S3 L1: UE Orthoses & Prostheses Flashcards by Naomi Nakazato

CASE: The pt has radial nerve palsy which caused their wrist to drop. What orthosis should be prescribed and why?

Dynamic orthosis to help pt extend wrist if pt presents with weak wrist extensors

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During initial fittings, the orthosis is worn only until how long?

5-30 mins. No longer than 30 mins.

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The splint is to be checked every _____. If there is no redness, proceed to _____.

5 mins
Increasing time

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Red marks should disappear within how long?

20 mins

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For first time wearing, orthosis is worn max 30 mins only then remove. For the following days, wear orthosis again but with _____ until pt is able to _____.

Progressively increasing time
Tolerate

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In Lateral Epicondylitis, which structure is most commonly affected?

ECRB

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What is the orthotic goal for Lateral Epicondylitis cases?

Decrease the pain and inflammation at the origin of the ECRB. Limit over facilitation of the muscle involved.

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What is the prescribed orthosis for acute Lat Epi? Why?

Wrist Cock-up Splint
Maintains wrist extension to avoid wrist flexion because it stretched ECRB. This splint is most common and for severe pain.

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What degree of wrist extension is done using the Wrist Cock-up Splint for Lateral Epi?

0-45 Degrees

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This orthotic splint, used for chronic Lat Epi, decreases the force of the muscle contraction by inhibiting muscle expansion and reducing tension at the musculotendinous unit proximal to the band.

Forearm Support Band or Counterforce Brace

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The Forearm Support Band or Counterforce Brace is most commonly prescribed to who?

Tennis elbow players and/or athletes

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Before prescribing a Forearm Support Band, what must the pt undergo first?

~2 wks. of healing time (w/ additional pain modalities)
~2 wks. augmented restriction of motion using Cock-up splint (until pain is lessened).

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In a Cubital Tunnel Syndrome case, which nerve is compressed and where is it compressed?

Ulnar nerve at the medial elbow

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For Cubital Tunnel Syndrome case, what is the goal of the prescribed orthosis?

Decrease pain and paresthesia and prevent ulnar nerve compression & stretching to allow healing

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This orthotic device that is used for Cubital Tunnel Syndrome cases where is avoids overextension of the elbow while and elbow pad is added to cover the medial portion.

Custom Splint with Elbow Pad

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What happens when you extend the elbow for pts with a Cubital Tunnel Syndrome condition?

Stretched the ulnar nerve at the level of the medial epicondyle

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What is the purpose of the elbow pad in a custom splint for Cubital Tunnel Syndrome pts?

Can be used during the day to protect the ulnar nerve from trauma or direct pressure.

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This orthotic splint is recommended for Cubital Tunnel Syndrome pts that helps prevent elbow flexion when sleeping (for pts needing to limit elbow extension)

Posey Soft Splint

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In what degree of elbow flexion is the Posey Soft Splint positioned in?

70 Degrees

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The Posey Soft Splint is also rx for pts with severe affectation on where?

Ulnar Nerve (e.g. Fractures) or conditions that result to nerve compression)

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It is the most common condition esp in pts whose work involved writing, typing, & augmenting the intrinsic muscles of the hand.

Carpal Tunnel Syndrome

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What nerve is compressed in the carpal tunnel to elicit Carpal Tunnel Syndrome?

Median Nerve

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Goal of orthosis for Carpal Tunnel Syndrome

Immobilize the wrist to prevent flexion (and promote healing)

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Position for Carpal Tunnel Syndrome

Wrist Extension: 10 to 15°
Wrist Ulnar Deviation: 5-10°
2nd MCP in straight line with radius
MCP Flexion: 15-20° (neutral deviation)
PIP flexion: 20-25°
DIP flexion: 10°

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Most recommended orthotic prescription to Carpal Tunnel Syndrome condition following the aforementioned position

Volar Resting Hand Splint

Advantage and Disadvantage of the Vilar Resting Hand Splint

Advantages: Easier to fabricate and cheaper Disadvantage: Plastic component may press onto the median nerve which impedes healing

Volar Resting Hand Splint is indicated for patients with _____

Mild CTS pts who underwent CTS surgery - Mis severity: Non c/c of radiating pain by resting

Orthosis Modification if Volar Resting Hand Splint will be used for Swan Neck Deformity

1. Increase MCP extension with PIP flexion 2. To counteract the deformity, device should end at metacarpal area to promote tenodesis effect

Orthosis Modification if Volar Resting Hand Splint is used for pure CTS w/o finger deformities

Device should end at the proximal part of hand (level of the thumb)

Contraindication for Volar Resting Hand Splint

Acute conditions - It might compress flexor retinaculum

When can a CTS pt transition from a Dorsal Resting Hand Splint to a Volar Resting Hand Splint?

When pt presents with (-) Tinel Sign

This orthotic splint is the best choice esp for acute conditions for median nerve compression or CTS conditions where it prevents wrist flexion and allows mobility of the fingers.

Dorsal Splint Resting Hand Splint

For severe CTS conditions, the pt c/c of what?

Radiating pain even c rest & disturbs at night

What is the goal of the orthotic splint for De Quervain Tenosynovitis?

Reduce inflammation to minimize glide of the APL and the EPB tendons in the first dorsal compartment, and to reduce forceful exertion these muscles.

What is the position of the hand in wearing the custom splint for De Quervain Tenosynovitis conditions? And why is it positioned that way?

Wrist is in neutral to slight extension with the thumb radially abducted. The thumb IP joint can be left free. This is to avoid too much compression and lessen pain on the APL & EPB

T/F: Custom splint for De Quervain Tenosynovitis should be worn at all times for patients with severe symptoms.

True! It has a rigid thumb spica

What is the goal of the orthotic splint for Trigger Finger condition?

Restrict tendon glide the A1 pulley and to restore normal tendon glide by reducing inflammation of the tendon sheath.

What is the position of the hand wearing the custom splint for Trigger Finger? And what does the position promote?

MCP Flexion: 10-15 Degrees PIP Flexion: 15-20 Degrees It promotes comfortable position of fingers (neutral)

For pts c AD, what is the shape of the handle recommended?

J-shaped to facilitate healing

What are the indications for finger and thumb orthosis?

Fractures Collateral Ligament Sprain Burns of the digits

What is the position of the digit when a pt has Boutonniere’s Deformity?

Flexion at the PIP joint and hyperextension at the DIP

Boutonniere’s deformity is common in pts with what condition?

Rheumatoid Arthritis

This splint is recommended for pts with Boutonniere’s Deformity where it blocks flexion at PIP joint and promotes extension.

Ring Orthosis

Where is the central portion located for a ring orthosis for Boutonniere’s deformity?

Central portion should be placed at the top of dorsal aspect of PIP

What is the position of the digit when a pt has Swan Neck Deformity?

Hyperextension at PIP and flexion at DIP

T/F: For CTS pts with swan neck deformity, we prescribe a ring orthosis

False. We don’t usually prescribe a ring orthosis as it can also be treated using a hand splint.

Where is the central portion of the ring orthosis for pts with Swan Neck Deformity?

Central portion should be at the volar part of the PIP promoting flexion.

Above the wrist; Control of the thumb and opposition are lost

Median Nerve Injuries

What should be the position of the thumb for median nerve injuries?

1. Position the thumb in neutral position (extension must be promoted) because the thumb may assume an ape hand position. 2. Thumb must be placed midway of abduction and flexion. Opposition would be lost particularly the intrinsic muscles of the hand supplied by the median nerve.

This orthotic splint is prescribed for patients with median nerve injuries, particularly above the wrist level.

Traditional Short Opponens Orthosis

It helps maintain the webspace between the thumb and the other fingers.

C-bar

When a pt suffers from a median nerve injury, what deformity can develop?

Ape Hand Deformity

In order to counteract Ape Hand deformity, what should be done?

The hand is molded into midway abduction and flexion and will be placed in a C-bar.

Used to position thumb opposite the fingers for gross grasp and fine motor pinch to promote opposition particularly of the thumb across the fingers that is supplied by the median nerve

Opponens Bar

This splint is suggested to orthotist for median nerve injury pts because it is more comfortable and easier to fabricate. Commonly made of cloth and cotton.

Volar Resting Hand Splint

When using the Volar Resting Hand splint for median nerve injuries, what are the modifications needed to be done?

1. Soft material should be reinforced with a lot of straps. 2. Position the straps where it should not create too much compression on the median nerve. 2. An MCP extension block can be incorporated to prevent MCP hyperextension

This condition occurs on both median and ulnar nerve injuries.

Claw-hand Deformity

For pts with median nerve injury suffering from MCP hyperextension, at what level should the device be? Where should the MCP block be placed?

1.MCP level 2. Dorsal component when there is a C-bar

If the device has no C-bar, where should be the MCP block be placed?

MCP block should be placed on the proximal hand

In median nerve injuries, what can happen if the C-bar is incorrectly placed?

If C-bar is incorrectly placed it may limit finer degree of mobility on the band causing restrictions.

What should be prevented in Radial Nerve Neuropathy?

Wrist Drop

What orthosis is prescribed to Radial Nerve Neuropathy where the orthosis does not compress the radial nerve since it is the nerve is at the dorsal portion?

Volar Wrist Flexion Control Orthosis (Volar Cock-up Splint)

What does the Volar Wrist Flexion Control Orthosis promote?

Extends the wrist to promote healing of the radial nerve

This orthosis gradually stretched the extensor tendons at the same time by positioning the knuckles into flexion which allows healing but will not overstretch the tendon after repair.

Dynamic Hand Finger Orthosis (Kunckle-bender orthosis)

Another indicated for the Dynamic Hand Finger Orthosis?

Used to stretch the extension contracture at the MCP joints when collateral ligaments have been allowed to shorten due to immobilization.

In cases where we don’t want the fingers/MCP to flex since we need to allow extensor tendon repair to facilitate healing, this is the recommended orthosis.

Dynamic Wrist Finger Orthosis for Extensor Tendon Repair

Can a resting hand splint be used for extensor tendon repair?

Yes but as long as the fingers are supported with spring components where the wrist and fingers are extended, not allowing flexion movement on fingers.

What is the position of the wrist in Dynamic Wrist Finger Orthosis for Extensor Tendon Repair?

Neutral or extension position with a flexion block at the MCP and IP joints of the involved fingers.

Where is extension traction often applied?

Across the MCP and IP joints to alleviate tension across the repair site.

T/F: As healing progress in extensor tendon repair, further flexion is allowed at the MCP and IP joints.

True

Shoulder orthosis is rarely used nowadays. What is the best way to immobilize the shoulder?

Taping and Bandaging

In shoulder orthosis, the more proximal the involvement is, ______?

The more it would be bulkier and complicated.

Shoulder orthosis that can prevent movement across the glenohumeral joint by stabilizing the arm. Rx for pts who suffered from burn injuries to avoid midline contractures of the arm

Airplane Splint

BASIC COMPONENT: Positioned between the thumb and 2nd digit and helps maintain the functional position of the hand. This is used for prehensile grasps of the hand. Helps prevent soft tissue contracture and maintains the length of the tissues.

C-bar

BASIC COMPONENT: Serves as a connection between the different parts of the splint. Can be longitudinal or horizontal.

Connector Bar

BASIC COMPONENT: Limits or prevents wrist from going to ulnar deviation.

Ulnar Deviation Bar

BASIC COMPONENT: Limit finger ABD/ADD

Deviation bar

BASIC COMPONENT: Holds fingers in place (sumasalo sa kamay)

Pan

BASIC COMPONENT: Holds thumb in place

Thumb Through

BASIC COMPONENT: Pinakagutter that holds the forearm in place

Forearm Trough

Volar Splint: ____ Trough Dorsal Splint: _____ Trough

1. Volar Forearm 2. Dorsal Forearm

Anatomical Bar immediate to the hypothenar eminence for anti-ulnar deviation

Hypothenar Bar

Anatomical Bar usually at the level proximal to the PIP & distal to MCPs

Lumbrical Bar

Anatomical Bar that is immediately lateral to the thenar eminence; Limits radial deviation

Opponens Bar

Anatomical Bar placed slightly proximal to MCP heads

Metacarpal Bar

BASIC COMPONENT: Sleeve that you wear around the thumb which limits thumb movement in any direction

Thumb Post

BASIC COMPONENT: Limits extension or hyperextension

Dorsal Block splint

Prescribed for pts with Ulnar Drift

Deviation Bar to prevent from digits to further deviate ulnarly and keep digits in place

Recommended for pts na nahuhuli bumalik yung paghawak ng kamay (e.g. Stroke pts)

Universal Cuff

Contraindications of Wrist Cock-up Splint

1. Active MCP synovitis 2. Joint inflammation resulting to volar subluxation and ulnar deviation

Disadvantage of Volar Cock-up Splint

Interferes with tactlie sensibility on the palmar surface of the hand

Disadvantage of Dorsal Cock-up Splint

Can impede lymphatic flow