Simple Is Often Better,
Clinical Pearl No. 11 – October 2010

HandLab Clinical Pearls

October 2010                          No. 11



Some years ago I was treating a toddler for bilateral palmar hand burns after he grasped his older sister’s hot curling iron. With our hot summers in North Carolina it was a challenge to prevent maceration with his long term wear of splints to maintain length of the thumb web. The interface molds fitted for total contact and even pressure to the scars only increased the maceration. An additional problem was the frequent need to clean the hand and splint because of the naturally inquisitive nature of the toddler. At one return visit I removed the child’s splints to discover the mother had placed multiple cotton balls between the splint and the scar.Oct-2010-No-11

Splint in place with cotton balls packed into thumb web space.

Not only did they provide perfect pressure to the scar as they were compressed, but they were inexpensive, easily replaced, and prevented maceration. Following this experience I often used cotton balls as a way of creating perfect contact between the thermoplastic splint and an underlying scar that needed to be held at length…especially during the hot summertime. The cotton balls are easily held in place by a piece of stretchy gauze. I realize currently the hydrating property of other materials is considered ideal. The use of the cotton balls is therefore likely most appropriate for scars that cross joints and must be held at length with positive pressure.Oct-2010-No-11-1

Final result for both thumbs.

Download Clinical Pearl No. 11, Simple Is Often Better, October 2010



Book Chapter – Therapist’s Management of the Stiff Hand, Rehabilitation of the Hand and Upper Extremity – 2011

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Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.