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Upper extremity orthotics
They are very common, especially in
the cases of the hand. The use of the term orthoses or splints are interchangeable. Objectives • Hand And Wrist Hand Orthoses • Forearm And Elbow Orthoses • Shoulder Orthoses, Fabrication Option • Upper limb Orthoses Evaluation (Hand, Wrist, Fingers, Shoulder and Elbow) • Guideline for Prescription. General classifications of splints or orthotics • Static orthoses: They do not permit motion and are referred to as resting or positional splints. ( to position or hold the wrist and hand) They are commonly fabricated from low temperature thermoplastic materials, but if a permanent orthosis is required, high temperature copolymer plastics are used.
Dynamic orthoses: They permit movement, they are splints that provide a dynamic force, They are generally using energy storing materials like rubber bands, spring steel, wound coiled wire, or plastic with memory. Thumb spica Thumb spica Opponens orthosis Hand and wrist orthoses • Because the complexity of the hand in terms of anatomy, function and associated complications with each injury, hand splinting or orthotic fabrication is clearly a specialty that requires careful examination of each client and in many cases, frequent modifications to the orthosis is required to meet his or her individual needs. Hand orthosis (Basic or short opponens)
• It is fabricated from low temperature
thermoplastics. • It is designed to immobilize the first carpometacarpal (CMC) and metacarpophalangeal (MCP) joints and position the thumb in opposition and abduction to maintain the web space and architecture of the hand. • There is no orthotic wrist control, so strong wrist flexors and extensors are required for functional use. • Positioning of the hand can be functional for grasp. • Indications: Inflammation or injury of the thumb. Median nerve lesions C6-7 spinal cord lesions. Hemiplegia with loss of thumb opposition. Wrist-hand orthosis (long opponens splint or volar forearm wrist orthosis) • It is fabricated from low temperature thermoplastics. • Like the short opponens splint, It is designed to immobilize the first carpometacarpal (CMC) and metacarpophalangeal (MCP) joints and position the thumb in opposition and extension to maintain the web space. The addition of wrist immobilization with volar wrist control design. Maintaining neutral or slight extension, offers less tension to the inflammed tendons. With reduction of the thumb movement in general. • Basically, this splint is short opponenens with wrist control.
• Indications: • Median and ulner nerve lesions • C5-6 spinal cord lesions • Wrist or thumb instability • Degenerative or inflamed wrist thumb joint. • Scaphoid or Bennett‘s fracture dislocation. Wrist driven prehension orthosis (tenodesis orthosis) • Several designs with a verity of materials from low- temperature thermoplastics to light weight metals are used to fabricate these orthoses. • Designed for clients with spinal cord injury at C6-7 level and who have 3-/5 to3+/5 extensor carpi radialis muscle strength, to facilitate the passive flexion of the thumb, index and middle fingers, to create passive three- jaw chuck hand position, or protect the hand for functional tenodesis. Utensil holders (ADL , UNIVERSAL SPLINT) • A custom or prefabricated splint, fabricated from leather and flexible metal. A small sleeve or pouch is located within the palmar aspect, permitting the placement of eating utensils, grooming aids and writing implaments. • Active shoulder motions and elbow flexion are required to maintain the objects placed in the splint. • Indications: • C5-6 spinal cord lesions. • Hemiplegia. Externally powered prehension unit (EPPU)
• The battery driven externally powered prehension unit (EPPU)
allows client with paralysis or sever weakness to have hand function with the use of WHO. • The rechargeable battery source drives the mechanical closing and opening of the hand. • Gross movement of the upper extremity operate the electrical switch, producing pronation to produce prehension and supination to open the hand Tone – reducing orthosis
Tone – reducing orthosis or antispasticity splints are prescribed
when hyper tonicity is present. • The primary objective is to reduce flexor tone, reduce the incidence of contractures, and maintain the arches of the hand by placing the hand and fingers in an extended and abducted position. Creating firm pressure to the palmer surface of the hand. Elbow orthosis • A) Static orthosis, fabricated from low-temperature thermoplastic, • It is formed over the volar surface of the elbow for the purpose of restricting motion and promoting tissue healing. • They can be removed for treatment and hygiene range of motion returns the angle of the splint can be adjusted by reforming the plastic shell, a process similar to that of serial casting • Indications for the static splints include burns, fractures, tendon, nerve, vascular repair, and cubital tunnel syndrome • B) Dynamic splints • When range of motion of the elbow is lost, dynamic splint s provide a low load with prolonged stretch of the soft tissues and skin over time. • Indications: • Burns and contractures. Shoulder orthoses
• Arm Sling: • Figure of eight sling. • Cuff sling. • Orthopedic sling. • Flail arm sling. • They are used to immobilize and promote healing of tissue after burn & trauma. • Hemi arm sling is use to prevent sublaxation of the shoulder while the arm is flaccid. Shoulder-elbow- wrist orthoses • The are called airplane splints. • They are used to protect soft tissue of the shoulder and prevent contractures. • Prefabricated kits are available, • The shoulder is abducted 70 to 90 degrees, and can be adjusted as healing progress. Care of orthosis • To clean orthosis, wipe with a damp cloth and completely dry with a towel, or allow to dry at room temperature. • Clean cotton stockings should be worn. Keep the stocking wrinkle-free. • Don the orthosis first and then the shoe. A shoe horn may be helpful, or • Slip the orthosis in the shoe first and then slide the foot into the orthosis using it like a shoe horn. • The orthotist will schedule a follow-up visit to make sure the device is working and to make sure patient is wearing it correct • Pt may experience some discomfort in other parts of the body, such as in knees, hip, back, and neck. These are normal reactions to the corrected alignment that the orthosis is providing. • If a squeaking sound is detected from the orthosis rubbing in shoe, a light dusting of talcum powder should remedy this noise.
