Upper Extremity and Spinal Flashcards
EWHO
elbow wrist hand orthosis
Opponens Orthosis/Spica Splint
Maintain, assist or provide opposition by stabilizing the thumb in a functional position
What is a thumb spica indicated for?
Scaphoid Fractures, thumb phalanx fractures or dislocations
Most common uses of thumb spica?
Gamekeepers thumb or skiers thumb
DeQuiervans tenosynovitis
Fitting of thumb spica:
Extends from DIP joint of thumb incorporates the thumb and extends up 2/3 of the proximal lateral forearm
Ulnar gutter splint indications:
phalangeal and metacarpal fractures
Most common uses of ulnar gutter splint:
most common-Boxer fracture
5th MCP and soft tissue injury to little and ring finger
Radial gutter splint indications:
fractures, phalangeal and metacarpal and soft tissue injury of the index and middle fingers
What is a wrist hand orthosis (WHO) commonly referred to as?
resting hand splint
What is a WHO used for:
Commonly used to prevent contractures
Maintains neutral/static wrist, hand, and finger
Cock-up splint uses:
Commonly used in cases of carpal tunnel syndrome
Maintains wrist in slight extension
Tenodesis orthosis
Commonly used in cases of cervical spinal cord injury that result in paralysis of prehension
What does a tenodesis orthosis do?
Creates approximation of the 2nd and 3rd digits and the thumb with active extension of the wrist
How long does extensor tendon repairs take?
12 weeks in some degree of splinting. 4-6 months for full recovery
How long are flexor tendons immobilized?
6-8 weeks
What are patients placed in following extensor tendon repair?
static volar splint
Setting of static volar splint:
wrist in 30d of ext, the MCP joints in 0-15d flexion, and IP joints in full extension
What are patients placed in following flexor tendon repair?
dorsal protective splint
Setting of dorsal protective splint:
30-40d wrist flexion, 50-70d MCP flexion, and the IP joints are allowed full extension
Mallet Finger: extensor tendon DIP; DIP joint:
DIP joint should be splinted with stack splint in a neutral or slight hyperextension position for six weeks
Mallet Finger: extensor tendon DIP; PIP joint:
the PIP joint should remain mobile
Exam of Central slip extensor tendon injury (may cause boutonniere deformity over time)
tender at dorsal aspect of PIP joint (middle phalanx)
inability to actively extend the PIP joint
Treatment of Central slip extensor tendon injury (may cause boutonniere deformity over time)
splint PIP joint in full extension for 6 weeks
Exam of collateral ligament injury (usually at the PIP joint)
maximal tenderness at involved collateral ligament
Treatment of collateral ligament injury (usually at the PIP joint)
stable joint: buddy tape for 2-4 weeks. Do not leave 5th digit exposed if ring finger is taped
Exam of extensor tendon injury at DIP joint
tender at dorsal aspect of the DIP joint
no active extension of DIP joint
Treatment of extensor tendon injury at DIP joint
Splint the DIP joint continuously for 6 weeks
Exam of FDP tendon injury
tender at volar aspect of the DIP joint
inability to flex the DIP joint
Treatment of FDP tendon injury:
splint finger and refer to orthopedic or hand surgeon
Exam of volar plate injury (usually at PIP joint)
maximal tenderness at volar aspect of involved joint
Treatment of volar plate injury (usually at PIP joint)
splint at 30 degrees of flexion and progressively increase extension for 2-4 weeks
Buddy tape at the joint if injury is less severe
Jersey Finger:
Flexor Digitorum Profudus tendon forced extension of the DIP joint during active flexion
How is the volar plate injured?
hyperextension of finger joint, dorsal dislocation
What is ususally affected in volar plate injury?
PIP joint
collateral ligament damage
extensor tendon can be pulled into hyperextension
Shoulder abduction orthosis:
Sometimes referred to as an “airplane splint”
Maintains abduction at the glenohumeral joint
CTLSO:
cervical, thoracic, lumbosacral orthosis
Cervical Orthosis (CO)
Soft Cervical Collar
Commonly used for mild soft tissue strains and sprains
Kinesthetic reminder to limit motion
Types of Cervical Orthosis
Semi-Rigid Cervical Orthosis Can provide access to the trachea Moderate Control of ROM Kinesthetic Reminder Adjustable OTS
Miami J Thoracic extension brace used for:
Lower C-Spine disruptions Level one instabilities Isolated compartment fracture Lateral mass fracture Spinous Process fracture Upper C-Spine disruptions For increased stability over the collar alone Stable Jefferson or Hangmans Fracture Type I Odontoid Fracture
What is the rigid frame design used for?
Commonly used in stable fractures and Moderate to Severe soft tissue damage
What does the rigid frame design limit?
flexion and extension
Where does the rigid frame design extend?
Extends Inferior into the Thoracic Region for greater control of all cervical levels
Chelsea rigid frame design used for:
stable fractures and Severe soft tissue damage. MotionC1-T1 Spinal Immobilization
What does the Chelsea rigid frame design limit?
Limits All Cervical Management Limit Flexion, Extension, Rotation, Side bending
Where does the Chelsea extend?
Extends Inferior into the Thoracic Region for greater control of all cervical levels
What is a Halo used for
Commonly used in unstable fractures
What does a Halo limit?
all motion
Where does a Halo extend?
Extends Inferior into the Thoracic Region for greater control of all cervical levels
Screws Directly into the skull
AIS=Adolescent Idiopathic Scoliosis
0-30 degrees:
Treated with signs of progression
AIS=Adolescent Idiopathic Scoliosis
30-45 degrees:
Orthotic Intervention
AIS=Adolescent Idiopathic Scoliosis
45 degrees +
surgical intervention
CTLSO is used to treat what?
Traditional Method of Scoliosis Treatment
Rigid frame Design
Not commonly prescribed except for curvatures in the higher levels of T-spine
Design of CTLSO
Uses three point pressure and kinesthetic reminder
Worn 23 hours / day
Boston Brace
Indicated for scoliosis measuring 25-35d and apex of T7
Who is a Boston Brace contraindicated in?
Curves >40d i.e. surgical candidates
Cheneau brace
Asymetrical Scoliosis Brace
TLSO function:
Increases Intra-abdominal pressure
Limits ROM
What is a TLSO commonly used for?
Commonly used for Herniated Nucleus Pulposus, and moderate soft tissue strains and sprains and fractures osteoporosis, trauma Degenerative, stabile thoracic or lumbar fractures, spondylolisthesis, Stenosis, disc pathologies
Who is contraindicated for a TLSO?
unstable fractures
posterior element spinal fractures, burst fractures
½ inch below sternal notch and ½ inch above pubic symphysis
Additional indictions of TLSO:
Anterior Compression Fractures of the vertebral body
Mild compression fracutres of T & L spine
What does a TLSO limit?
flexion
What is a LSO commonly used for?
Herniated Nucleus Pulposus, and other mild to moderate soft tissue strains and sprains. Single-column compression fractures with 1/3 or less anterior height loss
Can be used preventatively
Additional TLSO support:
Vasomotor and Respiratory support for SCI patients
Anterior column
made up of the anterior longitudinal ligament and the anterior one-half of the vertebral body, disc, and annulus.
Middle column
made up of the posterior one-half of the vertebral body, disc, and annulus, and the posterior longitudinal ligament
Posterior column
made up of the facet joints, ligamentum flavum, the posterior elements and the interconnecting ligaments
Boston Overlap Orthosis
Semi-Rigid Design (various rigidity options)
Increases Intra-abdominal pressure
Limits ROM
Boston Overlap orthosis commonly used for:
Herniated Nucleus
Pulposus, and moderate soft tissue strains
and sprains
Lumbosacral Orthosis (LSO)
Restricts trunk extension and lateral motion
Increases Intra-abdominal pressure
Should be positioned from T9 or distal to inferior angle of the scapulae
LSO commonly used for:
Herniated Nucleus Pulposus, spondylolisthesis, mechanical low back pain, and other mild to moderate soft tissue strains and sprains, S/P lumbar laminectomy, fusions, or discectomie
LSO contraindicated for:
unstable fractures or upper lumbar thoracic conditions
