Question

Discuss the precautions for wrist immobilization orthotic intervention.

Answer 1

A wrist splint allows an increase in the patient's exposure to a work program while still protecting the patient from injury.

precaution

Caution clients against tight fisting activities or repetitive, resistive finger flexion.

Recommend rest breaks and rotation of tasks at work and home that require provocative postures or repetitive movements.

Exercise: Proximal conditioning exercises and postural training may be helpful, especially for the deconditioned client with poor postures (such as forward rounded shoulders and flexed cervical spine). Altered axoplasmic flow that results from compression of the nerve at the carpal tunnel can cause the entire nerve to become sick and to become vulnerable to multiple sites of irritation along its axon.2–4

CLINICAL Pear

Poor posture can contribute to further median nerve problems as the already distally irritated nerve is exposed to proximal compression when good body mechanics are not used consistently.

Repetition, cueing, and client motivation are absolute prerequisites to abolishing bad habits.

What to Say to Clients

“Try to keep your wrist in a neutral position when performing daily activities.”

“Avoid sustained pinch or gripping, particularly prolonged pinching when your wrist is in a flexed or bent posture.”

“Avoid positioning your wrist in a bent or flexed posture (the fetal position) when sleeping. Use your splint at night to help keep your wrist in the safe, neutral position.”

“Think of your median nerve as the cord that attaches the vacuum to the wall outlet. If you bend that cord too often or if you bend it with enough force, you might damage the cord, and the vacuum won’t work as well. That is how your nerve is: if you bend it too often or with too much force at your wrist, the nerve can get damaged and it won’t work as well or it won’t work at all. Be proactive and try to prevent further damage by limiting the extremes of wrist motion at work and at home and when you sleep.”

“Whenever possible, use tools in the kitchen, the workplace, and the garden that have larger grips that are contoured to the arches of your hand. Your hand should close easily around the handle. You don’t want one that is too big or too small for your hand. The grip handle can be adjusted with dense foam to increase the diameter (if necessary) and to pad the surface somewhat so that it is easier on the structures, like your nerve, that lie underneath the skin of your hand.