Spinal and UE Orthotics Flashcards
Term: An orthopedic appliance or apparatus used to support, align, prevent, or correct deformities or to improve the function of moveable parts of the body
Orthotic
Q: What 6 things can an orthotic be used for?
- Support and align
- Immoblize, restrict, or mobilize
- Prevent or correct deformities
- Substitute or enhance motion
- Reduce pain and discomfort
- Improve function
Content: Purpose of Orthotics (3)
- Immobilization (immobilize joints/structures)
- Mobilization (Move/stretch tissues/joints)
- Restrction (Limit/control joint motion)
Content: Spinal Orthotic Principles (4)
- 3 point pressure system**
- Increases hydrostatic pressure
- Provide kinesthetic reminder
- Modify support systems
Content: Parts of the spinal support system (2)
- Extrinsic stability
- Intrinsic stability
Content: Parts of extrinsic stability (2)
Muscles
- Flexors (psoas, abs)
- Extensors (erector spinae, paraspinals)
Content: Parts of Intrinsic support (2)
- Ligaments
- Discs
Q: What is the purpose of ligaments in the spinal support system? (3)
- Linkage
- Transfer loads
- Smooth motion
Q: What is the purpose of discs in the spinal support system?
shock absorption
Content: Design Considerations for Spinal Orthotics (8)
- Necessity
- Cost
- Cosmetics
- Adjustability
- Weight
- Effectiveness
- Available ROM
- Functionality
Content: Cervical Orthoses: Soft Collars (3)
- Facilitate spinal alignment
- Limit some ROM
- Provide kinesthetic reminder
Diagram: Identify the Cervical Orthosis

Soft Collar
Diagram: Identify the Cervical Orthosis

Soft Collar - Headmaster Collar
- for neck weakness/head drop
- primarily for support
Diagram: Identify the Cervical Orthosis

Semi-Rigid Collar (Phildelphia Collar)
- support, stability, alignment, kinesthetic reminder
Diagram: Identify the Cervical Orthosis

Semi Rigid Collar (Aspen Collar)
- support, stability, alignment, kinesthetic reminder
Diagram: Identify the Cervical Orthosis

Semi-Rigid Collar (Miami J Collar)
- support, stability, alignment, kinesthetic reminder
Diagram: Identify the Cervical Thoracic Orthosis

Cervical orthoses with thoracic extension - SOMI
- no straps on back, good for pt. in long term supine positing
Content: Cerical orthoses with thoracic extension (2)
- SOMI (Sternal Occipital Mandibular Immobilizer)
- Often indicated for bed bound pts.
Diagram: Identify the Cervical Thoracic Orthosis

Cervical Orthosis with thoracic extension - Lerman-Minerva
Content: Halos
- Tri-planar motion control of the cervical spine
- Maximum immobilization
- Restricts 90-95% of normal motion
- Poor pt. acceptance with relatively high complication rate
Diagram: Identify the Lumbosacral Orthosis (LSO)

Flexible LSO
Diagram: Identify the Lumbosacral Orthosis (LSO)

Chairback LSO
Content: Chairback LSO (2)
- Restricts sagittal plain motion
- Tightening abdominal support reduces lumbar lordosis
Diagram: Identify the Lumbosacral Orthosis (LSO)

Knight LSO
Content: Knight LSO (2)
- Restricts sagittal and coronal plane motion
- Tightening abdominal support reduces lumbar lordosis
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

Knight-Taylor TLSO
Cotent: Knight Taylor TLSO (3)
- Restricts sagittal and coronal plane motion
- Tightening abdominal support reduces lumbar lordosis
- Tightening axillary straps facilitates thoracic extension
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

Jewett Hyper-extension TLSO
Content: Jewett Hyper-extension TLSO
Restricts thoracolumbar flexion and some coronal plane movement
Content: Common indciations for a Jewett Hyper-extension TLSO (3)
- Compression fx
- Kyphosis
- Arthritis
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

CASH Hyper-extension TLSO
Content: CASH Hyper-extension TLSO (3)
- Cruciform Anterior Spinal Hyperextension (CASH)
- Restricts thoracolumbar flexion
- More common in geriatric patients
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

Rigid TLSO (Body Jacket)
Content: Rigid TLSO (Body Jacket)
Restricts sagittal, coronal, and transverse plane movement
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

TLSO with cervical extension
Content: Orthotic Indications for Management of Scoliosis (4)
- Skeletal immaturity (premenarche)
- Curves between 20-40 degrees
- Documented progression
- Single or double curves
Content: Accommodative TLSO (2)
- Addresses fixed deformity
- Aligns head and trunk over pelvis
Content: Accommodative TLSO - Aligns head and trunk over pelvis (4)
- Reduces shear forces
- Facilitates UE use
- Enhances mobility
- Facilitates respiratory function
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

Accommodative TLSO
Content: Corrective TLSO (3)
- Progressive correction of idiopathic spinal curvatures
- Stabilization of congenital spinal curvatures
- Prevent and/or correct deformity
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

Corrective TLSO - Boston Brace
Content: Boston Brace (2)
- Generally considered the gold standard for adolescent scoliosis
- Worn full time (18-23 hours/day)
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

Corrective TLSO - Milwaukee Brace
Content: Milwaukee Brace (2)
- Indicated for upper thoracic and cervical curvature
- Worn full time (18-23 hours/day)
Diagram: Identify the Thoracolumbosacral Orthosis (TLSO)

Corrective TLSO - Charleston Bending Brace
Content: Charleston Bending Brace: (3)
- Generally indcated for smaller, flexible lumbar curvatures
- Worn only at night (8 hours/day)
- Bend pt. out of there scolosis and keeps them in that position
Content: Corrective TLSO - PT (5)
- Skin care
- Trunk mobility and strengthening
- Aerobic training
- Postural feedback and training
- Functional training with brace
Content: Indications for UE Orthoses (3)
- Trauma (Vocational, burns, MVA)
- Congenital Deformity
- Disease (RA, SLE, Neuro impairments esp. those with abnormal tone)
Content: Purpose of UE Orthoses (11)
- Symptom relief
- Prevent deformity
- Immobilization
- Stabilization
- Protection
- Correct deformity
- Scar management
- Aid function
- Provide resistance
- Influence spastic muscle
- Compensate
Content: Designs of UE Orthoses (4)
- Static
- Serial Static (remolding to stretch or mobilize)
- Static Progressive (turning dial to apply (new) force gradually)
- Dynamic
Term: uses static components to apply force
Static Progressive UE Orthosis
Term: Uses elastic components to apply force
Dynamic UE Orthosis
Content: Functional Anatomy related to UE Orthoses - Extensor Tendons (3)
- Extensor mechanism relies on the excursion of extensor tendons
- Extensor tendon excursion is considerably less than that of the flexor tendons
- Thus the extensor tendon mechanism is more prone to shortening, and it is more difficult to compensate for a loss of extensor excursion
T/F: Extensor tendon excursion is considerably more than that of the flexor tendons.
False: less
Q: What does the extensor mechanism rely on?
The excursion of extensor tendons
Q: The extensor tendon mechanism is more ________ to _____________, and it is more _____________ to ______________ for a loss of extensor excursion
prone, shortening, difficult, compensate
Content: Functional Anatomy related to UE Orthoses - MCP, PIP, DIP (2)
- Ligament length at the MCP and PIP joints is dependent on joint position
- MCP flexion with PIP and DIP extension is the anti-deformity (instrict plus) position
Q: What is the anti-deformity or intrinsic plus postion of the hand?
MCP flexion with PIP and DIP extension
Content: Ligament length with MCP extension
- Collateral ligaments are slack and prone to shortening
Content: Ligament length with PIP flexion
- Volar plate is slack and prone to shortening
Content: Hand Position - Intrinsic Plus (3)
- MCP flexion with PIP and DIP extension
- Positioning MCP in flexion protects IP extension
- Commonly used after trauma, burn, or tendon repair
Content: Hand Position - Intrinsic Minus (3)
- MCP extension with PIP and DIP flexion
- Often results from intrinsic denervation/ulnar nerve plasy
- Unopposed extension cause MCP hyper-extension and IP flexion
Q: What is the equation for pressure?
pressure = force x area
Content: Pressure (2)
- Pressure is never eliminated, only distributed
- Accomodate for bony prominences
Content: UE prominences to be aware of in regards to pressure (6)
- Olecranon
- Humeral epicondyles
- Styloid process
- Base of 1st MC joint
- Dorsal thumb, MP, and IP joints
- Pisiform
Content: UE nerves to be aware of in regards to pressure (4)
- Radial n.
- Ulnar n.
- Median n.
- Volar digit nerves
Q: Where in the UE can the radial n. be compressed?
Radial groove of humerus
Q: Where in the UE can the ulnar n. be compressed?
Cubital tunnel or distal forearm
Q: Where in the UE can the median n. be compressed?
Carpal tunnel
Content: Describe the functional hand splint (4)
- Wrist in 20-30 degrees of extension (neutral if inflamed)
- Thumb in palmar abduction
- MCPs in 15-20 degrees of flexion
- IPs in slight flexion
Content: Intrinsic plus splint
- IP position
- Thumb position
- Extension
- Palmar Abduction
Content: Wrist Immobilization Splint for carpal tunnel syndrome
0 degrees
Q: What is another name for radial nerve palsy?
Wrist drop
Content: Wrist Immobilization Splint for Colles’ fx
up to 30 degrees
Term: Inflammation of APL and EPB synovial sheaths
DeQuervain’s
Term: Ulnar collateral ligament injury
Gamekeeper’s thumb
Diagram: Identify what the following finger immoblization treats

Used for Immobilization
Diagram: Identify what the following finger immoblization treats

Swan neck
Diagram: Identify what the following finger immoblization treats

Boutonniere Contracture/Deformity
Diagram: Identify what the following finger immoblization treats

Mallet Finger
Diagram: Identify what the following finger immoblization treats

Lateral deviation
Diagram: Identify what the following finger immoblization treats

Trigger Finger