Orthotics Flashcards
Ox would be used for a 4 week post-burn to the entire volar aspect of the wrist and hand
WHO: Volar Ox
opponens bar should be located
proximal to the thumb MP joint
boutonnere defomity
PIP flexion and DIP hyperextension
Swan neck deformity
PIP hyperextension and DIP flexion
Pt is a 20 yo male with dx of T10 incomplete SCI which occurred in 2007. Ambulation exhibits moderate extensor spasticity with 10 deg knee hyperextension. Ankle control of choice is?
Solid AFO with 5 deg PF
Type of prehension provided by a wrist driven tenodesis Ox
Three jaw chuck
Extension at the MP joints is produced by
Extensor digitorum
MOst important motor acquisition of the C5 quad is
Shoulders and elbow flexion
Muscle grade of FAIR means the person is able to get through complete ROM
Against gravity
C6 would have all the muscles intact except:
Biceps
Deltoids
Extensor carpi ulnaris
Pronator Teres
Extensor Carpi Ulnaris
Colles Fx
Distal radius Fx
Ulnar nerve lesion at the wrist will clinically be presented with
Hyperextension of 4th and 5th MP joints and positive Froment’s sign
Clinical presentation of Claw hand will occur with which injury
Combined median and ulnar nerve injury and mid-forearm and below ulnar nerve injury
Symptoms of Erb’s palsy
Internal rotation and adduction of humerus
Complete SCI at C6, Pt would require what type of WHO
Hyperextension of MP joints and flexion of the IP joints of the 2-5th fingers
The soft tissue Cx of the hand which is likely to develop following paralysis of the ulnar and median nerves include
Hyperextension of Mp joints and flexion of the IP joints of the 2nd-5th fingers
A radial nerve injury at the elbow
WHO with a wrist extension assist
Which component will be used by a pt with a 0-2 intrinsics and 3-4 extensor digitorum/flexor digitorum superficialis and profundus
MP extension stop
Ox recommendation for a radial-ulnar nerve injury at the elbow
WHO with MP extension stop and 4th/5th IP extension assist
The volar surface of the forearm contains the ______ muscles which as a group originate at the _____ humeral condyle
Wrist flexors, medial condyle
The _____ interossei abduct and while the ______ interossei adduct
Dorsal, Palmar
The movement of the thumb called opposition occurs at the
Carpometacarpal joint
Nerve that innervates all of the anterior muscles of the arm
Musculocutaneous
A C6 quad powers a wrist driven flexor hinges
Extensor carpi radialis longus and brevis
General terms: Radial nerve of the brachial plexus innervates
Supinators and extensors
Most common MP joint deformity for digits 2-5 in RA is
Volar subluxation and ulnar deviation
Mobile segments of the hands proximal transverse arch are carpometacarpal joints
1-4-5
Radial nerve injury might require what additional component for the thumb on a HO
Thumb post
Total arc of motion of the wrist joint in the coronal plane
50 degrees
Goals for fitting an Inguinal Hernia Truss
-Place the Pt on their back with legs flexed (relaxes internal organs and allows gravity to assist in reducing the hernia into the inguinal tear
-Reduce the hernia
Pt comes into office with an open draining odorous wound to their medial malleolus. You should…
-Wear protective equipment when making PE
-Contact Pt’s physician and advise them of your observations
Cauda Equina refers to
The nerve roots/fibers at the end of the spinal column
Measuring a Pt for a TLSO hyperextension Ox, the Pt should be
Supine and standing
Anterior displacement of the vertebral body on the next lower vertebrae is known as
Spondylolisthesis
Opposition of the thumb and index finger is known as
Tenodesis
Nerve most likely involved in the Pt with drop foot is the
Peroneal nerve
(innervates the tibialis anterior muscle and when stimulated, causes concentric Cx of the muscle belly initiating a DF moment of the foot-ankle complex during normal gait
Desired wrist angle relative to the forearm in the “position of function” to pick up an object from a table is
30 degrees extension
Pt with radial nerve weakness would exhibit
Weakness when extending the wrist
(Innervates the extensor musculature of the wrist)
Most common Tx regime for a Pt referred to your facility with Radial nerve palsy would be
Static flexion control Ox
(Due to weakness in the extensor muscles resulting in wrist drop)
The Williams Flexion Spinal Ox differs from a APML style device in that it has a
Dynamic Superior band
(sidebars are not attached directly to the pelvic band)
Superior margin of the Williams Flexion Ox
1” inferior to the inferior angle of the scapulae
Pt presentation of median nerve palsy
Inability to flex the wrist (median nerve innervates the flexors of the UE)
Arthritis affects the
Cartilage
(Inflammation of the joint, wear of the cartilage of the synovial joints)
Main plantarflexors of the lower extremity
Gastroc and Soleus
Weight Bearing KAFO using a Thomas Ring to achieve suspension incorporates which bony prominence to take weight to un-weight the knee
Ischium
(Thomas Rings is a shaped metal rod of at least 3/8” diameter in adults that when properly contoured, achieves a bony purchase on the ischium to achieve un-weighting the lower extremity limb)
Muscle group that extends the hip during gait is
Hamstrings
(Extends the hip via a concentric contracture)
When taking an impression for a KAFO, for the best possible impression, it is important to use the Segmented impression procedure and
Posterior Popliteal rest
(helps to assure that correct positioning of the impression will help to control recurvatum in the impression)
Visually impaired 70 y.o. male Pt is referred to your office with a Rx for a “hyperextension back brace” for an anterior thoracic compression Fx as a result of a fall at home. Upon PE, you find a male with marked kyphosis and significant arthritis of both hands. Your choice of Ox devices should include
Utilization of Velcro for the closure to adapt to the Pt’s arthritis
14 y.o. with crouch gait. Types of Ox devices to consider
Custom molded floor reaction AFO with solid ankle and full footplate
The tibialis anterior fires concentrically during which cycle of gait
Toe Off (push off)
(This Cx enables the foot to clear the floor in both DF and supination)
Most commonly prescribed position for fitting a Pt with a s/p rotator cuff repair
15 degrees abduction and elbow at 90 degrees
Morton’s Neuroma
Neuroma is an inflammation of a nerve
Common between the 3rd and 4th toes
Common treatment of Morton’s Neuroma
Foot Orthotics
Injection of Analgesic
Injection of a Corticosteroid
Accommodative footwear
Prune Belly Syndrome
Congenital anomaly involving the Pt with an absence of abdominal musculature
Prune Belly Syndrome Device
Custom flexible soft spinal support
(requires the spinal support to assist in urination and bowel movements as well as support when sitting)
Ideal lesion level for Tx of an SCI Pt is with an RGO is
L1-L3
(Hip flexors are able to “drive” the Ox resulting in less energy expenditure and the ability to ambulate further in the RGO device)
C4 innervates what muscle actions
Diaphragm and shoulder elevators
C5
Shoulder flexors and abductors
Elbow Flexors
C6
Wrist extensors
C7
Elbow extensors (Triceps)
C8
Finger flexors, extensors, and intrinsics
T1-T6
Upper trunk muscles
T7-T12
Lower trunk muscles
L1-L2
Hip flexors
L3
Knee extensors
L4
Ankle dorsiflexors
L5
Toe extensors
S1-S5
Ankle plantarflexors, bowel, and bladder
An SCI Pt at the level of _____ will be able to feed themselves
C7
Patient with sparing of C7 has 3 important functional additions:
-Triceps, common finger extensors, and long finger flexors
Latissimus Dorsi receives its initial innervation at this level
C6
Innervated from the thoracodorsal nerve
Tricep musculature receives its innervation at level
C7
Innervated from the radial nerve
Ability to grasp occurs through innervation at this level
C7
Scheuermann’s disease involves which area of the spine
Kyphosis of the Thoracic spine
Average age of Pt suffering from Scheuermann’s disease is
Adolescents
-Curve angles are usually 15-40 degrees
-More exaggerated in females
Which nerve innervates the Quadricep muscles
Femoral Nerve
L2-4
What is aponeurosis
Flattened tendon
Function of the Latissimus Dorsi on the humerus
Adducts, medially rotates, and extends the humerus
C6-8
Serratus Anterior muscle
Abducts the scapula and rotates it
Stabilizes vertebral border of scapula
Draws scapula forward and upward
Innervated by the long thoracic nerve
Paralysis of the arm caused bty injury to the upper group of the arm’s main nerves during birth is known as
Erb’s Palsy
Trauma to the anterior compartment of the shoulder resulting in a flail arm results in a disorder known as
Brachial Plexus damage
(A nerve bundle ventral rami of the lower cervical and upper thoracic nerve roots of C5 vertebrae
Brachial plexus damage side effects
Brachial plexus innervates the deltoid muscle which is one of the primary supportive muscles that support the entire arm
Without innervation, the result is dislocation of the Glenoid Humeral joint
Treatment of Brachial Plexus injury
A/C separation Ox
(Arm flails through lack of muscular control)
Goal is to support the arm and keep the glenoid humeral joint in place
In the operative suite, the area below the table is considered
Non-sterile
