ORTHOSIS

 Upper extremity orthoses are devices applied externally o

t restore
or improve functional and structural characteristics of the
musculoskeletal and nervous systems.
 They are used frequently on patients who have neurologic

problems, such as stroke, TBI, MS, CP, SCI, and PNI. They often
are used in arthritic conditions as well.
 The material used in orthotic devices includes low-temperature
thermoplastics that can be custom-made for fit and other
appropriations.
 FUNCTIONS OF UPPER EXTREMITY
ORTHOSES

 Increase range of motion (ROM)

 Immobilize an extremity to help promote tissue

healing
 Apply traction either to correct or prevent contractures

 Assist in providing enhanced function

 Se rve as an attachment for assistive devices

 H e l p correctdeformities

 Block unwanted movement of a joint

 General Classification

Type Region
• Static • Volar or Dorsal
• Dynamic • Joints crossed
• Hybrid * Finger / thumb splint
* Wrist Splint
Function * Wrist Hand Orthosis
• Flexion
(WHO )
• Extension * Elbow (WHO)
• Abduction * Shoulder (Elbow-
• Adduction WHO)
• Rotation
 Key Components of the Upper Limb

 Shoulder: Positioning and support critical

 Elbow: Emphasis on flexion

 Wrist: Achieve most optimal placement and ROM

 Fingers: Proper positioning for patient goals

 Thumb: Primary emphasis for prehension and grasp

 Basic Components

 C-Bar  Forearm trough

 Connector b
ar  Anatomic bars
 Thumb post
 Crossbar
 Thumb trough
 C u ff or strap
 Blocks
 Deviation
barand pan
 Static Orthoses

 Classified as therapeutic orthoses

 F o r support and positioning of weak or paralyzed u
per
extremities
 U s e d to prevent contractures and furtherdeformity
 C a n also serve as a platform for other
therapeutic attachments
 Classified into levels of involvement:
WHO: Wrist-hand orthosis
HdO: Hand orthosis
EO: Elbow orthosis
SEWO: Shoulder-elbow-wrist orthosis
SEO: Shoulder-elbow orthosis
 Static Hand Orthosis

 Maintains the functional position of the hand and prevents

development of deformities.
 Serves as a vehicle for other therapeutic attachments
Patient Population:
 Patients with weakness or paralysis of the hand intrinsic
musculature and strong wrist extensors
 Without this orthosis these patients are at risk for
developing flat hand with the thumb carpometacarpal
joint in extension
 T h e C7 neurosegmental level quadriplegic exhibits this
weakness
Finger Orthosis ( PIP )

 Static Three point

orthosis for boutonniere
deformity
Finger Orthosis ( DIP )

 Ty p e
 Static or dynamic
 Region
 Volar or dorsal
 Joint crossed
 Function

Static Volar
DIP Extension Splint
 Static WHO

 Supports the wrist joint, maintains the functional

architecture of the hand, and prevents wrist-hand
deformities.
Patient Populations:
 Severe weakness or paralysis of the wrist and hand
musculature.
 Prevention of contractures or deformities
 Often used for post CVA or C1-5 Quadriplegics with zero
wrist extensors and an intrinsic minus hand
Hand Orthosis

Static Dorsal
Hand Orthosis
With an MCP
Block
Hand Orthosis

 Universal Cuff
 Wrist Cock-Up Splint (WHO)

 Maintain the wrist in the neutral or mildly extended

position
 Immmobilizes the wrist while allowing full MCP
flexion and thumb mobility
 Wrist Cock-Up Splint (WHO)

Contraindications:
 Active MCP synovitis
 Joint inflammation resulting to volar subluxation
and ulnar deviation

Disadvantages:
 Interferes with tactile sensibility on the palmar
surface of the hand
 Dorsal strap can impede lymphatic flow
 Dorsal Wrist Cock-Up Splint

 Stronger mechanical
support of wrist and
freeing up some of the
palmar surface for
sensory input
 Distributes pressure over
the larger dorsal wrist
surface area
 Better tolerated b
y
edematous hand
 Special Considerations

 For burns: make adjustments as bandage bulk

changes
 Preventin infection: when open wound has
g exudates, clean splints with warm soapy water,
hydrogen peroxide, or rubbing alcohol
 Patients in the ICU: use sterile materials; follow
protocol of the facility
 R A patients benefit from thin
thermoplast ( less than 1/8 inch )
 Thumb Spica Splint (WHO)

 H e l p stabilize CMC, MCP and IP joints

Thumb •Volar
Post •Dorsal
•Radial
Opponen Gutter
s Bar
 Static Elbow Orthoses

Shoulder slings Humeral Fracture Brace

 Static Elbow Orthoses

 Designed for reducing soft tissue contractures.

 Must be custom designed and custom fabricated with cuffs and straps.

 Application of low magnitude, long duration forces is preferable for reducing

contractures.

 Contracture reduction should be done slowly and incrementally in a therapeutic

setting.

Patient Populations:

 Can result from trauma or disease

 Largest population affected is SCI who depend on full ROM of the elbow to

propel a wheel chair or bring the hand to the face

 Static Shoulder Elbow Orthoses
 Commonly seen for support of a painful shoulder or traumatized brachial

plexus-injured limb for long term use as opposed to simple sling.

 The coupling between the forearm trough and the iliac cap can be customized to

permit a variety of motions for the glenohumeral joint.

 Common examples include: “gunslinger,” forearm trough, or shoulder

abduction orthosis.

Patient Population:

 Brachial Plexus injury

 Painful or subluxing glenohumeral joint

 Intrinsic plus hand and wrist C7-8 Spared

 Can have a an WHO extension if weak hand/wrist

4) Elbow-forearm wrist othosis:
 Regional name : elbow wrist hand orthosis
 Common name: sugar-tongsplint
 Functions Indications

- Immobilize elbow/forearm/wrist - CTD

topromote tissue healing - Forearm fractures
- Post operative elbowarthroplasty
- Post operative ulnarnerve
transposition
Elboworwristmobilizationorthoses:
 Regional name:elbow orthosesor wrist
orthoses
Functions
- Increased PROM by softtissue
elongation via low-load prolonged -
stretch
- Replace orassist weak wrist
extensors toenhance ADL
Indications
- Contracture
Post operative scarrelease
- Burns
- Fracture (late phase)
- Radial nervelesion
- Spinal cordinjury
- Brachial plexuslesion
- polio
Posterior elbowsplint Epicondylar straps

Articulated elbow orthosis

Dynamic supination/pronationsplint
 Shoulder Elbow Wrist Orthosis

 Frequently prescribed to protect soft tissues or to prevent contractures

of soft tissues or to correct an existing deformity.
 Can be utilized for static placement or designed to allow for maximum
mobility.
 These orthoses also known as a shoulder stabilizer or airplane
orthosis.
Patient Populations:
 Post rotator cuff repairs

 Anteroposterior capsular repairs

 Post-manipulation

 Axillary burns
Airplane Splints
2) Arm sling
 Regional name: shoulderorthosis
 Common names:
 figure ofeight slings
 universal sling
 Cuff sling
 Hemi sling
 Orthopaedic sling
 Flail arm sling
 Glenohumeral support
 Hook hemiharness
 Functions indications
- Immobilize topromote tissue - AC joint injury
healing - Scapular, humeral fractures
- PO shoulder repair/arthroplasty
- PO tendon,artery, or nerverepairs
- Rotator cuffinjury
- Bicipital tendinitis

- Prevent overstretching of GH - Brachial plexuslesion

musculature/ligaments
- Decreased shoulder painrelated - Upper motorneuron lesion:
to arm distraction and shoulder- hemiparesis with subluxation
hand syndrome

- Keep hand and forearmelevated

to reduceoedema
 Biomechanical efficacy:
- Slings may be static or dynamic.
- Dynamic slings use elastic straps and are designed to allow
some motion of the forearm while supporting thearm.
- The wrist should be supported by the sling to prevent
wrist drop if there is distal weakness.
- Hand should be higher than the elbow to decrease
the oedema.
- Caremust be taken to mobilize the shoulder SOS possible to
prevent adhesive capsulitis.
Nonarticular fracture
orthosis- humeral
fracture brace
Description o f orthoses:

1) Calvicular orthoses:
 Regional name: shoulderorthosis
 Common names: figure of four harness,
clavicular brace/ harness
 Functions Indications

- Restrict motion to Clavicular fractures

promote tissue healing
- Improve posture - Forward shoulderposture
- TOS
- Reduced scapular - Cumulative trauma
myofascial pain disorder
- Increase/maintain PROM - Pectoral contractures
 DYNAMIC SPLINTS /
FUNCTIONAL SPLINTS
 Purpose of Splinting: DYNAMIC

 Protects and assists weak musculature

to perform selective tasks

 Often uses internal or external power

sources to achieve increased

functionality of upper limb

 Often used for patient populations with

long standing limitations who would

benefit from increased function of
hand through use of orthoses
 Physiologic Considerations

 To o great stretch  To o little stretch

 Fatigued  Atrophy and weaken
 injury  Skin, tendons, ligaments,
 Failure and joint capsules will
shorten in the absence of
habitual tensile forces

• Enough stretch
– Three degrees of gain in ROM per week, with a range
of 1-10 deg, is acceptable (Cummings et al 1992 )
– High intensity short term stretching actually promotes
stiffness
– The client should sense tension in the tissues but feel
no pain
 Guidelines for Dynamic Splinting

Hepburn, 1987
 T h e stretch should not be perceived as a
“stretching” force until at least 1 hour has passed
 Client should remain comfortable with the orthosis
for up to 12 hours
 After removal, the client should feel no more than a
stiffness or mild ache
 Basic Components

 Outrigger
 Dynamic Assist
 Finger cuff
 Reinforcement bar
 Fingernail attachments
 Phalangeal bar/finger p
a
n
 Dynamic Splints

 Dynamic finger extension

splint
 Dynamic wrist extension
splint
 Tenodesis training

 Dynamic ulnar nerve splint

 Dynamic Finger Extension Splint
 Dynamic radial nerve splint
 Objectives:
 Immobilize the wrist in functional
position
 Passively extend the MCP to 0
 Permit full active MCP flexion
and unrestricted IP motion
 Indications:
 Paralysis of wrist, MCP, Finger
extensors
 Advantages:
 Relatively has a less obtrusive
shape as compared to the
outrigger design
 Dynamic Wrist Extension Splint

 Objectives:
 Passively extends the
wrist while allowing
wrist flexion
 To prevent contracture
of unopposed,
innervated wrist
flexors
 Indication:
 Weak or paralyzed
wrist extensors
Metatarsal Bar

Dynamic Springwire
Knucklebender Assist

Volar Forearm Trough

 Tenodesis Training Splint

 Rehabilitation
Institute of Chicago
 Objectives:
 To train tenodesis
grasp
 To promote a strong
tripod pinch with wrist
extension
 Allows finger opening
with wrist flexion
 Indication:
 C6 quadriplegia with
grade 3 strength of
wrist extensors
 Dynamic Ulnar Nerve Splint

 Dynamic anti-claw
deformity splint, Wynn
Perry Splint
 Objectives
 To passively flex the 4th
and 5th MCP’s
 To prevent shortening of
the MCP Collateral
ligaments
 To promote active IP
flexion
 Indication
 Ulnar nerve lesion
 Capener Splint

 Dynamic spring wire splint  Indications

for PIP extension
 Objectives:
 To passively extend the
PIP

Allows active IP flexion
 Provide stability to PIP
 Promote restabilization of
lateral bands and prevent
rupture of the central slip
-PIP flexion contracture
-PIP dorsal dislocation
-Volar plate injury
-Flexor tendon repair with
resulting PIP flexion
contracture
-Partial or complete tear
of the collateral ligament
- Boutonniere deformity
 General Precautions

 B e aware of and make adjustments

for pressure areas
 Check for presence of edema
 Timing
 Compliance
 S k i n reactions
THANK YOU