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Year 3: Prosthetics and Orthotics > Lecture 6: UE Orthoses > Flashcards

Lecture 6: UE Orthoses Flashcards

1
Q

OT scope of practice in regard to orthotics

A

assessment, design, fabrication, application, fitting, and training in orthotic devices

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2
Q

domains of hand therapy practice

A
  1. assess upper limb and relevant pt characteristics
  2. determine prognosis and individualized POC
  3. Implement POC and therapeutic interventions
  4. basic science and fundamental knowledge
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3
Q

articular vs non articular orthoses

A

articular crosses a joint

nonarticular does not cross or does not have a mechanical joint

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4
Q

purposes of UE orthoses

A

immobilize

mobilize/assist with movement

restrict motion

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5
Q

what characteristics need to be described when talking about an UE orthoses

A

fabrication (custom?)
articular or non?
location
direction of applied forces
purpose of orthoses

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6
Q

what do immobilizing UE orthoses do and examples of possible indications

A

stabilize joints/tissues by preventing excessive/abnormal movement

manage a deformity bu preventing contracture

protect structures from harmful/excessive load

i.e. stabilize unstable/painful joints, reduce inflammation, prevent deformities, facilitate healing, etc

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7
Q

what do mobilizing UE orthoses do and examples of possible indications

A

assist with movement

manage deformity by applying corrective force

i.e. assist with lost movement from nerve injury, elongate shortened tissue

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8
Q

what do restricting UE orthoses do and examples of possible indications

A

protect structures from harmful/excessive load

i.e. prevent joints from unsafe movements

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9
Q

what is a budding taping orthoses used for

A

stringer digital assists with movement of impaired digit

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10
Q

what are blocking splints used for

A

assists AROM by blocking movement of more mobile joints

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11
Q

Anti-deformity position of the UE

A

90 deg shoulder abduction with ER

elbow extension

neutral to slight supination of forearm

20-30 deg wrist ext

70-90 deg MCP flexion

IP extension

thumb and palmar abduction

*important considerations for burns

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12
Q

UE orthoses design principles

A

wear time depends on orthoses/purpose

longer splints = more comfy

wider straps = more even force distribution

contoured edges = for pt comfort

avoid pressure over bony prominences

in dynamic braces, angle of pull should be 90 deg

apply tension only sufficient to take the joint to comfortable end range

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13
Q

design categories of UE orthoses

A

static
dynamic
functional

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14
Q

types of static UE orthoses

A

static
- articular
- non-articular
- motion blocking (dorsal or volar)

serial static

static progressive

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15
Q

purpose of static splints

A

provide passive support

commonly prescribed for immobilization

provides protection for proper positioning

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16
Q

general position for static splints

A

for contracture prevention and healing

resting position = holds tissue in elongated position but not at end range

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17
Q

functional position of hand and wrist

A

20-30 deg wrist ext

40-45 MCP flexion

45 PIP flexion

relaxed flexion of DIPs

thumb abducted and in opposition to fingers

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18
Q

Healing time, non-union rate, and radial nerve palsy rate for pts with a closed humeral shaft fx using a static splint vs surgical treatment

A

non operative
- healing time = 16 weeks
- non union = 11%
- radial nn palsy = 1%

operative
- healing = 14-15 weeks
- non-union = 3-6%
- radial nn palsy = 3-4%

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19
Q

indication for elbow flexor spasticity static splint

A

due to UMN pathology

may be worn at night to maintain elbow extension ROM and prevent flexion contracture

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20
Q

purpose, position, and indication for airplane splint

A

purpose = immobilization

position in abduction

indications:
- axillary burns
- contracture prevention
- humeral neck fx
- brachial plexus injury

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21
Q

indications and position for abduction external rotation shoulder brace

A

indications
- s/p RTC repair
- after shoulder dislocation
- s/p shoulder arthrodesis

position = 30 deg ABD and 30 deg ER most comfy

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22
Q

shoulder sling purpose and indications

A

purpose = immobilization

indications
- post trauma
- post sx
- AC or GH dislocation

long term use can lead to elbow contracture

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23
Q

sling vs abduction brace for s/p RTC repair

A

no difference in effectiveness- function, pain, or healing

sling may be more cost effective

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24
Q

purpose and indications for elbow, forearm, wrist orthoses

A

stabilizes injuries of the forearm and wrist by preventing supination and pronation

typically positioned in neutral

indications:
- distal radius fx
- forearm fx
- triangular fibrocartilage injury
- terrible triad- elbow dislocation with associated radial head and coronoid fx
- contracture prevention

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25
Q

sugar tong splint purpose and indication

A

purpose = limits forearm supination/pronation, elbow extension, and wrist motion

indications
- carpal fxs
- distal radius fx
- distal ulna fx

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26
Q

indications for static wrist hand orthoses

A

burns
joint replacements
RA
peripheral nn injury
nn and tendon repair
carpal tunnel
wrist pain (prevent or manage)
contracture prevention

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27
Q

what does the carpal tunnel CPG say about bracing

A

neutral positioned orthoses worn at night

can suggest adjusting wear time to include day time, symptomatic, or full time use when night time only use is ineffective at controlling S&S

should recommend orthoses for those with CTS during pregnancy

28
Q

purpose and position of dorsal blocking splint

A

purpose
- block wrist and finger extension
- protect repaired flexor tendons

typically positioned in 0 or 30 deg wrist flexion

at neutral position may result in less flexion deformities, complications, and earlier return to activities

29
Q

purpose and indications for volar blocking splint

A

purpose = block wrist and finger flexion

indications:
-contracture prevention
- spasticity control
- distal radius fx

30
Q

indications for ulnar gutter splint

A

soft tissue hand injuries to 4th/5th fingers

4th and 5th metacarpal fx (i.e. boxers)

4th and 5th phalange fx (extended)

positioning for RA

31
Q

indications for radial gutter splint

A

soft tissue injury to 2nd and 3rd fingers

fx to 2nd and 3rd metacarpals

fx to 2nd and 3rd phalanges

positioning for RA

laceration over joints of 2nd and 3rd phalanges or metacarpals

32
Q

symptoms of DeQuervain’s Tenosynovitis

A

pain or tenderness while moving thumb

pain when grasping an object or making a fist

radiating pain to forearm

swelling at base of thumb

33
Q

kinds of splints used for DeQuervain’s

A

short hand based (wrist free) splint including the IP joint of the thumb

short hand based splint excluding the IP joint of the thumb

long lower arm based (wrist immobilized) splint including the IP joint of the thumb

long lower arm based splint excluding the IP joint of the thumb

34
Q

symptoms of gamekeepers or skiers thumb

A

pain with pinch grasp

weakness with pinch grasp

difficulty gripping objects

swelling or bruising at base of thumb

can be a tear or sprain of the UCL

35
Q

purpose/indications for thumb splint

A

immobilizes the thumb and possibly wrist

indications:
- scaphoid fx
- lunate fx
- thumb phalanx fx or dislocation
- gamekeeper’s or skier’s thumb
- DeQuervain’s tenosynovitis
- carpal tunnel syndrome (not standard)
- CMC osteoarthritis

36
Q

indications for thumb opponens splint

A

CMC OA
spastic CP
congenital deformity of thumb

37
Q

recommendation for CMC joint OA

A

strong rec for soft or rigid hand orthosis

38
Q

recommendation for other hand joint OA (aside from CMC joint)

A

conditionally recommendation for orthosis such as finger splints, digital orthoses, soft or rigid

39
Q

what does mallet finger look like

A

DIP flexion

40
Q

what does Boutonniere deformity look like

A

PIP flexion and DIP extension

41
Q

what does swan neck deformity look like

A

PIP extension with MCP and DIP flexion

common after trauma or in pts with RA

42
Q

what is Elson’s test

A

diagnostic test used for early detection of injuries to the central slip of the extensor tendon

when it becomes noticeable = Boutonniere

43
Q

what are relative motion orthoses

A

static orthoses - holds the affected finger in relative ext or relative flx compared to adjacent fingers

protects or unloads injured or repaired tendon

limits excursion of injured or repaired tendon

usually made of firm thermoplastic

typically worn for 4-7 weeks

usually 3 or 4 finger designs

44
Q

what is a relative motion flexor orthosis

A

15-20 deg MCP flexion relative to adjacent fingers

provides laxity in lumbricals while increasing tension on extensor hood

45
Q

indications for relative flexor orthosis indications

A

central slip laceration
Boutonniere deformity
digital nn repair
flexor tendon repair
interosseous repair
lateral band sprain/tear
post-PIP joint arthroplasty
unexplained pain in palm of hand
after metacarpal fx
improve alignment of fingers with RA

46
Q

how much extension is recommended for a relative motion extensor orthosis for long extensor tendon repairs vs sagittal band injuries

A

long extensor tendon repairs = 10-15 degrees of relative metacarpal joint extension recommended

sagittal band injuries = 15-20 degrees of relative extension recommended

47
Q

indications for relative extensor orthosis

A

extensor tendon repair zones IV-VIII

sagittal band disruption

intrinsic tendon transfer

limit motion of split skin graft on dorsum of hand

swan neck deformity

mallet or trigger finger

unexplained pain about the MCP joints or dorsum of the hand

metacarpal head fracture

improve alignment of fingers with RA

48
Q

purpose of a serial static orthoses and how they work

A

mobilization

prolonged low load

cast or brace with ROM control

worn full time

49
Q

indication for a serial static splint

A

elbow fracture or contracture

s/p biceps tendon repair

PIP flexion contracture

50
Q

possible MOI for a PIP flexion contracture

A

dislocation/hyperextension or hyper flexion

torsional injury

soft tissue injury

51
Q

comparison of serial static cast, dynamic orthosis, or static progressive splint for PIP flexion contracture

A

no difference in effectiveness

factors to consider:
- total end range time
- pt comfort
- compliance

52
Q

what is a static progressive orthosis and how is it used

A

single splint that is adjustable

worn at least 30 min 3x/day

joint held at current end range

positioning readjusting each wear

53
Q

possible indications for static progressive orthoses

A

PIP joint contractures

elbow flexion contractures

knee flexion contractures

54
Q

purpose of dynamic splints and how they work

A

purpose = mobilization

use elastics, coils, or spring tensioning mechanisms to provide low long prolonged duration stretch in typically one direction

shouldn’t produce pain

not as effective as static tension

55
Q

possible indications for dynamic splint

A

radial nn injury

s/p flexor tendon repair

56
Q

how is a dynamic splint used for s/p flexor tendon repair

A

dorsal blocking- limited MCP ext

elastic bands substitute/protect healing flexor tendons

resists finger extension

57
Q

purpose of specialized UE orthoses

A

act as a substitute for irreversible functional loss

58
Q

purpose of a tenodesis splint

A

intended to enhance tenodesis grip

indications = C6-C7 quadriplegia

59
Q

what does research say is the best intervention to reduce UE spasticity post stroke and level of evidence

A

static splinting (low)

dynamic splinting (low)

60
Q

what does research say is the best intervention to increase hand function post stroke and level of evidence

A

use of static splinting (moderate)

use of dynamic splinting (moderate)

manual stretching (moderate)

61
Q

what does research say is the best intervention to improve functional tasks post stroke and level of evidence

A

static splinting (moderate)

dynamic splinting (moderate)

manual stretching (moderate)

62
Q

post op protocol for extensor tendon repair

A

immobilization

early passive (controlled) mobilization

early active mobilization

prior evidence recommends early active mobilization with orthosis (unspecified) or controlled immobilization over immobilization

63
Q

what does research say about UE orthotic intervention for children with CP

A

lack of evidence to support UE orthoses in kids with CP

64
Q

what does research say about non-pharmacological interventions for spasticity in adults

A

low quality evidence for non-pharm interventions targeting spasticity, including splinting

65
Q

what does research say about using splints/orthoses for the treatment of RA

A

insufficient support for use of wrist splints/orthosis for pain management or to improve function in people with RA

Year 3: Prosthetics and Orthotics (10 decks)

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