Upper Extremity and Spinal Orthoses Flashcards
1
Q
Which orthosis is used for Gamekeeper’s thumb?
A
Thumb Spica Splint
- Thumb Spica Splint stabilizes the thumb in a functional position
- Preventing ulnar collateral ligament damage
2
Q
What is the purpose of a resting hand splint?
A
Wrist Hand Orthosis (WHO)
Purpose = Prevent contractures
- It maintains the wrist, hand, and fingers in a neutral/static position, commonly used for immobilization.
3
Q
Which orthosis is used for carpal tunnel syndrome?
A
Cock-Up Splint
- Maintains the wrist in slight extension to reduce pressure on the median nerve and alleviate symptoms.
4
Q
What type of splint is used in cervical SCI patients to assist with grasp function?
A
Tenodesis Orthosis
- It facilitates opposition/prehension by approximating the thumb and fingers during active wrist extension.
5
Q
Which splint is used for extensor tendon repair?
A
Static Volar Splint:
- Wrist immobilized in 30° extension
- MCP joints in 0–15° flexion
- IP joints in full extension.
6
Q
What is the splinting protocol for flexor tendon repair?
A
Dorsal Blocking Splint (DBS):
- The wrist is immobilized in 45° flexion
- MCP joints in 40° flexion
- IP joints are allowed full extension to protect the repair
7
Q
Which splint is used for mallet finger?
A
Stack Splint:
- Maintains the DIP joint in neutral or slight hyperextension for six weeks to support extensor tendon healing.
8
Q
Which injury requires referral to a hand surgeon due to forced extension during active flexion?
A
Jersey Finger
- This injury involves the flexor digitorum profundus tendon and requires specialized surgical treatment.
9
Q
What splinting technique is recommended for boutonniere deformity?
A
PIP Extension Splint:
- Maintains the PIP joint in full extension for six weeks to prevent flexion contractures.
- Aluminum splint
- oval 8 or ring splint
10
Q
Which orthosis is used for hyperextension injuries involving the volar plate?
A
Custom PIP Splint:
- Protects the joint and supports stability to prevent deformity caused by ligament damage.
11
Q
What is the purpose of a soft cervical collar?
A
Soft Cervical Collar:
- Provides a kinesthetic reminder to limit motion.
- Commonly used for mild soft tissue strains and sprains.
12
Q
Which orthosis is used for anterior cervical fusion recovery?
A
Aspen or Miami J Collar:
- Semi-rigid collars that limit motion, providing immobilization post-surgery.
- Indicated for anterior cervical fusion or Type I C2 fractures.
13
Q
Which orthosis provides the most rigid cervical immobilization?
A
Halo Orthosis:
- Rigid frame with screws anchored to the skull.
- Used for unstable cervical fractures to limit all cervical motion.
14
Q
What is the indication for a SOMI (Sternal Occipital Mandibular Immobilizer)?
A
SOMI
- Used for stable cervical fractures or moderate to severe soft tissue injuries.
- It limits flexion/extension and provides support into the thoracic region.
15
Q
Which orthosis is typically prescribed for scoliosis with a Cobb angle of 25–35°?
A
Boston TLSO:
- Semi-rigid brace worn 23 hours/day
- Most commonly used for scoliosis management with Cobb angles between 25–35°.
16
Q
What is the purpose of the Charleston Bending Orthosis?
A
Charleston Bending Orthosis:
- A low-profile TLSO worn at night for scoliosis management.
- Designed to apply corrective forces during sleep.
17
Q
What type of spinal orthosis is used for herniated nucleus pulposus or moderate soft tissue sprains?
A
Semi-Rigid TLSO:
- Increases intra-abdominal pressure and limits ROM to reduce symptoms and promote healing.
- Commonly referred to as a “body jacket.”
18
Q
Which orthosis is used to manage anterior compression fractures?
A
Jewett Hyperextension Orthosis:
- A rigid brace that limits flexion, used for stable anterior compression fractures in the thoracic or lumbar spine.
19
Q
What is the purpose of a Boston Overlap Orthosis?
A
Boston Overlap Orthosis:
- Semi-rigid LSO used for herniated nucleus pulposus or mild-to-moderate soft tissue injuries.
- Increases intra-abdominal pressure and limits ROM.
20
Q
What is the purpose of the three-column concept in spinal fracture management?
A
Three-Column Concept: A diagnostic framework dividing the spine into:
(1) Anterior column:
- Made up of the anterior longitudinal ligament and the anterior one-half of the vertebral body, disc, and annulus.
(2) Middle column:
- Made up of the posterior one-half of the vertebral body, disc, and annulus, and the posterior longitudinal ligament.
(3) Posterior column:
- Made up of the facet joints, ligamentum flavum, the posterior elements and the interconnecting ligaments.
21
Q
Which cervical orthosis allows tracheal access while maintaining moderate ROM restriction?
A
Philadelphia Collar - A semi-rigid cervical collar providing moderate ROM restriction and tracheal access.
22
Q
A patient with a stable Jefferson fracture needs an orthosis. Which one is most appropriate?
A
SOMI Orthosis - Provides rigid support, limiting flexion and extension. It extends inferiorly into the thoracic region for greater control, suitable for stable cervical injuries like a Jefferson fracture.
23
Q
A patient with a Type I C2 dens fracture requires immobilization. What orthosis would you recommend?
A
Miami J or Aspen Collar - These semi-rigid cervical orthoses provide moderate motion restriction, ideal for Type I C2 fractures.
24
Q
Which orthosis is appropriate for a patient with scoliosis and a Cobb angle of 30°?
A
Boston TLSO - This semi-rigid brace is the most common scoliosis orthosis for Cobb angles of 25–35°, worn 23 hours/day to prevent curve progression.
25
A patient recovering from a flexor tendon repair in the hand requires a splint. Which one would you use?
Dorsal Blocking Splint (DBS) - Immobilizes the wrist in 45° flexion, MCP joints in 40° flexion, and allows IP joints full extension to protect the tendon repair.
26
What orthosis would you recommend for a patient with mallet finger?
Stack Splint - Maintains the DIP joint in neutral or slight hyperextension for six weeks to ensure proper healing of the extensor tendon.
27
A patient with a herniated nucleus pulposus complains of low back pain. Which orthosis would be effective?
Semi-Rigid TLSO - Limits motion and increases intra-abdominal pressure to relieve symptoms and support the spine. Commonly referred to as a "body jacket."
28
A patient has a scaphoid fracture. What orthosis would you use?
Thumb Spica Splint - Stabilizes the thumb and extends up to the forearm, providing support and immobilization for scaphoid fractures.
29
What orthosis would you recommend for a hyperextension injury with a stable anterior compression fracture?
Jewett Hyperextension Orthosis - Limits flexion to prevent worsening of the fracture and provides appropriate support for stable injuries.
30
Which orthosis is indicated for a cervical SCI patient needing assistance with prehension and grasping?
Tenodesis Orthosis - Facilitates thumb and finger approximation during active wrist extension, enhancing prehension for functional use.
31
A patient with a boutonniere deformity presents. What is the appropriate splinting technique?
PIP Extension Splint - Maintains the PIP joint in full extension for six weeks to prevent contractures and promote tendon healing.
32
A patient presents with cervical strain after a car accident. Which orthosis would you use?
Soft Cervical Collar - Provides minimal support but serves as a kinesthetic reminder to limit motion, suitable for mild soft tissue strains.
33
A patient requires immobilization following an anterior cervical discectomy. What orthosis is appropriate?
Aspen or Miami J Collar - Semi-rigid cervical orthoses designed to immobilize the cervical spine following procedures like anterior cervical discectomy.
34
A patient with a distal radius fracture needs wrist stabilization. Which orthosis is recommended?
Cock-Up Splint - Maintains the wrist in slight extension to immobilize the distal radius and promote proper healing.
35
Which orthosis is used for a patient with a posterior ligamentous spinal injury?
Halo Orthosis - Provides rigid immobilization, limiting all cervical motion, and is indicated for unstable injuries involving posterior spinal elements.
36
A patient recovering from a stable C1 fracture needs support. Which orthosis would you recommend?
Philadelphia Collar - Offers moderate support while allowing tracheal access, ideal for stable cervical fractures like C1 injuries.
37
A patient with a PIP joint hyperextension injury has collateral ligament damage. What orthosis is used?
Custom PIP Splint - Protects the joint by stabilizing it, preventing further damage or deformity.
38
A patient with a thoracic spine burst fracture requires support. What is the best orthosis?
Rigid TLSO - Provides immobilization for thoracic spine fractures, limiting motion and protecting the spine during healing.
39
Which orthosis is indicated for a patient recovering from a mid-shaft humerus fracture?
Humerus Fracture Brace - Stabilizes the mid-shaft of the humerus, allowing controlled movement while supporting the fracture site.
40
A patient has DeQuervain’s tenosynovitis. What orthosis should be used?
Thumb Spica Splint - Provides immobilization and support for the inflamed tendons at the base of the thumb.
41
A patient with adolescent idiopathic scoliosis has a Cobb angle of 40°. What treatment is needed?
Referral for Surgery - A Cobb angle of 40° is beyond the scope of orthotic management and requires surgical intervention.
42
Which orthosis is used for a patient with mild mechanical low back pain?
Lumbosacral Orthosis (LSO) - A soft or semi-rigid LSO provides support and restricts excessive motion to alleviate low back pain.
43
A patient presents with hyperextension deformity from a volar plate injury. Which orthosis is needed?
Custom Finger Splint - Stabilizes the joint to prevent further hyperextension and deformity, supporting ligament healing.
44
A patient recovering from a lumbar discectomy needs stabilization. Which orthosis is appropriate?
Semi-Rigid LSO - Restricts trunk motion, provides lumbar support, and increases intra-abdominal pressure to promote recovery.
45
A patient presents with a stable thoracolumbar compression fracture. What orthosis should be used?
Jewett Hyperextension Orthosis - Limits flexion, providing effective support for stable compression fractures in the thoracolumbar region.
46
A patient with a boutonniere deformity involves an avulsion fracture of less than one-third of the joint. What is the best splinting method?
PIP Extension Splint - Splints the PIP joint in full extension, preventing deformity and promoting healing for small avulsion fractures.
47
What is the primary purpose of a spinal orthosis?
Spinal orthoses stabilize the spine by restricting motion, relieving pain, and supporting healing in conditions like fractures, degenerative diseases, or deformities.
48
Why is a three-column model used to evaluate spinal fractures?
The three-column concept divides the spine into anterior, middle, and posterior columns to assess fracture stability and guide treatment based on the extent of column involvement.
49
How does a Jewett Hyperextension Orthosis limit spinal motion?
It restricts spinal flexion by using a rigid frame with pads anteriorly and posteriorly, preventing further injury in stable anterior compression fractures.
50
Why are tenodesis orthoses beneficial for cervical SCI patients?
Tenodesis orthoses leverage active wrist extension to approximate the thumb and fingers, restoring functional grasp in patients with paralysis of prehension.
51
What is the difference between a semi-rigid and rigid TLSO?
A semi-rigid TLSO provides moderate motion limitation and is used for mild-to-moderate injuries, while a rigid TLSO offers maximum stabilization for severe fractures or degenerative conditions.
52
How does a Thumb Spica Splint support DeQuervain’s tenosynovitis?
It immobilizes the thumb and wrist, reducing inflammation and strain on the tendons in the first dorsal compartment.
53
What are the indications for a Halo Orthosis?
Halo Orthoses are used for unstable cervical fractures requiring maximum immobilization, including posterior ligamentous injuries or unstable odontoid fractures.
54
Why is a PIP Extension Splint used for boutonniere deformity?
It maintains the PIP joint in extension, preventing flexion contractures and allowing the central slip extensor tendon to heal properly.
55
How does a semi-rigid Lumbosacral Orthosis (LSO) alleviate low back pain?
It restricts excessive motion, provides lumbar support, and increases intra-abdominal pressure to offload the spine, relieving pain in conditions like mechanical low back pain or disc herniation.
56
What are the primary goals of scoliosis orthotic management?
Scoliosis orthoses, like the Boston Brace, aim to prevent curve progression in moderate scoliosis by applying corrective forces and maintaining spinal alignment.
57
How does a Cock-Up Splint help carpal tunnel syndrome?
It positions the wrist in slight extension, reducing pressure on the median nerve and alleviating symptoms of carpal tunnel syndrome.
58
Why is the Charleston Bending Orthosis worn only at night?
It applies corrective forces while the patient is sleeping, targeting scoliosis curves in a relaxed state without interfering with daytime activities.
59
What role does a dorsal blocking splint play in flexor tendon repair?
It protects the repaired flexor tendon by positioning the wrist in flexion and allowing controlled movement at the MCP and IP joints to prevent strain.
60
What is the advantage of a SOMI orthosis over a soft cervical collar?
A SOMI provides greater immobilization, extending support into the thoracic spine and limiting flexion/extension, making it suitable for more severe injuries or stable fractures.
61
How does the Milwaukee Brace differ from the Boston TLSO?
The Milwaukee Brace is a traditional rigid scoliosis orthosis that extends to the cervical spine, used for higher thoracic curves, while the Boston TLSO is low-profile and focuses on lower spinal curvatures.
62
Which splint is used for mallet finger, and why?
Stack Splint - Maintains the DIP joint in neutral or slight hyperextension for six weeks, preventing extensor tendon lag and allowing healing.
63
What is the appropriate treatment for jersey finger?
Referral to an orthopedic or hand surgeon - Jersey finger involves a flexor digitorum profundus tendon avulsion and requires surgical intervention to restore function.
64
What splinting technique is used for boutonniere deformity?
PIP Extension Splint - Maintains the PIP joint in full extension for six weeks, preventing further deformity and promoting central slip tendon healing.
65
Which injury involves hyperextension or dorsal dislocation of the PIP joint?
Volar Plate Injury - Typically caused by hyperextension; splinting stabilizes the joint to prevent deformity and promote ligament healing.
66
What is the difference in treatment for DIP injuries (e.g., mallet finger) versus PIP injuries (e.g., boutonniere deformity)?
DIP injuries (e.g., mallet finger) are splinted in neutral or slight hyperextension with stack splints, while PIP injuries (e.g., boutonniere deformity) require full extension with PIP extension splints.
67
Which splint is used for collateral ligament injuries of the finger?
Custom PIP Splint - Stabilizes the joint, providing support to damaged collateral ligaments while maintaining mobility in non-injured joints.
68
What is the primary splint used for central slip extensor tendon injuries?
PIP Extension Splint - Prevents flexion deformity and promotes healing of the central slip extensor tendon.
69
How are volar plate injuries typically managed?
Splinting the affected finger in a neutral or slightly flexed position to stabilize the joint and protect the healing volar plate.
70
What splinting technique is recommended for a swan neck deformity?
Oval 8 Splint or Ring Splint - Prevents hyperextension at the PIP joint and corrects the deformity caused by volar plate laxity.
71
What is the key evaluation step for suspected ligament or tendon injuries of the finger?
Perform a thorough physical examination, assessing joint stability, range of motion, and tendon function. Use specific tests like the Bunnell test for joint stiffness and flexibility.
72
Which injury typically results from forced DIP extension during active flexion?
Jersey Finger - The flexor digitorum profundus tendon avulsion caused by this mechanism requires immediate surgical referral.
73
What is the role of the Tripoint Splint for PIP joint injuries?
Provides controlled motion and support for ligament and tendon injuries while maintaining alignment and preventing contractures.
74
How should hyperextension injuries to the PIP joint be treated?
Immobilize in a PIP splint with slight flexion to stabilize the joint and allow healing of the volar plate and collateral ligaments.
75
What is the Cochrane review’s conclusion on mallet finger splinting methods?
All available splints achieve similar clinical outcomes for mallet finger. Surgical fixation does not significantly improve results compared to splinting alone.
76
What type of splint is used for PIP joint flexion contractures?
Dynamic Extension Splint - Provides continuous extension force to overcome contractures and restore joint mobility.
77
Volar Plate Injuries: mechanism? Evaluation? Treatment?
Volar Plate Injuries Mechanism: Hyperextension or dorsal dislocation of the PIP joint. Evaluation: Joint stability tests and imaging for avulsion fractures. Treatment: Splint in a neutral or slightly flexed position to stabilize the joint and protect the healing volar plate.
78
Collateral Ligament Injuries: mechanism? Evaluation? Treatment?
Collateral Ligament Injuries Mechanism: Side impact or joint dislocation causing lateral instability. Evaluation: Stress testing for instability; imaging for severe injuries. Treatment: Splint for immobilization, followed by controlled motion exercises.
79
Central Slip Injuries: mechanism? Evaluation? Treatment?
Central Slip Injuries (Boutonniere Deformity) Mechanism: PIP joint trauma or forced flexion. Evaluation: Elson’s test for central slip integrity. Treatment: PIP splinting in full extension for six weeks to prevent deformity and allow healing.
80
Swan Neck Deformity: mechanism? Evaluation? Treatment?
Swan Neck Deformity Mechanism: Laxity or injury to the volar plate, leading to PIP hyperextension. Evaluation: Physical examination for PIP hyperextension and DIP flexion deformity. Treatment: Oval 8 or ring splint to prevent PIP hyperextension and restore alignment.
81
Jersey Finger: mechanism? Evaluation? Treatment?
Jersey Finger Mechanism: Forced DIP extension during active flexion, causing avulsion of the flexor digitorum profundus tendon. Evaluation: Inability to flex the DIP joint actively; imaging to confirm avulsion. Treatment: Immediate referral to a hand surgeon for surgical repair.
82
Mallet Finger: mechanism? Evaluation? Treatment?
Mallet Finger Mechanism: Extensor tendon injury at the DIP joint due to forceful flexion. Evaluation: Inability to extend the DIP joint actively. Treatment: Stack splint to maintain DIP joint in neutral or slight hyperextension for six weeks.
83
Volar Plate Avulsion Fractures: mechanism? Evaluation? Treatment?
Volar Plate Avulsion Fractures Mechanism: Hyperextension or dislocation causing an avulsion at the volar plate. Evaluation: Imaging to confirm fracture; joint stability tests. Treatment: Splinting in a slightly flexed position to stabilize the joint and protect the fracture site.
84
PIP Joint Dislocations: mechanism? Evaluation? Treatment?
PIP Joint Dislocations Mechanism: Trauma causing dorsal or lateral displacement of the PIP joint. Evaluation: Physical examination and imaging to assess ligament and bone involvement. Treatment: Reduction followed by splinting to maintain alignment.
85
DIP Joint Injuries: mechanism? Evaluation? Treatment?
DIP Joint Injuries Mechanism: Trauma or hyperextension causing joint instability or tendon damage. Evaluation: Examination for range of motion and ligament integrity. Treatment: Stack splint for tendon injuries; immobilization for joint instability.
86
Flexor Tendon Injuries: mechanism? Evaluation? Treatment?
Flexor Tendon Injuries Mechanism: Laceration or avulsion affecting tendon function. Evaluation: Inability to actively flex the finger; imaging for avulsion. Treatment: Dorsal blocking splint and referral for surgical repair.
