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PassPMR - 08 Prosthetics & Orthotics > 6. Upper Limb Orthotics > Flashcards

6. Upper Limb Orthotics Flashcards

1
Q

List 4 Indications/functions for Static Orthosis Use 🔑🔑

A
  1. Immobilize, stabilize, and support a joint in a desired position (post op)
  2. Protect weak muscles from overstretch (burn)
  3. Prevent contractures (night splint)
  4. Support structures following surgical repair
  5. Facilitate the healing of soft-tissue injuries and fractures (injury)
  6. Painful disorders (RA, CTS)
  7. Improve function after stroke, peripheral neuropathy

Cuccurollo 4th Edition Chapter 6 P&O pg521

PMR Secrets 3rd Edition Chapter 34 pg278 q8

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2
Q

List 6 musculoskeletal conditions that needs orthosis

A

TENDON - JOINT - BONE - POSTOP

  1. Tendonitis
  2. Tenosynovitis
  3. Arthritis
  4. Hypermobility
  5. Enthesopathy
  6. Sprains
  7. Fractures
  8. Postsurgical and Postinjury Orthoses

Braddom 6th Edition Chapter 11 UL Orthosis pg213

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3
Q

List 2 Neuromuscular Conditions that needs orthosis

A
  1. Nerve Injuries (median, ulnar or radial n. injury)
  2. Brain Injury and Stroke (distal edema, joint subluxation, contracture formation, spasticity, weakness)
  3. Spinal Cord Injury (improve hand function)

Braddom 6th Edition Chapter 11 UL Orthosis pg219

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4
Q

The objectives of upper limb orthotic applications can be classified into three major areas

A
  1. Protection
    • Stabilize unstable bony components to promote the healing of soft tissues and bones.
    • Prevent progressive deformity (contractures)
  2. Correction
    • Correct alignment (subluxation)
  3. Assistance with function
    • Compensating for deformity, muscle weakness, or increased muscle tone.

Ref: Braddom Pg209

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5
Q

List 6 Indications for rest hand splint (cock up splint). Degree of extension. 🔑🔑

A

Rest hand splint (cock up splint)

  • WHOs in which the palmar section is extended (usually 0–20 degrees)

SKIN

  1. Skin grafting
  2. Contracture prevention

TENDON

  1. Wrist sprain/contusion
  2. Postsurgical wrist extensor tendon repair
  3. Reduce pain
  4. Flexor/extensor tendinitis

JOINT

  1. Resting wrist and hand in acute arthritis (RA)
  2. Pevent ulnar/radial deviation of the wrist/hand (e.g., RA)
  3. Wrist fusion

NEURO

  1. Prevent wrist flexion contracture in patient with radial neuropathy
  2. Carpal tunnel syndrome
  3. Reduce spasticity

Cuccurollo 4th Edition Chapter 6 P&O pg524-525

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6
Q

Why wrist is better kept at slight hyper extension in wrist hand orthosis?

A
  1. To maintain the length of the flexor tendon and improve hand function
  2. Discourage the development of a claw-hand deformity.
  3. To preserve the anatomic arches of the hand

Ref: Braddom Pg212

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7
Q

List 3 Complications Associated With Static Orthosis Use

A
  1. Skin breakdown (ill fitting)
  2. Contractures (long term use)
  3. Infection (poor hygiene)

Cuccurollo 4th Edition Chapter 6 P&O pg521

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8
Q

List 4 indications for thumb orthosis. 🔑

A
  1. Rheumatoid arthritis
  2. de Quervain’s tenosynovitis
  3. Thumb (CMC) Osteoarthritis
  4. Fracture of the first metacarpal
  5. Collateral ligament sprains
  6. Burns
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9
Q

Orthosis of choice for Thumb injury. 2 Marks. 🔑🔑

A
  1. Opponens orthosis
    • Immobilize the thumb and first MCP joint to promote tissue healing and/or protection or for positioning of the weak thumb
    • Opposition to other fingers to facilitate three-jaw chuck pinch
  2. Long Opponens orthosis
    • Longer orthosis with wrist control to prevent radial and ulnar-deviation deformities.
  3. Thumb Spica

Cuccurollo 4th Edition Chapter 6 P&O pg522

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9
Q

Orthosis of choice for Thumb injury. 2 Marks. 🔑🔑

A
  1. Opponens orthosis
    • Immobilize the thumb and first MCP joint to promote tissue healing and/or protection or for positioning of the weak thumb
    • Opposition to other fingers to facilitate three-jaw chuck pinch
  2. Long Opponens orthosis
    • Longer orthosis with wrist control to prevent radial and ulnar-deviation deformities.
  3. Thumb Spica

Cuccurollo 4th Edition Chapter 6 P&O pg522

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10
Q

Mechanism of work of Tone reducing orthosis. 4 Benefits & Indication. 🔑

A

Reflex-inhibiting positioning: Neurodevelopmental technique (NDT/Bobath) approach

Benefits

  1. Flexor tone reduction
  2. Prolonged stretch (serial static splinting)
  3. Prevent skin breakdown/maceration of palm by fingernails
  4. Increase passive range of motion via low-load

Indication

  • Spasticity due to upper motor neuron lesions (e.g., stroke, head injury, MS, cerebral palsy [CP])

Cuccurollo 4th Edition Chapter 6 P&O pg526

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11
Q

Orthosis for flexion contracture (boutonnière deformity & Dupuytren’s contracture). 2 Marks.

A
  1. Basic opponens orthoses but adds outriggers that assist PIP and DIP extension
  2. Interphalangeal extension-mobilization orthosis passively extend the PIP joints.

Cuccurollo 4th Edition Chapter 6 P&O pg522

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12
Q

List 4 Indications for MCP extension-mobilization orthoses

A

💡 Prevent flexion or induce extension:

  1. MCP-flexion contractures
  2. Volar Burns
  3. Post ORIF of metacarpal fracture
  4. Weak finger extension (e.g., radial nerve or brachial plexus lesion, stroke)

Cuccurollo 4th Edition Chapter 6 P&O pg524

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13
Q

Name it. Mechanism of work and 2 Indications. 🔑🔑 EXAM 2021

A

💡 Wrist extensors should be 3+ or better to use body-powered tenodesis

Rehabilitation Institute of Chicago (RIC) tenodesis splint

  • Tenodesis effect: promote finger flexion via wrist extension (extensor carpi radialis)
  • Low-temperature thermoplastics in three separate pieces
  • Uses a cord/string running from the wrist piece, across the palm and up between the index and ring fingers

Mechanism

  1. Flexion of proximal and distal IP joints flexion
  2. Immobilization of CMC and MCP joints

Uses

  1. SCI C6 Level
  2. Stroke with wrist drop
  3. Radial nerve palsy

Cuccurollo 4th Edition Chapter 6 P&O pg524-525

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14
Q

Name, Requirements & 4 conditions benefit from its use. 🔑🔑

A

BALANCED FOREARM ORTHOSIS

Require

  1. Biceps and pectoralis power 2/5 (can’t move anti-gravity so we eliminate it)
  2. Preserved ROM of the shoulder and elbow joints (no contracture)
  3. Adequate trunk stability and balance
  4. Adequate endurance in a sitting position

Conditions

  1. SCI C5 Tetraplegia
  2. Brachial plexus injury
  3. Guillain–Barr syndrome
  4. Polio
  5. Muscular dystrophy

Cuccurollo 4th Edition Chapter 6 P&O pg525-526

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15
Q

Positioning to avoid to minimize/prevent neuropathy 🔑🔑 EXAM

A
  1. Brachial plexus—avoid shoulder abduction >90 degrees and external rotation.
    • Shoulder can be flexed in 90 degrees with 10 degrees of horizontal adduction to take off stress from brachial plexus.
  2. Ulnar nerve—avoid elbow flexion at 90 degrees, upper extremity pronation
  3. Median nerve—avoid wrist hyperextension
  4. Peroneal nerve—avoid frog leg position, in which hip abducted at 45 degrees and knee flexe approximately 30 to 40 degrees

Cuccurollo 4th Edition Chapter 12 Burn pg917

16
Q

Positioning for each joint in burn patient 🔑🔑 EXAM

A
17
Q

Splint positioning for elbow burns

Splint positioning for dorsal hand burns 🔑🔑 EXAM

Splint positioning for voral hand burns 🔑🔑 EXAM

A

💡 Require maximal stretching to control the contracting forces of the healing burn.

ELBOW

  • Elbow extended and forearm supinated

DORSAL HAND

  • Wrist in 15 to 20 degrees of extension
  • Metacarpophalangeal (MCP) in 60 to 70 degrees of MCP flexion
  • Proximal interphalangeal (PIP) and distal interphalangeal (DIP) placed in full extension
  • Thumb—slight IP flexion and palmar abduction

Cuccurollo 4th Edition Chapter 12 Burn pg917

VORAL HAND

  • 15 to 20 degrees of wrist extension (same)
  • Extension of the MCP (difference)
  • Extension of the IP joints (same)
  • Digital & thumb abduction and extension (difference)

AIRPLANE ORTHOSIS

prevention of a shoulder adduction deformity after axillary burns, the shoulder should be held in abduction.

18
Q

Orthosis of choice for Burn injury. 2 Marks.

A

STATIC ORTHOSIS

  1. C-bar splint (thenar web spacer): 1st Webspace contracture post burn
  2. Dorsal Burn
  3. Volar Burn

Cuccurollo 4th Edition Chapter 6 P&O pg522-523

19
Q

Orthosis of choice for Hand deformities in rheumatoid arthritis. 3 Marks. 🔑🔑

Mention 4 hand deformities in RA and prescribe the suitable orthoses

A

1. Ulnar-deviation correction splint

Hand-finger orthosis with lumbrical bar

2. Wrist subluxation and radial deviation at the wrist

Resting wrist hand orthosis

3. Swan neck deformity

Swan neck ring splint: Prevents PIP joint hyperextension

4. Boutonnière deformity

Boutonnière ring splint: Immobilizes the PIP in extension and prevents flexion

Cuccurollo 4th Edition Chapter 6 P&O pg522

Ref: Braddom pg213

20
Q

Most common OA changes in hand and prescribe orthoses

A
  • CMC joint osteoarthritis
  • Hand-based thumb spica orthosis
    • Limiting motion
    • Decreases pain, especially with pinching-type activities.
21
Q

Orthosis of choice for Stroke patient to improve hand condition. 4 Marks. 🔑🔑

A
  1. Static Orthosis
    1. Universal Cuff Splint, Utensil Holder
  2. Tone reducing orthosis
    • Wear it 2 hours on and 2 hours off during the day and keep it on all night.
  3. Serial or dynamic splinting, after Botulinum toxin injection.
  4. Dynamic wrist hand finger orthosis (SeaboFlex)

Cuccurollo 4th Edition Chapter 6 P&O pg522

Stroke Clinical Hand Book 2020

22
Q

Three benefits of shoulder orthosis in stroke, how to prescribe it

A
  1. Reduce distal edema
  2. Joint subluxation
  3. Contracture formation.
23
Q

Ehlers-Danlos syndrome (EDS) hand orthoses

A

Silver Ring offers several low-profile prefabricated and cosmetically attractive orthoses for such patients.

Ref: Braddom pg213

24
Q

From the picture name and uses of the orthosis?

A

💡 Anti-Claw Orthosis

Name: combined median and ulnar nerve palsy orthosis

Use: use with median and ulnar nerve palsy blocking the metacarpophalangeal joint into slight flexion

25
Q

Orthosis of choice for Hand deformities in median and ulnar palsy. 2 Marks. 🔑🔑

A

Claw hand (both median and ulnar nerve injuries)

  1. Opponens orthosis with lumbrical bar
  2. MCP extension block orthosis (Dorsal Block)

Prevents MCP joint hyperextension but allows full MCP flexion

Cuccurollo 4th Edition Chapter 6 P&O pg522

26
Q

Orthosis of choice for Wrist drop. 2 Marks. 🔑🔑

A
  1. Resting wrist hand splint
  2. Universal cuff splint
  3. Dorsal WHO with an outrigger and MCP extension assist
27
Q

Orthosis of choice for Carpel tunnel syndrome & how to use them. 2 mark 🔑🔑

A
  • Purpose of the orthosis is to immobilize the wrist to minimize swelling from overuse of the tendons.
  • Hold the wrist in 0 degrees to 5 degrees of extension.
  • The patient should be instructed to reduce stresses at the wrist and to wear the orthosis all night.
  • Worn for 4 to 6 weeks, with gradual weaning from the orthosis and return to activity with work station modifications.

Ref: Braddom pg221

28
Q

Benefits of ROM in orthosis 🔑🔑

A

Joint movement has been credited with enhancing cartilage nutrition and preventing intraarticular adhesions.

Ref: Braddom pg213

29
Q

Two main programs are prescribed following flexor tendon repair, and what is your goal.

A
  1. Early passive motion
  2. Early active mobilization.

Goal

  1. Increases the rate of revascularization and healing of the repair
  2. Increases repair strength
  3. Remodel the gliding surface of the tendon itself
  4. Prevent any scar adhesions that could impede functional gliding.

PassPMR - 08 Prosthetics & Orthotics (9 decks)

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