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Upper Extremity Orthotics

Upper extremity orthotics are commonly used to treat injuries and conditions of the hand, wrist, elbow, and shoulder. They are generally categorized as either static orthoses, which do not permit motion, or dynamic orthoses, which allow some movement. Common static orthoses include short opponens splints to immobilize the thumb and wrist-hand orthoses with wrist control. Dynamic orthoses include tone-reducing splints and externally powered prehension units. The appropriate orthosis depends on the specific injury and desired functional outcomes.

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Catalina Culea
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127 views19 pages

Upper Extremity Orthotics

Upper extremity orthotics are commonly used to treat injuries and conditions of the hand, wrist, elbow, and shoulder. They are generally categorized as either static orthoses, which do not permit motion, or dynamic orthoses, which allow some movement. Common static orthoses include short opponens splints to immobilize the thumb and wrist-hand orthoses with wrist control. Dynamic orthoses include tone-reducing splints and externally powered prehension units. The appropriate orthosis depends on the specific injury and desired functional outcomes.

Uploaded by

Catalina Culea
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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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.
• 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.
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.
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:
• DeQuervains‘s tenosynovitis.
• 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.
Volar forearm static wrist hand orthosis
(resting hand splint)
• Commonly referred to as a resting hand splint.
• The objective of this splint is to place the hand and wrist in neutral or
functional position, with the MCP joints flexed 60 to 90 degrees and
the PIP and DIP joints flexed to 0 to 45 degrees. The wrist is in slight
extension to neutral.
• This position maintains the web space, perventing a flat hand or
flexion contractures of the hand, it is also used to reduce pain and
infammation.

• Indications:
• Flaccid hand due to paralysis.
• Burns or healing skin grafts.
• Degenerative or inflamed joints.
• Volkaman‘s ischemia.
• Trauma to hand or wrist.
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 antispsticity 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
porpouse of restricting motion and pomoting tissue
healing.
• They can be removed for treatment and hygine.as 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.
• Banana 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.

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