Brittany Whiteley

Case 6-2

Process/steps involved for clinical decision making process

a.
b.
c.
d.
e.
f.

Review case study

Receive script for splint
Providing splint/ensuring appropriate fit
Wearing schedule
Specific documentation
Materials used

1) Obtaining Referral
The occupational therapist will review the case and prepare to create an
occupational profile for Pt. OT will want to interview Pt, family members, and
any caregivers involved getting a good idea for the needs of Pt. It is important to
take into consideration what type of medical insurance Pt has so that you may best
decide what to do during the sessions. The Pt most likely will be covered by
workmans compensation system.
2) Determine Splint Design
Tenosynovitis can result in an overuse cycle: friction, tears, pain, and limited
motion followed by rest, avoidance, and weakness. Once the pain subsides the
cycle often repeats itself making it difficult for the involved joint to heal.
(Coppard & Lohman, 2008) Because de Quervains tenosynovitis involves injury
of the tendon and tendon sheath, it is best to create a static splint (Coppard &
Lohman, 2008). An articular thumb splint will be fabricated to immobilize the
thumb at the MP and DP joints. Specifically, the OT would create a wrist
extension, thumb CMC palmar abduction and MP flexion immobilization splint
for Pt. A forearm based splint will provide rest, support, and protection of the
tendons that run along the radial side of the wrist. This wrist will most likely be
positioned 15 degrees of extension to relieve pressure on the affected tendons.
The thumb CMC joint is palmarly abducted 40-45 degrees and MCP 5-10 degrees
of flexion. The OT should allow room for anticipated inflammation. (Coppard &
Lohman, 2008)
3) Considerations for making pattern
When fabricating a splint for Pt, the occupational therapist should create a thumb
immobilization radial design to provide support on the side in which she is having
pain. This will allow for minimal wrist extension and flexion but will help the
client to refrain from wrist deviation. This restriction will allow for the tendons
involved stay put so that it may heal. The occupational therapist will abduct the
thumb so that the thumb pad is able to make contact with the index pad. This is
important for functional use of the hand while the splint is worn. The materials
needed are thermoplastic that has a higher degree of self-bondage because it will
need to wrap around the thumb and attach itself to the material covering the web

Brittany Whiteley

Case 6-2

of the thumb. There will also need to be fabric straps attached to the dorsal aspect
of the arm to secure the splint in place.
4) Splint Wear Schedule
Splints worn for tenosynovitis are worn continuously only removing for selfhygiene purposes and range of motion exercises. (Coppard & Lohman, 2008)
This will prevent friction on the tendon insertion site by restricting its movement.
Range of motion exercises will be done intermittently throughout the day and the
client will only go through pain free range of motion. Pt should avoid activities
that the splint restricts her from completing because often times these are the
same activities that will cause enhancement of the condition. Pt will gradually be
weaned from wearing the splint. This will be done slowly so that she gradually
goes back to using the joints that are healed to prevent reinjury. After pain
subsides, a prefabricated splint will be recommended for work and sport
activities. This prefabricated splint will help with avoiding reinjury of the healed
parts. The OT should consider a different type of prefabricated splint for Pt since
she was uncomfortable in the previous one.
5) Education
Education should be given to the person, family and caregiver about the wear
schedule, precautions and responsibility in Pts rehab process. (Coppard &
Lohman, 2008). The OT should explain the importance of the splint and why this
type of splint and splint material was chosen for her situation. The occupational
therapist should familiarize Pt with the components of the splint to create a better
understanding it its purpose. Pt should be educated on splint care and hygiene as
well. Education on the healing process should be given so that the parties involve
fully understand the effects of their actions throughout the healing process.

Works Cited
Coppard, B. M. & Lohman, H. (2008). Introduction to splinting: A clinical reasoning and
problem-solving approach (3rd ed.). St. Louis, Missouri: Mosby Elsevier.