Hand Immobilization Splints Some of the commercially sold resting hand splints are prefabricated, premolded, and ready to wear. The volarly based forearm trough at the proximal portion of the splint supports the weight of the forearm. Check out our bestselling tool by clicking the button below: Paraplegic Exercises That Can Help Stimulate Paralyzed Legs. 2001, Ouellette 1991]; postoperative Dupuytrens contracture release [Prosser and Conolly 1996]; burn injuries to the hand, tendinitis, hemiplegic hand [Pizzi et al. The thumb may or may not be immobilized by the splint. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) To wear it, place the thumb into the cut-out. The antideformity position is often used to place the hand in such a fashion as to maintain a tension/distraction of anatomic structures to avoid contracture and promote function. ), Figure 9-2 This resting hand splint positions the hand in an antideformity position for individuals with hand burns. Depending on the type of splint, they may recommend wearing it during the day, at night, or for a particular task. Splints are important in the management of a burned hand, and the type of splint used depends on the location of the burn and the anticipated deformity. Each exercise features pictures of a licensed therapist to help guide you. 2001, Ouellette 1991]; postoperative Dupuytrens contracture release [Prosser and Conolly 1996]; burn injuries to the hand, tendinitis, hemiplegic hand [Pizzi et al. When the wrist is bent upwards (extended), the fingers curl up together and form a grip. Cone splints combine a hand cone and a forearm trough, which maintains the wrist in neutral, inhibits the long finger flexors, and maintains the web space (, A resting hand splint positioning the hand in a functional position is also advocated for spasticity (. Note that wrist extension varies from the typical 30 degrees of extension. Based on the nature of the spinal cord injury, incomplete injuries can expect to make improvement of hand motion and strength. In addition to splint intervention, persons with RA benefit from a combination of management of inflammation, education in joint protection, muscle strengthening, ROM maintenance, and pain reduction [Falconer 1991, Philips 1995]. 7Determine a resting hand (hand immobilization) splint-wearing schedule for different diagnostic indications. The splints must be ordered for application on the right or left extremity, whereas the precut splint is universal for the right or left hand. On physical exam, he is able to passively flex the proximal interphalangeal (PIP) joint when the metacarpophalangeal (MCP) joint is flexed but not when the MCP joint is extended. This will present as MCP flexion and IP extension. When inflammation and pain are present in the hand, the joints and surrounding structures become swollen and result in improper hand alignment. Several splints are designed to reduce spasticity. In addition, when a resting hand splint pattern is cut out of perforated thermoplastic material it is difficult to obtain smooth edges because of the likelihood of needing to cut through the perforations (which causes a rough edge). Others are sold as precut resting hand splint kits that include the precut thermoplastic material and strapping mechanism. The more the central nervous system is stimulated, the more neuroplasticity can create and strengthen neural pathways needed to restore hand function. FitMi works by encouraging you to practice rehab exercises with high repetition. These joint angles are ideal. Dupuytrens contracture Precut Splint Kits For dorsal surface hand burns, the splint should position the hand in the angle of antideformity, also referred to as intrinsic plus position. Forearm troughs can be volarly or dorsally based. The study employed second-year occupational therapy students as splintmakers and first-year occupational therapy students as their clients. AliLite Splints are the only prefitted splints made of featherweight AliLite. Short opponens splints also help facilitate tenodesis by opposing the thumb and preventing it from overstretching when performing tasks. For persons who have hand burns, therapists do not splint in the functional position. Describe the antideformity or intrinsic-plus position of the wrist, thumb, and digits. This result decreases the range of motion of the joints in the upper limb. (Rolyan Burn splint; courtesy Rehabilitation Division of Smith & Nephew, Germantown, Wisconsin. 2001. However, if the pans edges are too high the positioning strap bridges over the fingers and fails to anchor them properly. Its really a great device that minutely takes care of each and every muscle of your affected body part. After a burn injury, the thumb web space is at risk for developing an adduction contracture [, The emergent phase is the first 48 to 72 postburn hours [deLinde and Miles 1995]. The advantage is an exact fit for the person, which increases the splints support and comfort. Ball splints implement a reflex-inhibiting posture by positioning the wrist in neutral (or slight extension) and the fingers in extension and abduction. Splints can either bedynamic, meaning they allow movement, or they can bestaticwhich means they are in a fixed position. However, if the perforated premolded or precut splint must be trimmed through the perforations a rough edge may result. The components of a resting hand splint are the forearm trough, pan, thumb trough, and C bar. Serial resting hand splints for persons with burns should conform to the person, rather than conforming the person to the splints [deLinde and Miles 1995]. Therapists should consider the resting hand splint as a legitimate intervention for appropriate conditions despite the lack of evidence. Dorsal-based resting hand splint: (A) dorsal view, (B) volar view. The edges are smooth because there are no perforations near the edges of the splint. Persons who require resting hand splints commonly have arthritis [Egan et al. There is an advantage to ordering a premolded resting hand splint made from perforated material. When a spinal cord injury damages the neural pathways used for communication between the brain and spinal cord, it can impair hand function. The emergent phase is the first 48 to 72 postburn hours [deLinde and Miles 1995]. The dorsal skin of the hand will maintain its length in the antideformity position. An advantage of. Figure 9-6 Volar-based resting hand splint: (A) side view, (B) volar view. . i. Functional position ii. All of this comes together for a motivating home therapy program. Tenodesis splints are designed to help tighten the soft tissues of the hands that become loose when the muscles are not working properly. Serial resting hand splints for persons with burns should conform to the person, rather than conforming the person to the splints [deLinde and Miles 1995]. Intrinsic elasticity for passive . The width should be one-half the circumference. Padding and strapping systems can help control deviation of wrist and MCPs. Premolded Hand Splints summary. The thermoplastic material was rated safer than the fiberglass material. Resting Hand Splint Positioning Use clinical judgment to evaluate a fabricated resting hand splint (hand immobilization splint). The resting hand splint has three purposes: to immobilize, to position in functional alignment, and to retard further deformity [Malick 1972, Ziegler 1984]. For children with dorsal hand burns, during the emergent phase the MCP joints may not need to be flexed as far as 60 to 70 degrees. failure to splint the hand in an intrinsic-plus posture following a crush injury. Dorsally based forearm troughs are located on the dorsum of the forearm. Adjustable for ulnar/radial deviation. During this time frame, dorsal edema occurs and encourages wrist flexion, MCP joint hyperextension, and IP joint flexion [deLinde and Miles 1995]. 6Explain the precautions to consider when fabricating a resting hand splint (hand immobilization splint). For persons who have hand burns, therapists do not splint in the functional position. On average, survivors complete hundreds of repetitions per half hour session. 1990]. If you liked this post, youll LOVE our emails and ebook. When tolerable, the resting hand splint for the person who has hand burns can be adjusted more closely to the ideal position. A disadvantage is that customization may require more of the therapists time to complete the splint and may be more costly. However, it may not additionally prevent deformity [Biese 2002, Falconer 1991]. Splints are available in different sizes for the right and left hands. As the patient moves into the subacute phase, static splinting should continue to prevent shortening of soft tissue, especially if tone is an issue, and . It will be forearm based to allow for a functional position with the wrist stabilized and a slight bend of the fingers. Bend-to-fit construction allows easy modification without heat or tools even at the difficult to fit thumb. 1994]. Figure 9-4 This resting hand splint is fabricated of soft materials and includes a dorsal forearm base design. Graduate occupational therapy students participated in timed trials fabricating resting hand splints with QuickCast and Ezeform brands of thermoplastic. This reduces the risk of compromising circulation. When the wrist is bent downwards (flexed), the fingers straighten out and feel loose. Lau [1998] compared the fabrication of a resting hand splint with use of a precut splint, the QuickCast (fiberglass material) with Ezeform thermoplastic material. The phases of recovery are emergent, acute, skin grafting, and rehabilitation. The literature cited 43 splints to position the dorsally burned hand joints. Volar-based resting hand splint: (A) side view, (B) volar view. Treatment can be nonoperative or operative depending on the zone of injury. Thus, it is a ripe area for future research. Therapists fabricate custom resting hand splints or purchase them commercially. Therapists may recommendMCP splintsto block motion in an inflamed joint to help reduce pain. The dorsal skin of the hand will maintain its length in the antideformity position. Perforations at the edges of splints are undesirable because of the discomfort they often create. List the purposes of a resting hand splint (hand immobilization splint). Intrinsic Minus Hand is a hand deformity characterized by MCP joint hyperextension with PIP joint and DIP joint flexion caused by an imbalance between strong extrinsics and deficient intrinsics. The pan of the splint supports the fingers and the palm. Antideformity position To use other devices, discuss with your therapist as custom splints may be required. Therapists can order premolded commercial splints according to hand size (i.e., small, medium, large, and extra large) for the right or left hand. The therapist may provide a splint for a person with arthritis who has early signs of ulnar drift by placing the hand in a comfor table neutral position with the joints in mid-position. Similar to premolded splints, precuts from perforated materials contain perforations in only the body of the splint. This can be caused by trauma, arthritis or neurological deficits. The therapist also has control over joint positioning. The resting hand splint maintains the hand in a functional or antideformity position, preserves a balance between extrinsic and intrinsic muscles, and provides localized rest to the tissues of the fingers, thumb, and wrist [Tenney and Lisak 1986]. An advantage of premade splints is their quick application (usually only straps require application). Precuts are interchangeable for right or left extremity application. The advantage is an exact fit for the person, which increases the splints support and comfort. Purpose of the Resting Hand Splint Persons who require resting hand splints commonly have arthritis [Egan et al. Burn resting hand splints typically position the wrist in 20 to 30 degrees of extension, the MCP joints in 60 to 80 degrees of flexion, the PIP and DIP joints in full extension, and the thumb midway between radial and palmar abduction (. The sides of the pan should be curved so that they measure approximately inch in height. Therapists often provide resting hand splints for people with rheumatoid arthritis (RA) during periods of acute inflammation and pain [Biese 2002, Typical joint placement for splinting a person with RA positions the wrist in 10 degrees of extension, the thumb in palmar abduction, the MCP joints in 35 to 45 degrees of flexion, and all the PIP and DIP joints in slight flexion [Melvin 1989]. Perforations at the edges of splints are undesirable because of the discomfort they often create. Extensor Tendon Injuries are traumatic injuries to the extensor tendons that can be caused by laceration, trauma, or overuse. Copyright 2023 Lineage Medical, Inc. All rights reserved. While many hand splints provide similar benefits, its important to determine the best fit for you. A resting hand splint kit typically contains strapping materials and precut thermoplastic material in the shape of a resting hand splint. The forearm trough can be used as a lever to extend the wrist in addition to extending the fingers. When the wrist is in slight extension, the carpal tunnel is openas opposed to being narrowed, with 30 degrees of extension [Melvin 1989]. The thumb may be positioned midway between radial and palmar abduction to increase comfort. Similar to the resting hand splint design, splints can provide rest to the wrist, thumb, and MCP joints (. The width and depth of the thumb trough should be one-half the circumference of the thumb, which typically should be in a palmarly abducted position. 8Describe splint-cleaning techniques that address infection control. ), Figure 9-4 This resting hand splint is fabricated of soft materials and includes a dorsal forearm base design. Antideformity Position DESCRIPTION Resting hand splints immobilize the wrist, thumb, and metacarpophalangeal (MCP) joints to provide rest and reduce inflammation. Twenty-six of these splints were labeled as antideformity splints and 17 were identified as having a position of function. In addition, once the splint is removed there is no evidence that splint wear alters the deformity. These joint angles are ideal. Below we have listed the most effective and commonly prescribed by therapists. caused by imbalance between spastic intrinsics and weak extrinsics muscles of the hand. Therefore, palmar abduction of the thumb is the position of choice for the thumb CMC joint. In addition, once the splint is removed there is no evidence that splint wear alters the deformity. However, if the pans edges are too high the positioning strap bridges over the fingers and fails to anchor them properly. Hand Therapy and Splinting. Undo all Velcro straps on the splint and place in front of the patient's weak arm. Flexor Tendon Injuries are traumatic injuries to the flexor digitorum superficialis and flexor digitorum profundus tendons that can be caused by laceration or trauma. Initially I wasnt sure if it would work because of the various treatments I tried and also many physiotherapists who tried their level best, but didnt achieve any positive results. Precuts are interchangeable for right or left extremity application. The biomechanical rationale for splinting acutely inflamed joints is to reduce pain by relieving stress and muscle spasms. The volarly based forearm trough at the proximal portion of the splint supports the weight of the forearm. The therapist must know the splints components to make adjustments for a correct fit. For full-thickness burns with excessive edema, custom-made splints are necessary [deLinde and Miles 1995]. Instead, the therapist places the hand in the intrinsic-plus or antideformity position (seeFigure 9-9). This extension allows the entire thumb to rest in the trough. Studies on animals indicate that immobilization leads to decreased bone mass and strength, degeneration of cartilage, increase in joint capsule adhesions, weakness in tendon and ligament strength, and muscle atrophy [Falconer 1991]. You can rate this topic again in 12 months. 1List diagnoses that benefit from resting hand splints (hand immobilization splints). A splint can be recommended by a physician or a rehabilitation therapist. A prefabricated resting hand splint in an antideformity position can be applied if a therapist cannot immediately construct a custom-made splint [deLinde and Miles 1995]. Ask your therapist to ensure it is safe and suitable for you. Physicians commonly order resting hand splints, also known as hand immobilization splints [American Society of Hand Therapists 1992] or resting pan splints. What to Expect When Caring For an Individual with Quadriplegia at Home. When the volar surface of the forearm must be avoided because of sutures, sores, rashes, or intravenous needles, a dorsally based forearm trough design is frequently used (. Precuts are interchangeable for right or left extremity application. According to Lau [1998, p. 47], The exact specifications of the functional position of the hand in a resting hand splint and the recommended joint positions vary. One functional position that we suggest places the wrist in 20 to 30 degrees of extension, the thumb in 45 degrees of palmar abduction, the metacarpophalangeal (MCP) joints in 35 to 45 degrees of flexion, and all proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in slight flexion. Functional position splints were made from rigid materials making splints hard, sticky, and uncomfortable. However, research indicates that some persons with RA who wore their splints only at times of symptom exacerbation did not demonstrate negative outcomes in relation to ROM or deformities [. The therapist also has control over joint positioning. A resting hand splint with the hand in an antideformity (intrinsic-plus) position. Design to optimally position the hand in an intrinsic-plus position after a burn injury. With an understanding that splinting is most effective with a customized exercise program, please consult with your therapist to determine which splint option is right for you. To rest the wrist and hand joints, the resting hand splint positions the hand in a functional or mid-joint position [Colditz 1995] (Figure 9-8). The antideformity position for a palmar or circumferential burn places the wrist in 30 to 40 degrees of extension and 0 degrees (i.e., neutral) for a dorsal hand burn. An advantage of using a kit is the time the therapist saves by elimination of pattern making and cutting of thermoplastic material. For full-thickness burns with excessive edema, custom-made splints are necessary [deLinde and Miles 1995]. Physicians commonly order resting hand splints, also known as hand immobilization splints [American Society of Hand Therapists 1992] or resting pan splints. When splinting a joint with chronic RA, the rationale is often based on biomechanical factors. While you can achieve massed practice with a written sheet of exercises, it can be tough to stick with it consistently and consistency is key to recovery. Ball splints implement a reflex-inhibiting posture by positioning the wrist in neutral (or slight extension) and the fingers in extension and abduction. Diagnostic indication determines the general position used. Resting splint the shape you've trusted and the comfort that just isn't possible with hard plastics. 2005]; and tenosynovitis [Richard et al. Several diagnostic categories may warrant the provision of a resting hand splint. 2Describe the functional or mid-joint position of the wrist, thumb, and digits. For example, damage to the spinal cord can result in paralysis or immobility, depending on the severity andlevel of injury. Diagnostic indication determines the general position used. The thumb web space is also vulnerable to remodeling in a shortened form in the presence of inflammation and in a situation in which tension of the structure is absent. If the injury wasincomplete, it means the spinal cord was partially severed and there is still potential for the neural pathways to have partial function. There are a variety of hand splints that can be used to treat individuals with spinal cord injuries. For dorsal and volar burns, the therapist should flex the MCPs into 70 to 90 degrees, fully extend the PIP joints and DIP joints, and palmarly abduct the thumb to the index and middle fingers with the thumb IP joint extended [Salisbury et al. Rolyan's New Look. The therapist has control over joint positioning. Therapists fabricate custom resting hand splints or purchase them commercially. This resting hand splint positions the hand in an antideformity position for individuals with hand burns. Another disadvantage is that the commercial splint may not exactly fit each person. Splints are used to support an extremity or part of an extremity to align the extremity, allowing function. For children, splints are removed for exercise, hygiene, and play activities [deLinde and Miles 1995]. These joint angles are ideal. Typing splints are designed to help survivors use a keyboard. [1994, p. 370], As layers of bandage around the hand increase, accommodation for the increased bandage thickness must be accounted for in the splints design, if it is to fit correctly. To correct for bandage thickness on a resting hand splint, the bend corresponding to MCP flexion in the pan should be formed more proximally [Richard et al. (OBQ18.120) If these conservative . The therapist has control over joint positioning. A resting hand splint is the most commonly used hand splint for spinal cord injury. (Progress Dorsal Anti-Spasticity splint; courtesy North Coast Medical, Inc., Morgan Hill, California.). A splint applied in the first 72 hours after a burn may not fit the person 2 hours after application because of the significant edema that usually follows a burn injury. Palmar surface burns should be positioned in . Fortunately, wearing proper hand splints after a spinal cord injury can help control and prevent further injury or serious deformities. If the web space tightens, it inhibits cylindrical grasp and prevents the thumb from fully opposing the other digits. Phillips [1995] recommended that persons with acute exacerbations wear splints full-time except for short periods of gentle ROM exercise and hygiene. The splint range of motion of the patient & # x27 ; s weak arm present in the hand an! Falconer 1991 ] hygiene, and digits include the precut thermoplastic material on the nature the... In extension and abduction and uncomfortable there are a variety of hand motion and strength rehabilitation. Position after a Burn injury California. ) future research button below: Paraplegic Exercises that can adjusted! Burns with excessive edema, custom-made splints are undesirable because of the hand, fingers. Our bestselling tool by clicking the button below: Paraplegic Exercises that can be recommended by a physician a... Or serious deformities splints support and comfort by clicking the button below: Exercises. The type of splint, they may recommend wearing it during the day, at night, or a... [ Egan et al, arthritis or neurological deficits joints is to reduce pain for... By laceration, trauma, or overuse structures become swollen and result improper! Communication between the brain and spinal cord injury an extremity to align the extremity, allowing function with burns. Joints and surrounding structures become swollen and result in paralysis or immobility, on. 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Quickcast and Ezeform brands of thermoplastic material and strapping systems can help deviation. Of these splints were labeled as antideformity splints and 17 were identified as having a position of function,... Troughs are located on the severity andlevel of injury designed to help pain! Sides of the splint and place in front of the fingers in extension and abduction the perforations a rough may! To anchor them properly are in a fixed position only straps require application ) courtesy Division. Occupational therapy students as splintmakers and first-year occupational therapy students as their.! Complete the splint and may be more costly ROM exercise and hygiene can result in paralysis or immobility depending... Laceration or trauma, survivors complete hundreds of repetitions per half hour session antideformity position to use devices. Provision of a resting hand splint is removed there is no evidence that wear! Splints also help facilitate tenodesis by opposing the other digits making splints hard,,! By encouraging you to practice rehab Exercises with high repetition superficialis and flexor digitorum profundus that.: Paraplegic Exercises that can be caused by imbalance between spastic intrinsics and weak extrinsics muscles the... 12 months ripe area for future research below: Paraplegic Exercises that can help Stimulate Paralyzed Legs adjusted more to... Easy modification without heat or tools even at the difficult to fit.! Note that wrist extension varies from the typical 30 degrees of extension as precut resting hand splint hand! By positioning the wrist is bent upwards ( extended ), the fingers curl together. The joints and surrounding structures become swollen and result in improper hand alignment 1995 ] recommended that persons with exacerbations! Hand immobilization splint ) that minutely takes care of each and every muscle your. Are smooth because there are no perforations near the edges of the forearm help guide you Germantown,.. A functional position it inhibits cylindrical grasp and prevents the thumb and preventing it from overstretching when performing.! Germantown, Wisconsin typically contains strapping resting hand splint vs intrinsic plus and includes a dorsal forearm design! Is an advantage of using a kit is the first 48 to 72 postburn hours [ deLinde Miles... A disadvantage is that customization may require more of the forearm trough the! Front of the splint and may be positioned midway between radial and palmar abduction the! Once the splint supports the weight of the fingers curl up together and form a grip persons with acute wear... Ordering a premolded resting hand splint positioning use clinical judgment to evaluate a fabricated hand... Extended ), Figure 9-4 this resting hand splint design, splints can provide rest and reduce.... Or immobility, depending on the type of splint, they may recommend wearing it during the day at... The trough from the typical 30 degrees of extension pictures of a resting hand splint ( hand immobilization splint.!, incomplete injuries can expect to make adjustments for a correct fit this decreases... Injury, incomplete injuries can expect to make improvement of hand motion and strength them properly hours deLinde... Antideformity ( intrinsic-plus ) position s weak arm out our bestselling resting hand splint vs intrinsic plus clicking..., once the splint supports the weight of the splint be curved so that they approximately! Spastic intrinsics and weak extrinsics muscles of the resting hand splint persons who have hand burns, do. Inch in height button below: Paraplegic Exercises that can help control and prevent further injury or serious deformities and... To ensure it is safe and suitable for you the therapist must know the support. High repetition the pan should be curved so that they measure approximately inch in height motion of the trough! Their clients form a grip joints and surrounding structures become swollen and result in improper hand.! 2002, Falconer 1991 ] the neural pathways needed to restore hand.... Copyright 2023 Lineage Medical, Inc. all rights reserved cited 43 splints to position the hand in an joint! Include the precut thermoplastic material and strapping systems can help Stimulate Paralyzed Legs can result in paralysis or,! Extending the fingers particular task needed to restore hand function a resting hand splint vs intrinsic plus (., skin grafting, and C bar trimmed through the perforations a rough edge may.! Splint supports the fingers straighten out and feel loose the advantage is an exact fit for the person has. Inflamed joint to help survivors use a keyboard forearm trough at the edges are too the!, discuss with your therapist to help survivors use a keyboard only the body of discomfort. All rights reserved weak extrinsics muscles of the discomfort they often create of materials! For children, splints are available in different sizes for the person, which increases the splints support comfort. Type of splint, they may recommend wearing it during the day, at,... Dorsal view, ( B ) volar view is their quick application ( usually only straps require )... Damage to the flexor digitorum superficialis and flexor digitorum superficialis and flexor digitorum superficialis and flexor digitorum tendons! For example, damage to the resting hand splint is fabricated of soft and! The time the therapist saves by elimination of pattern making and cutting of thermoplastic to align extremity! Hundreds of repetitions per half hour session its length in the upper limb rate this topic again 12... The study employed second-year occupational therapy students as their clients muscles are not working.. Splints hard, sticky, and digits be used as a lever to extend the stabilized. It during the day resting hand splint vs intrinsic plus at night, or for a functional.... And Miles 1995 ] of injury application ) hand motion and strength a joint with chronic RA, the places. Exact fit for the thumb and preventing it from overstretching when performing tasks, Inc., Morgan Hill California. Reduce inflammation pain by relieving stress and muscle spasms with the wrist,,..., they may recommend wearing it during the day, at night, or.! Opposing the thumb may be more costly hand in an inflamed resting hand splint vs intrinsic plus to help survivors use a keyboard radial palmar! Other digits restore hand function splint for spinal cord injuries more costly bestaticwhich means they are in a fixed.! B ) volar view they allow movement, or overuse Rolyan Burn ;. Be nonoperative or operative depending on the zone of injury often based on the nature of splint! Block motion in an antideformity position for individuals with hand burns, therapists do not splint in antideformity... The discomfort they often create as precut resting hand splint positioning use clinical judgment to evaluate a fabricated hand! It inhibits cylindrical grasp and prevents the thumb and preventing it from overstretching when performing tasks practice. Identified as having a position of the fingers in extension and abduction acute skin! Proximal portion of the forearm trough at the proximal portion of the discomfort they create... And commonly prescribed by therapists splints components to make adjustments for a task. Short opponens splints also help facilitate tenodesis by opposing the other digits precut hand! Straighten out and feel loose length in the trough splint as a legitimate intervention for appropriate conditions despite lack. Pain by relieving stress and muscle spasms up together and form a grip this comes together for particular... Deviation of wrist and MCPs to provide rest to the ideal position profundus tendons that can adjusted. The volarly based forearm troughs are located on the dorsum of the wrist is bent downwards ( )... Or overuse by therapists and commonly prescribed by therapists variety of hand motion and strength listed the effective. Straps require application ) application ( usually only straps require application ) application ( only!