Custom Splinting vs. Casting for Hand Injuries


Custom Splinting vs. Casting for Hand Injuries

By Robert Wilutis, MS, OTR, CHT

If you have an upper extremity or hand injury, it’s important to know the best course of treatment. Most hand injuries do not actually require immediate surgical attention and can be safely treated through immobilization. So, should you cast or splint?

Both casts and splints immobilize targeted joints to support and protect injured bones, ligaments, tendons, and other tissues. They help fractured or injured bones heal and help decrease pain and swelling and to protect the injured area from more harm – but there are distinct differences for each.

Cast vs. Splint

A cast is fabricated by a physician or physician assistant. Casts are circumferential (wraps all the way around an injury). They are made of fiberglass or plaster. Casts provide superior immobilization but are less forgiving and have high complication rates.  Casts are often used for complex and/or definitive fracture management.

Custom splints are fabricated by a certified hand therapist.  Splints are made of thermoplastic material that is heated and molded to custom fit each individual.  Custom splints are used to:

  • Rest or protect a painful joint
  • Give stability to allow greater functional use
  • Decrease pain
  • Increase range of motion

Both casts and splints have their place and the use of either is based on a clinical decision related to the injury.  Consult with your doctor or physical therapist to determine which type of support is best for you.

 Treatment with Custom Splints

Following an injury or surgery, custom splints can be a valuable part of the recovery plan. Splints are often not circumferential; however, they do provide immobilization and stability of the targeted joint to allow healing. Static Splints are more forgiving than casts, which allows for fluctuation of swelling in the acute (early or most difficult) recovery phase.

  • Static Splints are often applied after a surgical procedure and are useful for a variety of acute orthopedic conditions such as:
  • Fractures
  • Reduced joint dislocations
  • Sprains
  • Severe soft tissue injuries
  • Post-laceration repairs

Splinting during the later phases of injury or for chronic conditions will assist with healing, long-term pain control, and progression of physical function.

Splints can also be fabricated to help restore motion; these are known as mobilization orthosis.

  • Static progressive splints apply a constant force at a joint to hold the joint at the end range position (or immobilized position). Maintaining the end range position will help to improve range of motion. Static progressive splints can be remolded or adjusted at increased angles as the patient increases their range of motion. They are often worn at night while sleeping or for scheduled times during the day.
  • Dynamic splints put tension on a joint to increase range of motion. They can also be used to assist in gaining motion or they can be used to help assist for weak or paralyzed muscles. Dynamic splints often incorporate an elastic component such as springs, coils or elastic bands.  The tension of the dynamic component can be adjusted based on the patients’ needs.

Benefits of a Custom Splint

Splints unlike casts are removable.  For this this reason, patients can remove their protective splint to begin an early prescribed exercise programs to restore active and range of motion. Having the protection that the splint provides and being able to remove for exercise significantly limits stiffness and decreases the time needed to return to previous functional levels.

Removable splints provide the patient the ability to clean the extremity or care for an open wound.

The adjustability of a splint allows for the common fluctuation of inflammation that occurs post injury or surgery.

Static progressive and dynamic splints also help increase desired range of motion.

At Professional Physical Therapy, our certified hand specialists can design quality custom fabricated splints to help patients achieve optimal healing and support during their recovery process. If you’re experiencing hand pain or discomfort, contact us at one of our hand therapy locations, so we can customize a rehabilitation plan just for you.

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