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Cubital Tunnel Custom Arm Night Splint

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Posted 9/21/2018 9:20 AM (GMT -5)
Hello,
My occupational hand therapist made a custom splint for my other arm yesterday, but I asked her to add foam cushioning which she did, but did not put it inside the entire area.

Now, I understand why they usually don't add much padding. The splint has pressure points around the elbow, and elsewhere, and it doesn't really swaddle the arm.

I'm going back over the lunch hour today to have it adjusted, likely with most of the padding removed.

Does anyone else have experience with this? Just seems like it would be difficult to mold the splint to fit nicely around the arm when adding a lot of soft padding.

Thank you.

Post Edited (Q22) : 9/21/2018 9:06:33 AM (GMT-6)

Posted 9/21/2018 1:08 PM (GMT -5)
Hi Everyone,

I'm back from having the custom arm splint adjusted. We kept the foam for now. She made extra space in the splint for my elbow, which should be great. In my opinion, every custom splint should be done that way. Why have a splint put undue pressure on an elbow?

I always wanted something that will apply little or no pressure to my elbows when I sleep on my back.

Will try it tonight and see how it works.
Posted 9/21/2018 1:34 PM (GMT -5)
Q22, glad to read the adjustment was made. I hope this works out well & you are able to sleep tonight without issues.

Keep us posted.
Posted 9/22/2018 6:05 PM (GMT -5)
I don't think I like the custom arm splint the OT made for my other arm. They are supposed to EVENLY swaddle the arm, but I had requested that they add foam padding to this one. Had I known these splints can't really be made properly (so it seems) to evenly swaddle the arm with foam padding, I would have never requested it.

I feel that the OT should have known. I'm not sure if they would be willing to start over and make another one, but I suppose they would if I complain to the insurance company, but I would rather not, unless it's necessary.

I would rather not eventually need elbow surgery
on my "good arm", so getting the splint right is very important to me.

My nerve twitches when I wear the splint, so there must be compression.
Posted 9/22/2018 6:58 PM (GMT -5)
Q22:
Making a custom splint can be an exacting process.

Adding density/memory foam or other padding can actually be counter-productive. Foam and padding can cause a shift or redistribution of pressure and contribute to added points of pressure on the contralateral aspects of the splint. The optimal custom molded splints have less padding/foam (not more). The best/optimal splints are the result of a casting process that captures intimate contact and detailed profiling of the topography of the arm/extremity (ex. exactly captures the dips and grooves and crevices and bony prominences).

It is often the case that a custom splint will need a few tweaks in contouring as a person initially begins to wear it. A heat gun can be used to remold or reshape areas of pressure or friction. Keep in mind that your arm is dynamic and constantly in flux (muscle tone and contours, tissue composition and fluid retention) while a splint is static and rigid. Polypropylene splints try to balance static stabilization and positioning with the dynamics of a living arm segment.

Work with your occupational therapist on contouring the splint over several visits to see if you can arrive at a happier place with the splint and your hopes for expectations.
Posted 9/22/2018 7:17 PM (GMT -5)
Seashell wrote: Foam and padding can cause a shift or redistribution of pressure and contribute to added points of pressure on the contralateral aspects of the splint.

Hi Seashell,
Thank you for your reply. That is exactly what I thought the first night I wore it. I had the splint adjusted yesterday, and suggested removing the foam, and remoulding it, but she didn't seem interested. I thought she could have simply dipped it back into the hot water and remoulded it.
Posted 9/23/2018 12:03 AM (GMT -5)
Hi Q22

Nice to meet you! I would suggest that you keep at it until they get it right. A bad product now can affect you poorly the rest of your life. You may have to fight to get what you need but stay calm, document everything and don't give up.

Warmly,
Chutz
Posted 9/30/2018 8:24 PM (GMT -5)
Thanks everyone for your helpful replies. My OT tried to adjust the splint for me, but it was a lost cause, so she made a new one for me at no charge.

Seashell, I read key points of your post to the OT (I did not reveal the source) regarding how foam can create pressure points. I believe this was what actually got me into a new splint, so thank you very much. This splint is for my "good" arm (left). The right splint feels nearly perfect - fits like an old glove, but the left doesn't feel quite right yet.

They are going to ask my health insurance company if they will cover a TENS & electrical stimulation unit for me, although she believes it's still too early for electrical stimulation. It's one unit, but does both TENS & electrical stimulation. The way she explained electrical stimulation, it seems like it exercises the muscles without actually exercising. I'm not sure how beneficial that would be.
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