Upper Extremity Orthoses Flashcards
How to describe an UE orthoses
-Fabrication: pre-fabricated vs custom
-Articular (crosses a joint) vs Nonarticular (doesn’t cross a joint or have a mechanical joint)
-Location
-Direction: applied focuses (flex, ext, radial, abduction)
Purpose: immobilize, mobilize/assist with movement, restrict motion
What is the purpose of immobilization UE orthosis?
-stabilizing joints/tissues by preventing excessive/abnormal movements
-manage a deformity by preventing a contracture
-protect structures from hamrful/excessive load
-stabilize unstable/painful joints to reduce inflammation, prevent deformities, facilitate healing of injured tissues (fracture, tendons, ligaments)
What is the purpose of mobilization UE orthosis?
-assist with motion
-manage deformity applying corrective forces
-assist with lost movement from nerve injury
-elongate shortened tissue
What is the purpose of restriction UE orthosis?
-protect structures from hamful/excessive load
-prevent joints from unsafe movements
UE Orthoses for Specialized Purposes
-Substitute hand grip/dexterity
-Exercise/therapy tool to assist function (buddy tapping or blocking splint)
Anti-Deformity Positions of the UE
-90 deg of shoulder ABD with ER
-elbow extension
-neutral to slight supination forearm
-20-30 deg wrist ext
-70-90 deg MCP flex
-IP ext
-thumb in palmar ABD
-consider burns
UE orthosis Design Principles
-increase wear time gradually vs full time wear depending on diagnosis/purpose of orthosis
-longer splints are more comfortable and stable
-wider straps distribute force more evenly
-contoured edges for patient comfort
-avoid pressure forces over bony structures
-in dynamic braces, angle of pull should be 90 deg
-apply tension only sufficent to take the joint to comfortable end range
Design categories of UE orthoses
-Static (static, serial static, progressive static)
-Dynamic
-Functional
Static splints
-provide passive support
-prescribed for immobilization
-provides protection through proper positioning
Articular vs nonarticular
Static splint positioning
-contracture prevention and/or healing
-resting position = holds tissues in elongated positions but NOT at end range
-Functional positions:
20-30 deg wrist ext
40-45 deg MCP flex
45 PIP flex
relaxed flex of DIPs
thumb ABD and in opposition to fingers
Static splint indications
-closed humer shaft fracture (non-articular)
-elbow flexor spasticity (non-articular)
-S/P RTC repair
What is the purpose of an airplane splint?
Static splint
-purpose: immobilization
-position in ABD
-Indications: axillary burns, contracture prevention, humer neck fracture, bracial plexus injury
What is the purpose of Abduction-External rotation shoulder brace?
Static Splint
-S/P RCT repair
-After shoulder dislocation
-S/P shoulder arthrodesis
-30 deg abd/ER most comfortable
What is the purpose of a shoulder sling?
Static Splint
-Purpose: immobilization
-Indications: post-trauma, post-surgery, AC or GH dislocation
-Long term use may lead to elbow flexion contracture
Elbow-Forearm Wrist Orthoses
Static Splint
-Stabilizes injuries of the forearm and wrist by preventing supination and pronation
-positioned in enutral
Indications: distal radius fracture, forearm fractures, tirangular fibrocartialge injury, terrible triad - elbow dislocation with associated radial head and coronoid fractures, contracture prevention)
Sugar Tong Splint
Static Splint
-limits forearm supination/pronation, elbow extension, and wrist motion
Indications: carpal fractures, distal radius and ulna fracture
Indications for Static Wrist Hand Orthosis
-Burns
-Joint replacements
-RA
-Peripheral nerve injuries
-Nerve and tendon repairs
-Carpal tunnel syndrome
-Wrist pain
-Contracture prevention
Dorsal Blocking Splint
-blocks wrist extension and finger extension
-protect repaired flexor tendons
-positioned in 0 or 30 deg of wrist flex
Volar Blocking Splint
-blocks wrist flexion and finger flexion
-indications: contracture prevention (burns to the hand, SCI, CVA, TBI)
-spasticity control
-distal radius fractures
Ulnar Gutter Splints
-soft tissue hand injuries to 4th/5th digit
-boxer fracture: 4th/5th metacarpal fracture
-4th/5th phalange fracture (extended)
-positioning for RA
Radial Gutter Splints
-soft tissue injuries to 2nd and 3rd fingers
-fractures of the 2nd and 3rd metacarparls
-fractures of the 2nd and 3rd phalanges
-positioning for RA
-laceration over the joints of the 2nd and 3rd phalanges or metacarpals
DeQuervain’s Tenosynovitis
-pain or tenderness while moving thumb
-pain when grasping an object or making a fist
-radiating pain to forearm
-swelling at base of thumb
Special test: Finkelstein Test
Gamekeepr’s or Skier’s Thumb
-pain with pinch grasp
-weakness of pinch grasp
-difficulty gripping objects
-swelling or bruising at base of thumb
-can be a tear or sprain of the UCL
Suddent ABDuction of 1st MCP
Thumb Spica Splints
-immobilizes thumb and possibly wrist
-Indications for scaphoid, lunate fractures, thumb phalanx or thumb dislocation, gamekeeper’s thumb, deQuervain’s, CTS, CMC OA
Thumb opponens splints
indications
-CMC OA
-Spastic CP
-congenital deformity of thumb
Mallet Finger
-Dip flexion
Boutonniere Deformity
-PIP flex
-DIP ext
Swan-neck deformity
-PIP ext
-DIP Flex
commonly seen after trauma or with RA
Elson’s test
-central slip laceration
-extend PIP with 90 deg flex over edge of table
Finger orthoses for mallet finger
-stack splint
-aluminum splint
Finger orthoses for boutonnierre deformity
-ring splint with PIP extension force
-dynamic splint
Finger orthses for swan-neck deformity
-ring splint with PIP flex force
-oval 8 finger splint
Relative motion flexor orthosis
-15-20 deg MCP flex
-provides laxity in lumbrical, while increasing tension on extensor hood
Relative flexor orthosis indications
-central slip laceration
-boutonniere deformity
-digital nerve repair
-flexor tendon repair
-interosseous tears
-lateral band sprain/tear
-post PIP joint arthroplasty
-unexplained pain in palm of hand
-after metacarpal fracture
-improve alignment of fingers with RA
Relative motin extensor orthosis
-10-15 deg of relative metacarpal joint extension for long extensor tendon repairs
-15-20 deg of relative extension for sagittal band injuries
Relative extensor orthosis indications
-extensor tendon repairs zones IV-VIII
-sagittal band disruption
-intrinsic tendon transfer
-limit motion of split skin graft on dorsum of hand
-swan neck deformity
-mallet finger
-unexplained pain about the MCP joints or DORSUM of hand
-Metacarpal HEAD fracture
-improve aligment of fingers with RA
Serial Static orthoses
Purpose: mobilization
-prolonged low load
-cast or brace with ROM control
-worn full-time
Serial static splint indications
-elbow fracture/contracture
-s/p biceps tendon repair
-pip flexion contracture
Static progressive orthoses
-single splint that is adjustable
-worn 30 mins 3x/day
-joint held at current end range
-positioning readjusting each wear
-Indications: PIP joint contractures, elbow flexion contractures, knee flexion contractures
Dynamic splints
Purpose: mobilization
-Uses elastics, coils, or spring tension mechanisms to provide a low long, prolonged duration stretch in typically one direction
-should not produce pain
-not as effective as static tension
Indications for Dyanimc splints
-radial nerve injury
-s/p flexor tendon repair
