed for individuals with median, ulnar, radial, and plexus injuries.

• Define the concept of three-point pressure.

Key Terms

• Contracture

• Dynamic splint

• Immobilization

• Safe position

• Serial casting

• Static splint

• Three-point pressure

Introduction

Using splinting to treat a peripheral nerve injury is important but often challenging. This chapter discusses the basic use of splinting forces as an intervention for brachial plexus, radial, median, and ulnar nerve injuries. Lower extremity nerve injuries are not addressed in this chapter; however, the basic splinting concepts may be translated to those nerve injuries as well.

All injuries to peripheral nerves result in possible motor loss and subsequent muscle imbalance creating the potential for further loss of function secondary to adaptive contractile and noncontractile tissue shortening and lengthening. The objectives of splinting include protection of injured tissues, enhancement of a healing environment, prevention or minimization of contracture formation, acting as a substitute for lost motor function, and facilitation and enhancement of functional daily activities. The prescription, fabrication, and fitting of a custom orthosis requires a strong understanding of the basic mechanical principles of splinting; knowledge of the mechanical properties of splinting materials; knowledge of deep and surface anatomy; knowledge of the impact of compressive, tensile, and shear forces on the integument; and a thorough understanding of the pathophysiology, diagnostics, and treatment of peripheral nerve injury. Therapists who use splinting should strive to practice with a “minimalistic” approach with emphasis on simplicity, cost accountability, flexibility, and sustainability in the attainment of splint effectiveness. This method of practice promotes patient satisfaction and compliance.¹ The ideal splint should be comfortable, lightweight, functional, easy to don and doff, and aesthetically “pleasing” to the patient while performing the function for which it was intended.

Splinting Mechanics and Terminology

The most frequently used splint for the appendicular skeleton is a three-point pressure splint. The proximal and distal forces occur in the same direction, and the middle force is in the opposite direction (Fig. 18-1). The wrist splint uses two points of pressure—one at the palm and the other along the proximal forearm—and an opposite directional point of force at the wrist (Fig. 18-2). The wrist splint is classified as a first-class lever.² Force is defined by type, such as push or pull; amount; application angle; and point of application.³ The wrist splint has no moving parts and is commonly referred to as a static ...