UE Orthotics and Hand Function

Question 1

what are the goals of hand orthotics

Answer 1

prevent deformity
prevent overstretching of muscles
maintain integrity of joints and arches of the hand

Question 2

reasons why a splint needs to provide functional hand position

Answer 2

for natural teneodesis
for maintainence of tendon length
for return of hand function
for anti spasticity

Question 3

when does the most UE recovery occur

Answer 3

in the first 6 months with the greatest rate being in the 1st 3 months of that time

Question 4

what is the functional position of the hand

Answer 4

wrist supported in neutral to 30 degrees of extension
normal transverse and longitudinal arches
finger flexors and extensors are shortened for tenodesis
thumb abducted and in opposition with pads of index and middle finger
preserved web space

Question 5

spinal cord injury grips

Answer 5

tenodesis
lateral pinch
thumb looping (used for pulling up your pants)
interlacing (used for writing or eating)
hypothenar to hypothenar (used for picking up heavier objects)
2 point pinch
incomplete

Question 6

what do we need to make sure for someone with a C4 and above level of injury

Answer 6

positioning of UE to minimize comlications
maintain PROM
address any increased tone
educate family and patient on positioning and PROM
provide wrist supports during the day and resting hand splint at night

Question 7

when would a resting hand splint be indicated

Answer 7

for better positioning at night
when there is weak wrist extension (puts hand in 20-30 ext)
provide stability
prevent deformity

Question 8

what is the C5 hand known as

Answer 8

the “in between” level
continue with interventions with C1-C4 hand and look for any other muscle return
if they have strong elbow flexors position arm to avoid contractures

Question 9

What type of orthotic could some with a C5 level of injury use and why

Answer 9

a wrist cock up splint because it provides wrist ext. with forearm support, maintains the natural arches of the hand while leaving the fingers free and provides more support than a basic wrist orthotic

Question 10

mechanics of tenodesis

Answer 10

active wrist extension that causes finger flexion and thumb approximation
this position is critical for grasping objects

Question 11

what is the purpose of a short opponens orthotic

Answer 11

to pull the thumb into adduction towards the lateral aspect of the index finger

Question 12

who would benefit from a RIC tenodesis trainer

Answer 12

someone with weak C6 just beginning with tenodesis skills
someone with C5 level of injury with weak wrist extension
someone with decreased tightness in long finger flexors

Question 13

what is the goal of the long opponens splint

Answer 13

maintain wrist in neutral extension and thumb and first finger in proper pinch position

Question 14

who would benefit most from a long opponens splint

Answer 14

most effective for patients with a C5 injury

Question 15

what tendon transfer would restore wrist extension needed for tenodesis and a strong key grip

Answer 15

a brachioradialis tendon transfer

Question 16

what muscle is the most common of the elbow tendon transfers

Answer 16

the posterior deltoid; detached and grafted to the elbow to restore elbow extension when the triceps are de-innervated

Question 17

what are the risks of a tendon transfer and joint fusion

Answer 17

dependency period
risk of losing function
cost
deformity
infection

Question 18

advantages to splinting

Answer 18

low cost
immediate
no dependency period