Week 6 UE orthoses Flashcards
FO
finger orthosis
HFO
hand finger orthosis
HO
orthosis
WHO
wrist hand orthosis
EO
elbow orthosis
EWHO
elbow wrist hand orthosis
SO
shoulder orthosis
Describing an UE orthoses
fabrication
articular vs nonarticular
location
direction
pupose
Articular
crosses a joint
Nonarticular
does not cross a joint or doesn’t have a mechanical joint
Purpise of UE orthoses
immobilize
mobilize/assist with movement
restrict motion
Immobilization
Stabilization joints/tissues
by preventing
excessive/abnormal
movements
Manage a deformity by
preventing a contracture
Protect structures from
harmful/excessive load
i.e., Stabilize
unstable/painful joints
to reduce inflammation,
prevent deformities,
facilitate healing of
injured tissues
(fracture, tendons,
ligaments
UE orthoses for specialized purpose
substitute hand grip/dexterity
exercise/therapy tool to assist function
Budding tapping
stronger digit assist with movement of impaired digit
Blocking splint
assist with AROM by blocking movement of more mobile joint
Anti-deformity positions of the UE
90° of shoulder
abduction with
external rotation
* Elbow extension
* Neutral to slight
supination forearm
20- 30°wrist
extension
70-90°MCP Flexion
IP extension
Thumb in palmar
abduction
increase wear time gradually vs full time wear depending on
diagnosis/ purpose of orthosis
Longer splints are more ______
comfortable and stable
Wider straps distributes force more evenly
more comfortable
Why contoured edges
pt comfort
Avoid pressure forces over
bony structures
in dynamic braces
angle of pull be 90 deg
apply tension only sufficient to take
the joint to comfortable end range
Design categories of UE orthoses
static
dynamic
functional
Static splint overview
Provide passive support
Commonly prescribed for immobilization
Provides protection through proper positioning
Positioning static splints
contracture prevention and/or healing
resting position
Resting position
holds tissues in elongated positions, but not at end range
Functional position of the hand and wrist for static splints
20° - 30° of wrist extension
40° - 45° MCP flexion
45° PIP flexion
Relaxed flexion of DIPs
Thumb abducted and in
opposition to fingers
Static splint indication - closed humeral shaft fracture
Healing time
non operative - 16 weeks
operative - 14/15 weeks
Static splint indication - elbow flexor spasticity
Due to upper motor
neuro pathology
May be worn at night to
maintain elbow
extension ROM &
prevent flexion
contracture
Airplane splint
static splint
Airplane splint purpose
immobilization position in shd abduction
Airplane indication
axillary burns
contracture prevention
humeral neck fx
brachial plexus injury
Abduction external rotation shoulder brace
statice splint
30 deg abd & 30 ER most comfortable
Abduction-external rotation shoulder brace indications
s/p rotator cuff repair
After shoulder
dislocation
s/p shoulder
arthrodesis
shoulder sling
static splint
shoulder sling purpose
immobilization
shoulder sling indications
post-trauma
post-surgery
AC or GH dislocation
why should shoulder sling be used long term
lead to elbow flexion contracture
sing vs abduction brace for rotator cuff repair
no diff in effectiveness - function, pain, healing. sling may be more cost effective
Elbow forearm wrist orthoses
static splint
elbow-forearm wrist orthoses stabilize injuries of forearm and wrist by
preventing supination and pronation
typically positioned in neutral
Elbow-forearm wrist orthoses indications
Distal radius fracture
Forearm fractures
Triangular fibrocartilage injury
Terrible triad
Contracture prevention
Terrible triad
elbow dislocation with associated radial head and coronoid fractures
sugar tong splint
static splint
Sugar tong splint limits
forearm supination/pronation, and wrist motion
Sugar tong splint indications
carpal fractures
distal radius fracture
distal ulna fracture
Indications for static wrist hand orthosis
Burns
Joint replacements
Rheumatoid Arthritis
Peripheral nerve injuries
Nerve and tendon repairs
Carpal tunnel syndrome
Wrist pain (prevention or
mgmt.)
Contracture prevention (i.e.
CVA or SCI or burns)
Dorsal blocking splint
Block wrist & finger
extension
Protect repaired flexor
tendons
Typically positioned in 0°
or 30° of wrist flexion
– A neutral position may
result in less flexion
deformities,
complications, and earlier
return to prior activities
Volar Blocking splint
block wrist and finger flexion
Volar blocking splint indications
Contracture
prevention
Burns to the hand
* CVA, TBI, SCI
Spasticity control
Distal radius fractures
Ulnar gutter splints indications
Soft tissue hand injuries to 4th
and 5th fingers
4th and 5th metacarpal fractures
(i.e. Boxer’s fracture)
4th and 5th phalange fractures
(extended)
Positioning for RA
Radial gutter splint indications
Soft tissue injuries to the
2nd and 3rd fingers
Fractures of the 2nd and
3rd metacarpals
Fractures of the 2nd and
3rd phalanges
Positioning for RA
Laceration over the joints
of the 2nd and 3rd
phalanges or metacarpals
Hand Orthoses
use when wrist motion can be unrestricted
DeQuervain’s Tenosynovitis symptoms
Pain or tenderness while
moving thumb
Pain when grasping an
object or making a fist
Radiating pain to forearm
Swelling at base of thumb
Gamekeeper’s or skier’s thumb symptoms
Pain with pinch grasp
Weakness of pinch grasp
Difficulty gripping objects
Swelling or bruising at
base of thumb
Gamekeeper’s or skier’s thumb cause
sudden abduction of 1st MCP
can be a tear or sprain of the UCL
Thumb spica splints
immobilizes the thumb and possibly wrist
Thumb thica splint indications
Scaphoid fractures
Lunate fractures
Thumb phalanx fractures or
dislocations
Gamekeeper’s thumb or
skier’s thumb
DeQuervain’s tenosynovitis
Carpal tunnel syndrome (not
the standard of care)
CMC osteoarthritis
Thumb opponens splints indications
CMC osteoarthritis
Spastic CP
Congenital deformity of
the thumb
CPG CMC joint OA
Strong Recommendation for soft or
rigid hand orthosis
CPG other hand joint OA
Conditionally recommendation
for orthosis such as finger splints, digital orthoses,
soft or rigid
Mallet finger
DIP flexion
stack splint
aluminum splint
Boutoniere deformity
PIP flexion with DIP ext
ring splint
dynamic splint
Swan neck deformity
PIP ext with MCP and DIP
Commonly seen after trauma or in pt with RA
swan neck ring splint
Oval 8 finger splint
Static orthosis
holds the the
affected finger in relative
extension or relative flexion
compared to the adjacent
fingers.
Static orthosis protects or unloads
the injured or repaired tendon
Static orthosis limits
excursion of the injured or repaired tendon
Static orthosis is made of
firm thermoplastic
Static orthosis is typically worn for
4-7 weeks
usually 3 or 4 finger design
Relative motion flexor orthosis
15-20 degrees MCP flexion relative to the adjacent
fingers
Provides laxity in lumbricals, while increasing
tension on extensor hood
Relative motion flexor orthosis indications
Central slip laceration
Boutonniere deformity (Acute or chronic)
Digital nerve repair
Flexor tendon repair
Interosseous tears
Lateral band sprain/tear
Post-PIP joint arthroplasty
Unexplained pain in palm of the hand
After metacarpal fracture (or other metacarpal
involvement)
Improve alignment of fingers with RA
Relative motion extensor orthosis
10-15 degrees of relative metacarpal joint extension
recommended for long extensor tendon repairs
15-20 degrees 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/Trigger finger
Unexplained pain about the MCP joints or dorsum of hand
Metacarpal head fracture
Improve alignment of fingers with RA
serial static orthoses overview
Purpose:
Mobilization
Prolonged low load
Cast or brace with
ROM control
Worn full-time
Serial static splint for PIP flexion contracture
Possible MOI:
Dislocation/Hyperextension
or Hyperflexion
Torsional Injury
Soft tissue injury
comparison of orthoses for PIP flexion contracture
No difference in effectiveness
Factors to consider: total end range time, patient
comfort and compliance
Static progressive orthoses overview
Single splint that is adjustable
Worn for at least 30 minutes, 3x/day
Joint held at current end range
Positioning readjusting each wear
Example Indications: PIP joint contractures, elbow
flexion contractures, knee flexion contractures
Dynamic splints overviews
Purpose: Mobilization
Uses elastics, coils, or
spring tensioning
mechanisms to provide a
low long, prolonged
duration stretch in typically
one direction.
Should not produce pain
Not as effective as static
tension
Specialized UE orthoses
act as substitute for irreversible functional loss
Tenodesis splint
Intended to
enhance
tenodesis grip
Indications:
– C6-C7
quadriplegia
To reduce UE spasticity
Use static splinting (low)
Use of dynamic splinting (low)
To increase hand function
Use of static splinting (moderate)
Use of dynamic splitting (moderate)
Manual stretching (moderate)
To improve functional task
Use of static splinting (moderate)
Use of dynamic splitting (moderate)
Manual stretching (moderate)
Orthoses for extensors tendon repair
Zones IV-VIII: Surgical repair
* Post-op protocols:
– Immobilization
– Early Passive(Controlled)
Mobilization
– Early Active Mobilization
Prior evidence recommends early active
mobilization with orthosis (unspecified) or early
controlled immobilization over immobilization.
Rationale for prescription, effectiveness of, upper
limb orthotic intervention for children with cerebral
palsy: A systematic review
There is a lack of evidence to support UE orthoses in
children with CP.
Non-pharmacological interventions for spasticity in
adults: An overview of systematic reviews
Low quality evidence for non-pharmacological interventions
targeting spasticity, including splinting
Splints/orthoses in treatment of Rheumatoid Arthritis
Insufficient support for use of wrist splints/orthosis for pain
mgmt. or to improve function in people with RA
