Full Cock Up Splint Complete Wrist-Hand Orthosis for Neurological Spastic Hand, Flexion Contracture Prevention & Comprehensive Upper Limb Rehabilitation

The Full Cock Up Splint formally classified as a Wrist-Hand Orthosis (WHO) represents the clinically more comprehensive evolution of the standard cock up splint, extending the thermoplastic support platform from the forearm and wrist all the way to the fingertips to provide simultaneous wrist and complete finger immobilisation within a single integrated orthotic device. The full cock up splint maintains the wrist and hand in slight extension, with the platform extending to the end of the fingers excellent for a variety of wrist and hand indications such as arthritic hand positioning, reconstructive surgery, and spasticity making it the orthosis of choice whenever the clinical requirement is not merely wrist control but comprehensive management of the entire hand's resting posture, finger alignment, and long-term soft tissue integrity. 

The Critical Clinical Distinction: Full vs Standard Cock Up Splint

Understanding the clinical difference between the full and standard cock up splint is essential to correct prescription. The standard cock up splint terminates at or just proximal to the metacarpophalangeal joints its design philosophy is to immobilise the wrist while deliberately freeing the fingers to allow functional hand use during daily activities and to prevent the wrist muscle atrophy associated with more complete hand immobilisation. A wrist immobilisation splint immobilises the wrist while allowing full metacarpophalangeal flexion and thumb mobility, enabling the person to continue to perform functional activities with the added support and proper positioning of the wrist the splint provides a design that is entirely appropriate for the majority of wrist conditions where the fingers are neurologically intact and voluntarily mobile.

The Full Cock Up Splint addresses a fundamentally different clinical population: patients in whom the fingers themselves require immobilisation, passive positioning, contracture prevention, or protection from the damaging effects of neurological muscle tone imbalance, arthritic joint inflammation, or post-surgical vulnerability. In these presentations, leaving the fingers free as the standard cock up does would allow the very deformity, contracture, or inflammatory damage that the orthosis is intended to prevent. The full-length finger platform of the Full Cock Up Splint resolves this by bringing the entire hand wrist, MCP joints, PIP joints, DIP joints, and fingertips within the corrective and protective envelope of the orthosis.

Neurological Applications: Stroke, Hemiplegia & Spastic Hand

The most prevalent and clinically significant application of the Full Cock Up Splint is in the management of the neurological upper limb following stroke, traumatic brain injury, and cerebral palsy conditions in which the disruption of upper motor neurone pathways results in spastic hypertonicity of the wrist and finger flexor musculature, progressively drawing the hand into a posture of wrist flexion, finger flexion, and thumb-in-palm deformity. This spastic flexion posture if allowed to persist unsupported across daily rest periods, sleep, and inactivity drives the progressive adaptive shortening of the flexor tendons, volar skin, and palmar fascia that ultimately consolidates into a fixed flexion contracture that severely limits upper limb function, hygiene maintenance, and quality of life.

The Full Cock Up Splint directly opposes this contracture-driving mechanism by maintaining the wrist and all finger joints in a neutral to mildly extended position throughout the wearing period applying a gentle, sustained counter-force to the spastic flexor musculature that prevents the sustained shortening of the length-sensitive components of the flexor system. For post-stroke patients in the subacute and chronic phases, consistent overnight use of the full cock up splint is a cornerstone of upper limb management preserving the passive range of motion in the wrist and fingers that is the prerequisite for functional use of the hand in active rehabilitation programmes, and preventing the hygiene and skin integrity challenges associated with severe uncorrected flexion deformity.

Radial Nerve Palsy & Flaccid Hand: Substituting for Absent Extensor Function

In radial nerve palsy and other conditions producing a flaccid hand including brachial plexus injury and peripheral nerve disorders the loss of active extensor function at the wrist and fingers causes the hand to rest in a position of unopposed flexor tone, with the wrist dropped and the fingers partially or fully flexed. Unlike the spastic hand, where the problem is excessive active flexor tone, the flaccid hand presents with passive gravitational collapse into flexion in the absence of active extensor counter-force.

The Full Cock Up Splint addresses both of these mechanistically distinct presentations through the same device, by passively positioning the wrist and all finger joints in the extension posture that absent or insufficient active motor function cannot independently maintain. For the flaccid hand, this passive extension support also preserves the optimal length-tension relationship of the intact but unopposed finger flexors preventing them from developing the adaptive shortening that would compound the functional deficit if nerve recovery eventually occurs and active finger extension is able to resume.

Rheumatoid Arthritis & Inflammatory Hand Conditions

In rheumatoid arthritis and other inflammatory polyarthropathies, the Full Cock Up Splint provides the comprehensive hand and wrist rest that is the cornerstone of inflammatory flare management for patients with multi-joint involvement. Unlike the standard cock up splint which rests the wrist but leaves the inflamed MCP and PIP joints free to move and sustain ongoing inflammatory loading the Full Cock Up Splint immobilises the entire hand during the wearing period, providing pain relief through joint rest across all affected joints simultaneously. The flexible padded stays along each finger distribute the splint's corrective extension forces gently across the digit surfaces, avoiding the localised joint pressure that rigid finger channels would generate in inflamed and tender arthritic joints.

For patients with established rheumatoid hand deformity including ulnar deviation, volar subluxation of the MCP joints, and swan-neck or boutonnière deformities of the fingers the full cock up splint also functions as a deformity-modifying orthosis, applying corrective positioning forces to the deviated joints during rest and sleep and reducing the progressive joint destruction that unsupported deformity allows during the inflammatory process.

Post-Surgical Hand Management: Protecting Operative Corrections

Following a range of hand surgical procedures including flexor tendon lengthening for neurological spasticity, MCP joint arthroplasty for rheumatoid arthritis, palmar fasciectomy for Dupuytren's contracture, and reconstructive procedures for traumatic hand injuries the Full Cock Up Splint serves as the standard post-operative positioning device that maintains the corrected alignment achieved through surgery while the soft tissues heal. The comprehensive wrist-to-fingertip coverage of the splint ensures that all joints addressed by the surgical procedure are held in the prescribed post-operative position throughout the healing and scar maturation phase protecting the operative correction from the rebound contracture and deformity recurrence that are the most common causes of suboptimal surgical outcomes in hand reconstruction.

Night Platform Serial Stretching: Progressive Contracture Correction

For patients presenting with established, non-fixed wrist and finger flexion contractures whether arising from neurological conditions, burns, prolonged immobilisation, or post-traumatic scarring the Full Cock Up Splint can be applied as a serial static night platform extension splint, with the wrist and finger extension angle set at the patient's current end range and incrementally advanced at each clinical review as the contracture responds to the sustained overnight stretch. A slow, sustained stretch allows the tissues to remodel and lengthen without generating the inflammatory response that aggressive high-force stretching produces making the night platform approach a clinically effective and patient-tolerable strategy for progressive contracture reduction over the weeks and months of treatment required to achieve meaningful, sustained range of motion gains.

Fabrication & Fitting Considerations

The Full Cock Up Splint is most effectively fabricated as a custom thermoplastic device by an occupational therapist or orthotist, allowing the precise wrist extension angle, MCP extension angle, and finger position to be individually prescribed and moulded to the patient's specific anatomy and clinical requirements. The splint is applied to the volar surface of the hand and forearm, with the distal edge extending to the fingertips and the proximal edge terminating approximately two-thirds of the way up the forearm. Multiple Velcro closure straps at the forearm, wrist, and finger platform allow secure, independent application and removal, with the ability to adjust compression as limb volume changes throughout the rehabilitation period.

Indicated For:

Post-stroke spastic hand and wrist flexion spasticity, hemiplegia upper limb management, traumatic brain injury neurological hand positioning, cerebral palsy hand deformity management, radial nerve palsy and wrist drop with finger involvement, flaccid hand paralysis, rheumatoid arthritis multi-joint inflammation management, post-surgical hand positioning following tendon lengthening, MCP arthroplasty, Dupuytren's fasciectomy and hand reconstruction, established wrist and finger flexion contracture serial stretching, burn scar contracture of the hand, and any clinical presentation requiring simultaneous wrist and finger immobilisation in a neutral to extended functional posture.