Musculoskeletal System - Splints And Orthotics

Question 1

Distal Interphalangeal Split

Answer 1

• Immobilizes the DIP to heal an injury or rest a painful/inflamed joint

Indications:

• Mallet finger (heal the extensor tendon in a slightly hyperextended or neutral position)
• Distal phalanx fracture
• DIP joint arthritis

Question 2

Ulnar Gutter Splint

Answer 2

• Covers the ulnar side of the forearm and hand as well as the 4th and 5th digits
• Keeps 4th and 5th MCP in 60-90* flexion, IP in full extension, wrist in slight extension

Indications:
- Metacarpal fracture
- Phalanx fracture
Indications:
- Metacarpal fracture
- Phalanx fracture

Question 3

Radial Gutter Splint

Answer 3

• Covers the radial side of the forearm and hand as well as 2nd and 3rd digits
• Thenar hole to allow for free thumb movement
• Immobilizes the metacarpals and phalanges to heal a fracture

Indications:

• Metacarpal fracture
• Phalanx fracture

Question 4

Thumb Spica Splint

Answer 4

• Covers the radial side of the forearm and hand as well as the thumb
• Covers entire thumb or stops at the proximal phalanx (to allow for IP motion)
• Immobilizes wrist and thumb MCP
• Keeps wrist in 20* ext, MCP in slight flexion

Indications:

• Gamekeeper’s thumb
• Scaphoid fracture
• 1st metacarpal fracture
• DeQuervain’s syndrome
• Other thumb injuries

Question 5

Volar/Dorsal Forearm Splint

Answer 5

• Extends from proximal forearm to metacarpal heads
• Allows full elbow and MCP joint motion
• Thenar hole to allow free thumb movement
• Immobilizes the wrist
• Keeps hand and wrist in functional position; wrist in 20* ext (finger flexors shorten and have a mechanical advantage for grasping)

Indications:

• Carpal fracture
• Distal radius fracture
• Ulnar fracture
• Sprain
• Tendonitis

Question 6

Sugar Tong Splint

Answer 6

• Wraps from volar surface of hand and forearm, around the elbow, and up the palmar surface of forearm and hand
• Allows for greater immobilization than a volar/dorsal forearm splint
• Limits supination, pronation, and any wrist motion
• Keeps elbow in 90* flexion, wrist/forearm in neutral

Indications:

• Carpal fracture
• Distal radius fracture
• Ulnar fracture

Question 7

Long Arm Splint

Answer 7

• Covers posterior elbow joint
• Spans from wrist to distal humerus
• Immobilizes elbow flexion, extension, forearm supination and pronation
• Keeps elbow in 90* flexion and forearm neutral

Indications:

• Elbow fracture
• Proximal forearm fracture
• Tendonitis
• Tendon repair

Question 8

Corset

Answer 8

• Fabric with metal uprights to provide pressure and relieve pain

Indications:
- Mid and low back pathologies

Question 9

Halo Vest Orthosis

Answer 9

• Invasive cervical thoracic orthosis
• Full restriction of all cervical motion
• Metal ring with 4 posts attached to a vest, stabilized by 4 pins inserted thru the skull

Indications:
- Cervical spine injuries to prevent further damage or dislocation during recovery

Question 10

Milwaukee Orthosis

Answer 10

• Promotes spinal realignment 2* to traction effect via 3-point structure (at occiput vs pelvis)
• Custom made CTLSO
• Corrective padding applied to areas of severity of curve
• Better for females (who are more at risk for scoliosis and also have better pelvic “shelf” for the orthosis to be held up

Indications:
- Scoliosis

Question 11

Taylor Brace

Answer 11

• Limits trunk flexion and extension

- 3-point control design

Question 12

TLSO

Answer 12

• Prevents all trunk motion

Indications:

• Post-op stabilization
• Low thoracic or lumbar SCI
• Hyper-extension TLSO for protruding lumbar discs or lumbar discectomy

Question 13

Foot Orthosis

Answer 13

• Worn inside shoe
• Often custom molded

Indications

• Poor foot alignment
• Hyperpronation
• PFPS caused by hyperpronation
• Plantar fasciitis

Question 14

AFO are generally indicated for what conditions? How are they casted/in what position? Describe the AFO itself.

Answer 14

• Peripheral neuropathy
• Nerve lesions
• Hemiplegia
• Casted in subtalar neutral
• 2 metal uprights connected proximally to a calf band and distally to a mechanical ankle joint and shoe
• May be locked into place
• May allow anterior/posterior capability

Question 15

Plastic AFO

Answer 15

• Cosmetic
• Lighter
• Requires minimal fluctuation of edema (if present)

Question 16

AFO with foot plate incorporated

Answer 16

• Assists with reduction in plantarflexion tone

Question 17

Solid AFO

Answer 17

• Controls dorsiflexion/plantarflexion and inversion/eversion
• Trim line anterior to the malleoli
• Ankle can be set to 90*
• Can be made with an articulating ankle for tibial advancement during mid-late stance phase

Question 18

Posterior Leaf Spring AFO

Answer 18

• Plastic AFO
• Trim line posterior to the malleoli
• Assists with dorsiflexion
• Prevents foot drop
• Requires adequate medial/lateral ankle control

Question 19

Floor Reaction AFO

Answer 19

• Assists with knee extension during stance through positioning of calf band and/or positioning at the ankle
• Limits DF in stance to prevent knee buckling

Question 20

KAFO (Knee-Ankle-Foot Orthosis)

Answer 20

• 2 metal uprights extending from the foot/shoe to the thigh with calf and thigh bands
• Lock mechanism available for stability

Indications:
- Patient with low tone

Question 21

Craig-Scott KAFO

Answer 21

• Allows individual to stand with a posterior trunk lean

Indications:
- Paraplegia

Question 22

HKAFO

Answer 22

• Extension to the hip joints and a pelvic band
• Controls rotation at the hip and ABD/ADD
• Heavy; restricts swing-to or swing-through during gait

Indications:
- Weakness of the hip, foot, knee, ankle

Question 23

RGO

Answer 23

• Derivative of the HKAFO
• Cable system; bear weight on one LE to allow cables to advance opposite LE during gait

Indications:
- Paraplegia

Question 24

Parapodium

Answer 24

• Pediatric standing frame

- Ambulation achieved by shifting weight and rocking the base across the floor

Question 25

Heel Wedge

Answer 25

• Applied to the medial heel to prevent excessive hindfoot eversion and to the lateral heel to prevent excessive hindfoot inversion

Indications:

• Pes planus
• Pes cavus

Question 26

Heel Lift

Answer 26

• Rigid insert
• Adds extra height to the heel
• Takes pressure off the Achilles’ tendon

Indications:

• Achilles’ Tendonitis
• Achilles’ Tendon repair
• Leg length discrepancy

Question 27

Heel Cushion and Heel Cup

Answer 27

• Cushion decreases heel pain; soft pad on inner sole
• Cup covers plantar surface of calcaneus and extends upwards on all 3 sides; stabilizers calcaneus in neutral position; provides shock absorption of heel

Indications:

• Calcaneal spurs
• Plantar fasciitis

Question 28

Metatarsal Bar/Pad and Rocker Bar

Answer 28

• Bar/Pad has is a flat padding placed posterior to the metatarsal heads either on the outer (bar) or inner (pad) sole of the shoe; relieves pressure from the metatarsal heads and transfers weight to the shafts
• Rocker Bar similar to metatarsal bar in its placement; convex strip rather than flat; assists with difficulty in terminal stance 2* to great toe mobility deficit; relieves pressure from metatarsal heads

Indications:
- Metatarsalgia