Week 10 Principles Of Otc/Custom Orthoses In Patient Management Flashcards
Why do we use an orthosis?
(Mobilization/Protection)
(Shorten/Lengthen) tissues - mobilizing orthoses, someone who might have a contracture
(Defunction/Function)
The main reason we use an orthosis is for protection. Maybe trying to abate acute symptoms.
Protection; lengthen; function
Classifications of orthoses
Static Orthoses
Goals: (Mobilize/Immobilize) joints Prevent deformity Prevent soft tissue contracture (Acute/chronic) stage of healing
Indications:
Fractures
Carpal Tunnel Syndrome
(Osteoarthritis/Rheumatoid Arthritis) - people get an ulnar drift
Nerve or Tendon Repairs - don’t want to overstretch that repair
Static is the most common
Trying to support injured or unstable joints in the acute phase of injury. Newer injury that occurred. If pain free at rest – can just use only for aggravating injuries.
Extension splint – want to maintain the (flexion/extension) ROM by holding them statically in that position
Single finger splint – supporting the joints that are proximal and distal to it.
MP of the thumb for instability – can be used for fractures and carpal tunnel.
Immobilize; acute; Rheumatoid arthritis; extension;
Classifications of orthoses
Mobilization orthoses
Serial static orthoses
Applied at (minimum/maximum) length of tissue for extended periods of time to allow tissue to adapt to new position
Uses (stress relaxation/TERT)
Indications:
(Joint contracture/dislocation)
(Swan Neck/Boutonniere)
Serial static – static splint that you can remold
Taking the stiff joint and hold it in a stiff position in a tolerable end range. Hold tissue at a constant length and can remold the splint to increase the stretch.
Pic – anterior elbow splint – someone who has an elbow flexion contracture, so trying to get them to maintain and gain that elbow extension. As they can get further in the range the material goes in the hot water and it will soften and can put it back over the pt to get them in more extension.
Can get pt to wear it over night not to interfere with ADLs.
maximum; stress relaxation; joint contracture; Boutonniere;
Classifications of orthoses
Mobilization orthoses
Serial static orthoses
Pic – for boutonniere. The more chronic the boutonniere the more the PIP might sit into (flexion/extension). If it s more fixed/chronic, have to be able to pull the pip into (flexion/extension) and can remold into further and further extension.
flexion; extension
Classifications of orthoses
Mobilization orthoses
Static progressive orthoses
Used in (acute/chronic) stage of tissue healing
Used when a joint has a (soft/hard) end-feel
Worn for extended periods of time > utilizes concept of (stress relaxation/TERT)
Static progressive – holds them statically but they can progress it while it is on . Can move into more ROM in different positions (more supination, pronation, etc
Static progressive – can progress the ROM while they have it on . Good for pts who can’t get to the clinic (distance from clinic).
Need more force to move past limitation. 30 min at a time 3x a day.
Usually renting or purchasing these. Have to make sure the pt uses it since it will be mainly just for home
Pic - elbow flexion and extension – black knob behind the olecranon – turn that knob to increase flexion and extension.
One orthosis can make use of tenodesis – when wrist extends the fingers flex and when the wrist flex the fingers extend.
chronic; hard; TERT
Classifications of orthoses
Mobilization orthoses
Dynamic Orthoses
Goals: Substitute for loss of (motor/sensory) control Correct existing deformities Controlled stress to improve ROM Aid in fracture healing
Indications:
(Nerve palsies/nerve lacerations)
Joints that have a (soft/hard) end-feel during proliferative phase of wound healing
(Comminuted intra-articular fracture/simple fracture)
Dynamic – can be rubberbands, spring, etc
These have some sort of elastic component
Hard to regain extension due to the natural resting position of the hand (flexion)
A splint is more beneficial than trying to stretch with the other hand due to maximizing TERT.
Pic - outrigger splint – pt who had a radial nerve palsy – missing wrist and finger extension. Splint on dorsal side – wrist up to the splint . These pts can flex, they just can’t extend so the problem is releasing objects. The rubber bands have tension so when the pt relaxes it pulls the MCPs into a neutral extension. So the pt is going to be flex against the rubber bands and as you relax your hands it can release. Only wear this splint during the day, not at night. Great option for daily use if have radial nerve palsy.
motor; nerve palsies; soft; Comminuted intra-articular fracture
Fracture Bracing
What is fracture bracing?
Compresses muscle tissue to stabilize long bone fractures:
Mid-shaft humeral fractures
Both bone forearm fractures
Directs forces (proximally/equally) in all directions during a muscle contraction Internal force mechanically stabilizes the fracture
Sarmiento brace – comes all the way around the humerus and strap pulls it tight. As the pt is using the arm and there is muscle contraction helps spread the force to stabilize the fracture.
When people guard, elbow is probably in flexion so need to make sure to get that extension.
equally;
Common Elbow/Forearm Orthoses
Posterior Long Arm
Probably had a fracture of the (shoulder/elbow) or a repair to the (rotator cuff/bi or triceps). Secure braces that can be remodeled.
elbow; bi or triceps
Common Elbow/Forearm Orthoses
Anterior elbow brace
Use this if someone has an elbow (flexion/extension) contracture or if pt has cubital tunnel because don’t want them in end range (flexion/extension).
flexion; flexion
Common Elbow/Forearm Orthoses
Hinged Elbow Brace
Can use for distal (tricep/bicep) repair or instability of the elbow. They allow for some motion. Problem – at the axis where there is the dial and the plastic cover got lifted and the button gets moved and the settings change on accident which is not good for blocking motion.
bicep;
Common Elbow/Forearm Orthoses
Muenster Orthosis & Sugartong Orthosis serve the same purpose
Muenster Orthosis
Purpose:
Limit (supination/pronation / flexion/extension)
Stabilize (radio-ulnar/glenohumeral) joint
Immobilize (PRUJ/DRUJ)
Indications: TFCC Repair (FCU/ECU) stabilization (PRUJ/DRUJ) fracture/dislocation (Radial/Ulnar) abutment syndrome Galeazzi fracture-dislocation
Motions allowed:
Typically full elbow (flexion/extension)
Limited elbow (flexion/extension)
No (supination/pronation /radial / ulnar deviation)
Allowing for flexion and extension of the elbow but limiting the supination and pronation.
Want pts in a derotation orthosis who have TFCC or ulnar abutement to limit pronation which is bad for people with (radial/ulnar) sided issues.
supination/pronation; radio-ulnar; DRUJ; ECU; DRUJ; Ulnar; flexion; extension; supination/pronation; ulnar;
Common Elbow/Forearm Orthoses
Muenster Orthosis & Sugartong Orthosis serve the same purpose
Sugartong Orthosis
Purpose:
Limit (supination/pronation / flexion/extension)
Stabilize (radio-ulnar/glenohumeral) joint
Immobilize (PRUJ/DRUJ)
Indications: TFCC Repair (FCU/ECU) stabilization (PRUJ/DRUJ) fracture/dislocation (Radial/Ulnar) abutment syndrome Galeazzi fracture-dislocation
Motions allowed:
Typically full elbow (flexion/extension)
Limited elbow (flexion/extension)
No (supination/pronation /radial / ulnar deviation)
Allowing for flexion and extension of the elbow but limiting the supination and pronation.
Want pts in a derotation orthosis who have TFCC or ulnar abutement to limit pronation which is bad for people with (radial/ulnar) sided issues.
supination/pronation; radio-ulnar; DRUJ; ECU; DRUJ; Ulnar; flexion; extension; supination/pronation; ulnar;
Common wrist orthoses
Wrist Control Orthosis
Indications: (Carpal tunnel syndrome/DQ) Wrist (sprain/fractures) Partial fusion, arthrodesis Overuse injuries (Medial/Lateral) epicondylitis Sprains
CTS – this splint pulls them into extension since it is more functional. If not managing the symptoms the way they would hope then would move the brace to neutral because that is where the least amount of pressure is in the carpal tunnel.
Over use injuries – abate acute symptoms (medial/lateral epicondylagia). Once pain free at rest get them out of the brace and only for aggravated injuries.
CTS; fractures; Lateral
Common wrist orthoses
Radial gutter and Ulnar gutter
Indications:
(Metacarpal or phalangeal/DIP or IP) fractures
Can be forearm-based or hand-based
Hand-based ulnar gutter – same thing but doesn’t cross the wrist
RF or SF – look at the (radial/ulnar) gutter
MCPs are flexed to maintain the length of the collateral ligaments which is MCP (flexion/extension) and IP (flexion/extension).
Metacarpal or phalangeal; ulnar; flexion; extension
Common wrist orthoses
Radial gutter and Ulnar gutter
Indications:
(Metacarpal or phalangeal/DIP or IP) fractures
Can be forearm-based or hand-based
Pic - hand based radial gutter
Radial gutter – would come down the forearm
Metacarpal or phalangeal;
Common Thumb Orthoses
Long thumb Spica Orthosis
Indications:
(Scaphoid/Pisiform) fracture
(S-L/LT) ligament repair
Basal joint Arthroplasty
Xo splint - mix between cast and orthosis
Can heat them up and molds to splint. Extremely rigid – for higher level activities because want rigidity of a cast but only for that time.
Scaphoid; S-L;
Common Thumb Orthoses
Short opponens orthosis
Indications: Basal joint arthritis (CMC/MCP) synovitis (DIP/MCP) instability (Bennett’s/Rolando) Fracture
Bennett’s fracture goes into two pieces which is far more common than the Rolando (goes into three pieces)
Pic on the left – staying as far away as possible form the distal palmar crease to allow for MCP flexion. If too high can’t flex the MCPs.
CMC; MCP; Bennetts;
Common Thumb Orthoses
Figure 8 orthosis
Indications:
RCL/UCL sprain at the (MCP/PIP)
Provides lateral support at the (MCP/ CMC and IP) but allows motion at the (MCP/ CMC and IP)
The only blocked is the MCP . Trying to get as much motion but only protecting the affected joint.
MCP; CMC and IP
Common Hand/finger orthoses
Zancolli orthosis
“Anti-claw” Orthosis
Uses:
(Radial/Ulnar) neuropathy
Blocked PIP (flexion/extension) for Home Exercise Program (HEP)
Ulnar; extension
Common Hand/Finger Orthoses
Yoke Splint
Relative Motion Splint
Quadriga Effect - injury to the flexor tendon
Position affected digit’s MCP in relative ext/flex to adjacent digit
Allows for safe early active motion and functional hand use
Decreased tension of ruptured/repaired tendon
Uses:
(Sagittal Band/Extensor tendon) Injury
Chronic (Boutonniere/Swan Neck) Deformity
Reverse blocking > PIP (flexion/extension)
Less stress on the injured sagittal band so less tension on the injured tissue
Relative extension splint – holding middle finger in extension relative to the adjacent digits. Able to offload the area to get the pt moving sooner which can decrease adhesions and help with ROM.
Relative motion – can make a relative flexion splint. If injured finger had a chronic boutonniere can place in flexion relative to the other digits.
Person most likely has a sagittal band injury if in Yoke splint.
Sagittal band; Boutonniere; extension
Common Hand/finger orthoses
What is the associated injury?
Cylinder Finger Cast
Holds pip in full (flexion/extension) – associated with (boutonniere/swan neck)
extension; boutonniere
Common Hand/finger orthoses
Oval 8 Orthosis
Allowing full flexion but blocking the hyperextension – swan neck deformity, could’ve happened due to injury of the volar plate.
Got it
Common Hand/finger orthoses
Options at the dip joint
Dorsal Metal Splint
If someone comes in with a mallet finger, can treat conservatively.
Option to use for someone with a (mallet finger/boxers knuckle). Putting the metal piece on the dorsal aspect of the finger and pulling the finger up into (flexion/extension). Only limiting the DIP, the PIP can flex.
mallet finger; extension;
Common Hand/finger orthoses
Options at the dip joint
Stax Splint
Premade splint for protection of the (PIP/DIP). Can use for a mallet finger but might not get the right amount of pull to get into full extension. Can use for a tuff fracture. Able to flex the PIP.
DIP
Custom or OTC orthosis?
Comfort - the more rigid a splint is the less comfortable it will be
External hardware
Need for rigidity?
Purpose
Fracture?
Repair?
Overuse?
Durability
Cost - insurance
Time
Availability
Coo
