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Medicine > Braddom - Upper Limb Orthotic Devices > Flashcards

Braddom - Upper Limb Orthotic Devices Flashcards

1
Q

Orthos means

A

Correct or make straight

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2
Q

Any externally applied device used to modify structural and fx characteristics of the neuromuscular skeletal system

A

Orthosis

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3
Q

Orthosis alternatively known as

A

Orthotic device

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4
Q

Upper limb orthotic applications

Objectives

A

Protection
Correction
Assistance with function

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5
Q

Will act as a keystone for hand position

A

Wrist

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6
Q

The wrist will act as the keystone for hand p ing and outlines the basis for all splinting, except

A

Isolated digital splinting

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7
Q

Weight of the hand pulls the wrist into

A

Flexion

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8
Q

Flexion of wrist will inc tension in the

A

Extrinsic extensor tendons - pulling metacarpophalangeal joints into hyperextension

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9
Q

Goal of hand splinting

A

To prevent claw hand

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10
Q

How does wrist splinting prevent claw hand

A

Prevent wrist flexion
Inc tension extrinsic extensor tendons, pulling MCP (pulled into hyperextension)

Extrinsic flexor -tension -> PIP and DIP flexion

Metacarpal arch of hand flattens
Thumb- adduction

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11
Q

Key for finger function

A

MCP joint

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12
Q

When MCP joint are hyperextended

A

IP joints flex

Tension of flexors

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13
Q

Hand splinting should

Position

A

Wrist - slight extension - maintain flexor tendon length and improve hand function
MCP -maximum stretch - IP flexed

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14
Q

Oppose development of a claw hand deformity

A

Slight wrist extension

MCP max stretch

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15
Q

Safe, intrinsic plus

Hand splinting

A

Slight wrist extension

MCP max stretch

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16
Q

Fosters the weaker intrinsic motions of the MCP flexion and IP extension that are difficult to obtain

A

Slight wrist extension

MCP max stretch

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17
Q

2 basic hand grips

A

Power and precision

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18
Q

The wrist is held in dorsiflexion with the fingers wrapped around an object held in the palm

A

Power grip

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19
Q

Holding a screw driver in a cylindrical grip

A

Power grip

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20
Q

Is useful for holding a ball

A

Spherical grip

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21
Q

Useful for carrying heavy objects

A

Hook pattern

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22
Q

The thumb is held against the tip of the index and middle finger

A

Precision grip

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23
Q

Functional hand splinting is aimed at improving this functional activity of

A

Pinch

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24
Q

Three of types of pinch

A

Oppositional pinch
Precision pinch
Lateral key pinch

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25
Q

Three jaw chuck

A

Oppositional pinch

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26
Q

Best to splint towards this type of pinch

A

Oppositional pinch

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27
Q

Allows best compromised between fine precision pinch and strong lateral pinch

A

Splint towards oppositional pinch

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28
Q

What practical orthosis can substitute or improve thumb adduction

A

None

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29
Q

Splinting thumb

A

Enhance prehension, do not forced to extend and radial abduction

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30
Q

When increasing joint range of motion with splinting, the angle of pull needs to be

A

Perpendicular to bony axis that is being mobilized

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31
Q

Improvement of range of motion is directly proportional to the length of time a joint is

A

Held at its end range

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32
Q

The improvement in range of motion is directly p portional to the length of time a joint is held at its end range.
What principle is this?

A

TERT principle

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33
Q

TERT is used with this type of splinting

A

Static progressive splinting

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34
Q

Provides support to a body part without crossing any joints

A

Nonarticular

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35
Q

Used for circumferential support to the arm during fracture healing

A

Humeral fracture splint

Non articular

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36
Q

Used to immobilize a proximal radius fracture

A

Sugar tong splint

Non articular

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37
Q

To extert pressure over a healing scar to prevent hypertrophic scarring

A

Gel shell splint

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38
Q

Provides static support to hold a joint or joints stationary

A

Static splint

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39
Q

Splint for acut carpal tunnel syndrome

A

Volar wrist splint

Static

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40
Q

Splint to reduce tone in spastic muscles

A

Volar wrist splint

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41
Q

Is also a static but is periodically changed to alter the joint angle at which splint is positioned

A

Serial static

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42
Q

Serial static are applied with the tissue at its

A

Tissue of Max length

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43
Q

Permits motion in one directon but blocks motion in another

A

Static motion blocking

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44
Q

Designed to allow flexion but block hyperextension of the PIP joint (rheumatoid arthritis)

A

Swan neck splint

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45
Q

One of the most commonly used splint for regaining joint motion

A

Static progressive

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46
Q

Orthosis is not remolded to increase joint motion

A

Static progressive

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47
Q

They use nonelastic components such as stayic lines, hinges, screws, turnbuckles to place force on a joint to induce progressive chnge

A

Static progressive

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48
Q

Decreases the static line length as it turned, thereby inc the range of joint motion

A

MERit static progressive component

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49
Q

Provides the elastic force to help regain joint motion

A

Dynamic splint

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50
Q

Uses a spring coil or wire tension assist to inc extension in a PIP joint with a mild contracture

A

Finger extension splint

Dynamic

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51
Q

Allows certain motions but blocks others

It uses a passie eslastic line of pull in the desired direction but permits active motion in oppsitve motion

A

Dynamic motion blocking

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52
Q

Splint for flexor tendon repairs

Passively pulls the finger into flexion with an elastic thread or rubber band

A

Kleinert postoperative splint

Dynamic motion blocking

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53
Q

It allows active digital extension, while parts of the splint block full extension of the MCP joint and the wrist

A

Kleinert postoperative splint

Dynamic motion blocking

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54
Q

Offers traction to joint while allowing controlled motion

A

Dynamic traction

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55
Q

Hand-based PIP extension split with an outrigger which gives constant longitudinal traction while joint is gently flexed and extended

For intraarticular fracture
Type of splint

A

Dynamic traction

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56
Q

Facilitates fx in a hand that has lost motion because of nervous system injury

A

Tenodesis

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57
Q

Electrically powered devices that mchanically move joints through a desired range of motion

A

Continuous passive motion orthoses

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58
Q

Keeps the joint suple and maintains articular, ligamentous and tenginous structure mobility during healing phases after injury or surgery

A

Continuous passive motion

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59
Q

Promote functional use of the upper limb with impairment resulting from weakness, paralysis, or loss of a body part

A

Adaptive or functional usage devices

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60
Q

Promote fx use the upper limb with impairment resukting from weakness, paralysis or loss of a body part

A

Adaptive or functional usage devices

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61
Q

Inflammation at a muscle or tendon origin or insertion

A

Enthesopathy

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62
Q

Tendonitis, tenosynovitis, enthesopathy result from

A

Result from excessive repetitive movement or external stressors

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63
Q 
Tendonitis, tenosynovitis, enthesopathy 
Usually involve (upper limb tendons)
A

Wrist extensors
Abductor pollicis longus
Extensor pollicis brevis (thumb)

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64
Q

Wrist extensors
Abductor pollicis longus
Extensor pollicis brevis (thumb)

Tenosynovitis

A

De Quervain’s stenosing tenosynovitis

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65
Q

Goal of splinting in tendonitis

A

Immobilize the affected structures in order to facilitate healing and dec inflammation

66
Q

More common enthesopathy of the upper limb

A

Lateral epicondylitis

67
Q

Lateral epicondylitis tx with

A

Tennis elbow orthosis

68
Q

Forearm band that changes the lever arm against which the wrist extensors pull

A

Tennis elbow orthosis

69
Q

Essence of tennis elbow orthosis

A

Puts the origin of the extensor muscles at rest and dec microtrauma from overuse

70
Q

Tennis elbow orthosis is placed

A

2 fingerbreadths distal to lateral epicondyle and is a firm strap against which the extensors press against when contracting

71
Q

Medial epicondylitis brace

A

Golfer’s elbow

72
Q

Causes snapping sensation in the volar surface of the digits on release of grasp

A

Trigger finger

73
Q

Trigger finger is usually a result of trauma to the

A

flexor tendon sheath of the fingers or thumb (thickened tendinous sheaths and restriction of motion)

74
Q

Digit can become locked in flexion

A

Advanced trigger finger

75
Q

Goal in triggerfinger

A

Halt the repetitive motion temporarily to allow healing

76
Q

Hwo to achieve goal in trigger immobilization

A

Immobilization

77
Q

Splint of trigger finger covers

A

Proximal phalanx and the MCP joint of digit

78
Q

Splin for trigger finger

Mechanism

A

Dec tendinous excursion through the first annular pulley at the base of the MCP joint, allows inflamed structures to rest

79
Q

Momentary subluxations with spontaneous resudction that result in torn ligamentous structures

A

Sprains

80
Q

Sx sprain

A

Experience pain, swelling and dec function

81
Q

Sprains tx

A

Immobilizartion in a position of fx

82
Q

Common sprains include

A

Dislocation of the IP and MCP joints caused by hyperextension injuries (sports)

83
Q

First and second degree ligamentous tear goal is to

A

Protect and rest the area by applying functional splinting

84
Q

Goal of third degree ligamentous tear is

A

Fully mobilize and approximate the ligaments

85
Q

Common splint for digital splints are

A

Finger extension splints that hold PIP joint extension
Allow flexion DIP
-keeps oblique retinacular ligament and terminal extensor tendon lengthened

86
Q

Finger extension splint for digital sprains prevent

A

Boutonniere deformities

87
Q

Ulnar collateral ligamentous injuries at the MCP joint of thumb are tx with

A

Hand-based thumb spica spint producing immobilization during healing phase

88
Q

Wrist sprains management

A

Wrist splints in slight extension

89
Q

Some motion but avoid creating significant stress.

Limit available range to 40 degrees of total motion

A

Splints with no splint (metal bar insert)

90
Q

Are helpful for mild sprains at the elbow because they limit the extremes of range but allow limited fx

A

Lbow neoprene

91
Q

Circumferential
Permits motion of elbow, forearm and hand
Arm fractur

A

Humeral fracture brace

92
Q

Humeral fracture of brace prevents

A

Edema

Resultant joint stiffness

93
Q

Used primarily for phalangeal and metacarpal fractures

Splint extend from the proximal forearm to beyong the dip joint

A

Gutter splint

94
Q

Has been credited woth enhancing cartilage nutrition and preventing intraarticular adhesions

A

Joint movement

95
Q

Most common dse affecting the joins in the upper limb

A

Osteoarthritis

96
Q

Joint dse in this area have most significant impact on fx

A

Hand

Wrist

97
Q

Chronic inflammatory dse that affects snyovial joints

A

RA

98
Q

RA most commonly affects

A

Wrist, MCP joint, PIP joint

99
Q

RA deformities include

A

Subluxation, ulnar deviation at the wrist
Swan neck deformity
Boutonniere deformity of fingers

100
Q

Deformed position of the finger in which joint closest to tge fingertip is permanently bent toward palm while nearest joint to the palm is bent away from it (DIP flexion with PIP hyperextension)

A

Swan neck deformity

101
Q

PIP flexion with DIP hyperextension

A

Boutonniere deformity

102
Q

Most common form of arthritis

A

Osteoarthritis

103
Q

Osteoarthritis is primarily a disease of

A

Cartilage, not synovium

104
Q

Osteoarthritis most commonly involves the

A

CMC joint of thumb

105
Q

CMC joint osteoA

Management

A

Thumb spica hand based or forearm based

Limit motion at base of thumb, splint dec pain, esp pinching

106
Q

What deformity is incurred in distal median nerve injury

A

Simian hand

107
Q

Fx most affected by simian hand

A

Thumb palmar abduction and opposition

108
Q

Thumb palmar abduction and opposition

Nerve

A

Distal median nerv injury

109
Q

Distal median nerve injury
Simian hand

Management

A

Spring coil design
MCP joint slight extension
Position thumb in palmar abduction

110
Q

Most common presentation with radial nerve injury distal to humeral spiral groove

A

Wrist drop

Finger drop

111
Q

Goal radial nerve injury
Wrist drop
Finger drop

A

Enhance wrist and finger extension

112
Q

Position of radial nerve palsy splint

A

Fore-arm based with an outrigger, holds the wrist fingers and thumb in extension and allows flexion digit

113
Q

Benediction hand

A

Proximal ulnar nerve injury

114
Q

Features hyperextension of the 4th and 5th MCP joint
And flexion of PIP
Loss of balance between extrinsic and intrinsic hand muscles

A

Benediction hand

Proximal ulnar nerve injury

115
Q

Goal proximal ulnar nerve inury/ benediction

A

Prevent fixed deformity of 4th and 5th MCP and improve fx

116
Q

holds the MCP joints of the fourth and fifth fingers in slight flexion by a spring coil or figure-of-eight splint design

A

Ulnar nerve palsy splint

117
Q

Position goal ulnar nerve palsy splint

A

The spring coil design assists MCP flexion and permits extension of the MCP joints but blocks hyperextension

118
Q

This is compromised in low median and ulnar nerve injuries

A

Thumb position - weakened opposition and palmar abduction

119
Q

Incomplete nerve injury by compression median nerve

A

Carpal tunnel syndrome

120
Q

Purpose of splint

Carpal tunnel syndrome

A

Immobilize the wrist to minimize swelling from overuse of the tendons

121
Q

Carpal tunnel

Wrist extension degres

A

0-5

122
Q

Wrong common name of carpal tunnel syndrome splint

A

Wirst cock-up splint

123
Q

Prefabricated wrist splints for carpal tunnel syndrome degree of extension

A

45, exceeds dec pressure in carpal tunnel

124
Q

Carpal tunnel splint should be worn until

A

4-6 weeks

125
Q

Compression of the ulnar nerve in elbow

A

Cubital tunnel syndrome

126
Q

Cubital tunnel syn tx with

A

Long arm splints that hold elbow in 45 degrees flexion
Forearm neutral
Wrist in 0-5 degrees extension
Thumb fingers free

127
Q

Brain injury

Orthotic devices design for

A

Prevent doformities and to help adjust muscle tone

128
Q

In upper limb paralysis a resting hand splint is commonly used to position the wrist in slight extension, the MCP joints in slight flexion, and the IP joints in extension.

A

wrist in slight extension, the MCP joints in slight flexion, and the IP joints in extension.
thumb is supported in a position between palmar and radial abduction.

129
Q

vents ligamentous stresses on the thumb, especially in the insensate hand.

A

Full support of the first CMC joint

130
Q

Now used to dec tone in patients with focal spasticity

A

Botulinum toxin

Followed by serial and dynamic splinting - normal posture and position

131
Q

Places the fingers and hand in a reflex-inhibiting position and serves to reduce tone

A

Ball antispasticity splint

132
Q

dynamic orthosis with functional electrical stimulation that is most appropriate for patients who have some shoulder and elbow movement but no hand function (i.e., lack of active finger extension).

positions the wrist and fingers into extension in preparation for functional activities

A

SaeboFlex

133
Q

mobile arm support

A

enhance function for patients with proximal upper limb weakness, especially when the weakness is profound and the outlook for recovery is guarded.

134
Q

particularly helpful when performing such activities of daily living as eating and grooming. When attached to a wheelchair with a swivel joint, this is often also called a balanced forearm orthosis.

A

mobile arm support

135
Q

slings restrict active motion of the shoulder by

A

keeping the humerus in adduction and internal rotation and placing the elbow in flexion

136
Q

designed to unload the weight of the arm on the s der, but do not approximate the humeral head back into the glenoid fossa

A

Shoulder sling (brain injury)

137
Q

Slings or half arm trays have not been found to correct the shoulder subluxation completely.

A

T

138
Q

is often preferred because it will not restrict use of the limb, and the humerus is more naturally approximated into the glenoid fossa.

A

arm trough or half lap board

139
Q

spinal cord injury at the C1-C3 level

Goal

A

prevent contractures and to hold the wrist and digits in a position of function with a resting hand splint

140
Q

C4-level injury the goal

A

use the available shoulder strength, p viding a mobile arm support to enhance function as previously described.

141
Q

C5-level injury the goal

A

statically position the wrist in extension with a ratchet-type hinged orthotic device to hold devices and use the shoulder musculature for function.

142
Q

C6 tetraplegic goal

A

enhance finger flexion using a tenodesis flexion effect from wrist extension.

143
Q

Rehabilitation Institute of Chicago tenodesis splint

A

Thumb position - Palmar abduction

PIP joints of index and long fingers in slight flexion

144
Q

Produces three point pinch

A

Rehab tenodesis splint

145
Q

Flexor tendon repair

Postsurgical and postinjury orthoses

A

Kleinert and Duran

146
Q

features dynamic traction into flexion, but allows active digit extension within the constraints of the splint.

A

Kleinert splint

147
Q

statically p tions the wrist and MCP joints in flexion and the IP joints in extension

A

Duran splint

148
Q

Kleiner + Duran +
a tenodesis-type action splint for a specific, active assisted range-of-motion exercises, can be used only if a specific surgical suture technique has been used.

A

Indiana Protocol splint

149
Q

Mallet finger injury

A

Stax splint

150
Q

static splint holding the DIP joint in full extension.

A

Stax splint

151
Q

Proximal injury

Extensor tendon

A

wrist statically in extension with dynamic extension of MCP (allows active flexion 30 degrees) and IP joints

152
Q

Burn patients typically prefer

A

adducted and flexed p tion of the upper limbs to maintain comfort (loss of fx range motion)

153
Q

Burn dorsak surface of hand

A

wrist is kept in 15 to 20 degrees of extension, the MCP joints in 60 to 70 degrees of flexion, the PIP and DIP joints in full extension, and the thumb between radial abduction and palmar abduction

154
Q

If tendons are exposed burn)

burns of the dorsal surface of the hand

A

wrist is kept in 15 to 20 degrees of extension, the MCP joints in 30-40 degrees of flexion, the PIP and DIP joints in full extension, and the thumb between radial abduction and palmar abduction

MCP 30-40 flexion (slack tendons until wound closure)

155
Q

Palmar hand burns require

A

maximum stretching to p vent the contracting forces of the healing burn.

15 to 20 degrees of wrist extension, extension of the MCP and IP joints, digital abduction, and thumb abduction and extension.

Open palm
Pancake position

156
Q

Axillary burns

Goal

A

Prevent shoulder adduction deformity

157
Q

Axillary burns

Held in

A

shoulder should be held in abduction with an airplane splint.

158
Q

tendency toward hypertrophic scarring after a burn is addressed with

A

compression garments, e tomer molds, facial splints, gel shell splints, and silicone gel sheeting

159
Q

Patients with arthritis who have been taking c steroids for long periods often have fragile skin, so their splints should be

A

Padded throughout

160
Q

Tells an overly aggressive stretch is being applied to the shortened neurovascular bundles

A

Blueness or redness of the digits

161
Q

Neurovascular bundles sometimes shorten because of joint contracture

Management

A

splint tension must be decreased and the contracture stretch should be less aggressive. 20

Medicine (29 decks)

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