 Minimization of pressure

 Biomechanical analysis
▪ Pressure = Total force / Area of force application
 Reduce pressure – increase application area
 Reduce pressure – provide maximum contour
 Reduce pressure – protect areas of risk
▪ Padding is not a solution
▪ It reduces space between the tissue & splint
▪ More compression
 Reduces shear stress – avoid large sudden changes in
pressure.
 Advantageous application of forces
 Newton’s third law
▪ For every action there is equal and opposite reaction
 Leverage
▪ Lever is a tool to effect movement
 Mechanical advantage
▪ Force arm/Resistance arm
 Direction of force application
▪ Three point pressure system
 Static orthoses - They serve as a rigid support in
fractures, inflammatory conditions of tendons
and soft tissue, and nerve injuries.
 Dynamic/functional orthoses - These types of
upper extremity orthoses are used primarily to
assist movement of weak muscles. Some
dynamic splints have a dual or bilateral
mechanism for providing tension, safely
accommodating moments of spasm and so
possibly limiting or avoiding soft-tissue injuries.
 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
 Serve as an attachment for assistive devices
 Help correct deformities
 Block unwanted movement of a joint
 Figure-8 harness/clavicular brace
 Figure-8 harness/clavicular brace

Functions Indication
Restrict motion to promote tissue Clavicular fractures
healing
Improve posture Forward shoulder posture
TOS
Reduce scapular myofascial ( pain ) Cumulative trauma disorder(CTD)

Increase / maintain PROM Pectoral contractures

 Placement
 Material goes over clavicles, under arms, and
crosses over high thoracic spinous processes.
 Biomechanical efficiency
 These orthoses restrict movement of the
clavicle and to some extent inhibit scapular
protraction while allowing free movement at
the GH joint
 Figure of eight sling
 Cuff sling
 Hemi sling
Functions
Immobilize to promote tissue
healing
Prevent overstretching of GH
musculature/ ligaments
Decrease shoulder pain;
Related to arm distraction and
shoulder - hand syndrome
Keep hand and forearm elevated
to reduce edema
Indication
AC joint injury
Scapular, humeral fractures
PO shoulder repair/arthroplasty
PO tendon, artery, or nerve
repairs
Rotator cuff injury
Bicipital tendinitis
Brachial plexus lesion
UMN lesion : Hemiparesis with
subluxation
 Placement
 Most sling support the forearm with the elbow
flexed, shoulder internally rotated, and arm
adducted.
 Biomechanical efficiency
 Sling may be static or dynamic
 Dynamic sling-allow some motion of forearm while
supporting the arm.
 The wrist should be supported if distal weakness.
 Hand should be higher than than elbow
 Care - mobilize the shoulder as soon as
possible
 Contraindication
 UMN lesion
 Airplane splint

 Biomechanical efficacy – sh in abduction,with

degree determined by the pathology.
 Care – Not to overstretch skin, nerves, or
vascular structures
 Contraindications – TOS,arm abd<90 degree
Functions Indications
Immobilize to promote tissue healing Axillary burns
PO shoulder fusion
PO axillary scar release
Shoulder dislocation

Increase PROM by soft tissue Burns

elongation via low-load , porlonged Contractures
stretch (serial static splinting)
 Placement – The circumferential proximal
forearm cuff is suspended from shoulder
saddle by straps or cable. Orthosis is
suspended from a chest strap.
Functions Indications
Substitute for weak/absent shoulder BPL
and elbow muscles LMN lesion with proximal weakness

Enhance ADL
 Biomechanical Efficacy
 GH joint - approximated to mainimize
subluxation.
 Suspension rom a cable allows free arm swing
while maintaining GH joint approximation and
minimizing migration of the shoulder saddle.
 The external elbow hinge should have a
manual lock in several ratcheted positions if
the orthosis is substituting for weak or absent
elbow flexion.
Functions Indication
Support/position arm and assist weak Severe proximal weakness
proximal muscles to strengthen muscles BPL
and peform ADL SCI
Polio
GBS
MD
Allow patients with high tone to self UMN lesions with high tone
feed
 Biomechanical Efficacy
 Pt must have 2+ or better strength in either
neck, trunk, shoulder or elbow muscle to
successfully depress the elbow, thus elevating
the hand.
 Patients may be able to achieve tabletop
activities(page turning, writing, key boarding)
Functions Indication
Immobilize or restrict elbow motion to Medial/lateral epicondylitis
promote tissue healing Cubital tunnel syndrome
PO tendon, artery , nerve repair
Olecranon fracture
Burns
Increase elbow PROM via low-load , Burns
prolonged stretch ( serial static Elbow contractures
splinting)
 Posterior elbow splints
 For elbow immobilization in elbow surgery or
inflammation
 Serial cast
 For prevention or correction of contractures by
promoting soft tissue stretch and passive ROM
 Air splint

 Used to maintain or
increase elbow
extension

 Form of
circumferential
inflatable sleeve,
also used for
contractures and
elbow
immobilization
 Dynamic elbow flexion
orthosis
 Used to maintain the
elbow in 90° of flexion in
cases of elbow
contractures, burns, and
fractures
 Turnbuckle splint
 Dynamic wrist splint
Function Indication
Increase PROM by soft tissue Contractures
elongation via low-load,prolonged PO scar release
stretch Burns
Fracture
Replace or assist weak wrist extensors Radial nerve lesion
to enhance ADL SCI
BPL
Polio
 Preformed dynamic
pronation-supination
splint
 Applies gentle force for a
sustained and gradual
stretch to increase ROM.
 Force is controlled by
twisting the tubing in the
opposite direction of the
motion desired.
 Sugar – Tong splint
 Biomechanical Efficacy
 Orthosis should totally restrict
elbow, wrist and forearm AROM
yet should allow full active use
of all digits.
Functions Indication

Immobilize elbow/forearm/wrist to CTD

promote tissue healing Forearm fractures
PO elblow arthroplasty
PO ulnar nerve transposition
  wrist sprain, wrist or forearm fractures, arthritis
 Wrist cock-up splint
 Wrist extension splint
 Ulnar gutter splint
Functions Indication
Immobilize to promote tissue CTS
healing Flexor/extensor tendinits
Laterl/medial epicondylitis
Wrist sprain/contusion
Arthritis
Foreram/Wrist fractures
PO wrist extensor tendon repair
PO skin grafting
PO wrist fusion
Substitute for weak wrist SCI
extension BPL
Function Indications
Prevent overstretching of wrist Radial nerve lesion
extensors
Stabilize the wrist for grasp and Polio
pinch,prehension/strength
Immobilize wrist / forearm to Burns
maintain PROM PO scar release
Restrict motion to prevent Arthritis
harmful wrist postures during Athletes or performing artists
activity
Elongate soft tissue via low load, Burns
prolonged stretch Wrist contractures
 Biomechanical Efficacy
 The wrist can be positioned in extension,but
for optimal hand function.
o
 The wrist should be in 15 to 30
 For carpal tunnel syndrome, the wrist should
be neutral to maximize carpal tunnel lumen
and minimize median nerve compression
 Volar
 On palmar surfaceVery supportive
 Less sensory input during functional tasks
 Dorsal
 On dorsal side
 Allows more sensory input during functional tasks
 Metacarpal bar
 Helps with positioning
 Thumb hole
 Easier to position
 More contoured for snug fit
 Risk of impinging thumb
 Metacarpal bar
 Helps with positioning
 Thumb hole
 Easier to position
 More contoured for snug fit
 Risk of impinging thumb
 Soft tissue hand injuries to
the fourth and fifth fingers
 Fourth and fifth metacarpal
fractures
 Fractures of the fourth and
fifth phalanges
 Positioning for rheumatoid
arthritis
 Long Opponens Splint
 Thumb Spica
Functions Indications
Immobilize thumb/wrist to promote CMC/MP synovitis
tissue healing De Quervain’s tenosynovitis
Thumb sprain
CMC/MP collateral ligament
injury(gamekeeper’s thumb)
Scaphoid/thumb fracture
PO thumb
-ORIF
-Surgical CMC/MP fusion
-Arthroplasty
-Tendon transfer
-Ligament repair
- Nerve repair
- PO trapeziumectomy
Function Indications
Substitute for weak thumb muscles Median/Ulnar nerve lesion
; stabilize thumb in opposition for
three jaw chuck pinch
Maintain thumb PROM Burns
Restrict motion to prevent harmful Arthritis
thumb positions during activity Athletes or performing artists
Elongate soft tissues via low load, Burns
prolonged stretch Thumb contractures
 Biomechanical Efficacy
 The orthotic material usually covers two thirds
of the distal radial forearm and surrounds the
thumb to the IP.
 Volar
 Immobilizes wrist, 1st CMC joint, depending on
the height of thumb post, may stabilize 1st MP
joint and/or 1st IP joint
 Volar surface of forearm is covered
 Dorsal
 Immobilizes Stabilizes wrist, 1st CMC joint,
depending on the height of thumb post, may
stabilize 1st MP joint and/or 1st IP jointDorsal
surface of forearm is covered
 Radial Gutter
 Immobilizes Stabilizes wrist, 1st CMC joint,
depending on the height of thumb post, may
stabilize 1st MP joint and/or 1st IP joint
 Radial surface of forearm is covered
 Hand based (Short Opponens)
 Immobilizes 1st CMC joint, 1st MP joint,
depending on length of thumb post, may stabilize
1st IP joint
 Immobilization for hand flexor and extensor
tendinitis
 tendon, nerve, or fracture repair
 maintenance of passive ROM in patients with
UMN lesions, burns & contractures
 Purposes
 Immobilizes wrist, fingers, and thumb
 Immobilizes in "functional hand position" or
"intrinsic plus position"
 Prevents deformity
 Rheumatoid Arthritis
 Crush injuries
 Burns
 Spasticity due to upper motor neuron lesions
 Static
 proximal interphalangeal (PIP) orthosis
▪ Boutonniere & swan-neck deformities (rheumatoid
arthritis)
 distal interphalangeal (DIP) orthosis
▪ immobilize the DIP joints in extensor tendon and
collateral ligament repairs
 Caused by a Volar plate rupture
 Lateral bands drift dorsally and exacerbate the
hyperextension at the PIPI joint. They become
ineffective in extension at the DIP joint and the
unopposed action of the profundus causes
flexion at the DIP joint.
 Dynamic
 MP joint dynamic orthosis
 wrist driven flexor hinge splint
 externally powered tenodesis
 Purpose
 Creates a functional grasp:
▪ Facilitates joint movement
▪ Makes use of passive tension properties of muscles
 Specifically:
▪ Optimizes passive tension in muscles that cross multiple
joints (wrist, MP, and IP joints)
▪ Positions CMC joint so that pad of thumb comes in
contact with lateral aspect of index finger
▪ Facilitates lateral prehension
 C7 Quadriplegia
 Radial nerve palsy
 as recovery takes place and active wrist extension
occurs
 Spasticity reduction splint
 Finger spreaders - NDT therapists advocate
use of reflex inhibiting patterns
 finger and thumb abduction key point
 Cone splint
 should not stretch wrist of fingers
 Does tend to have and inhibitory effect on flexor muscles
 large end ulnar, small end radial
 Types
 High Profile
 Low profile
 Multiple joints
 Single Joints
 Substitute for loss of function
 Correct joint deformity
 Control joint motion and arthrokinematics
 Maintain range of motion
 Fracture alignment
 Tissue healing
 Wound healing
 Tendon injuries following surgery
 Radial nerve palsy
 Joint replacement
 Burns
 Wound Healing
 Fractures
 C7 Spinal cord injury
 Flexor Tendon Splint
 Prevents rupture of the healing tendon (hand in
protected position)
 Tendon movement to prevent or break adhesions)
 Radial Palsy Splint
 Promotes wrist extension during active grip,
which then strengthens grip
 PIP Extension Splint
 Promotes dorsal glide
 Introduces controlled tension to healing flexor
tendon
 Passive stretch on palmar structures (such as skin
burn wound)
 Tenodesis Splint
 Promotes finger flexion and thumb opposition
during active wrist extension