UPPERLIMB

ORTHOSIS

BY,
DR ANEETA SHAJI
1ST PMR PG
INTRODUCTION:

 Orthosis—or alternatively, orthotic device—is the

preferred term
 The terms splint and brace are less preferred because
they imply only immobilization and do not suggest
either improved function or restoration of mobility
OBJECTIVES:

 Protection, correction,and assistance with function

 Protection: Orthotic devices can provide compressive
forces and traction in a controlled manner, protecting
the impaired joint or body part
 Correction: Orthoses help in correcting joint contractures
and subluxation of joints or tendons, assisting in the
prevention and reduction of joint deformities
 Assistance with function: Orthoses can assist function by
compensating for deformity, muscle weakness, or
increased muscle tone
BIOMECHANICAL PRINCIPLES

 Three-point control concept

 Tissue tolerance to compression and shear forces
 The biomechanics of levers and forces
 Selection of materials
 Static vs dynamic control
BIOMECHANICAL PRINCIPLES

 Three-point control concept is the basis of nearly all

upper and lower limb orthotic designs
 A strong force is applied at a joint and a counterforce
applied proximal and distal to that joint
 Location of the force and counterforce may be clearly
identified as a specific loop or bar in the orthotic
design
BIOMECHANICAL PRINCIPLES

Tissue tolerance to both compressive and shear forces

 There are more than 30 pressure-sensitive bony

prominences in the wrist, hand, and fingers alone
 Avoiding prolonged, excessive pressure over these bony
prominences will preserve skin integrity and patient comfort
 Higher pressures of 100 to 300 mm Hg are tolerated for
only 2 to 4 hours continuously
 Lower pressures of 20 to 50 mm Hg are tolerated for up to
12 hours a day continuously.
BIOMECHANICAL PRINCIPLES

The biomechanics of levers and forces

 A relationship exists between the magnitude of the

pressure applied (force) and the distance to the
fulcrum (lever)
 The farther from the fulcrum or from the joint, the less
pressure needed to generate a fixed force across the
joint
 By increasing the lever distance, less pressure can
generate the same force across the joint
BIOMECHANICAL PRINCIPLES
selection of materials for upper limb orthoses:
 Depends on the flexibility, strength, and durability of the material
 Most UL orthoses are fabricated of thermoplastics for the structural
design
 Low temperature thermoplastics are commonly used because they can
be easily shaped or formed to the patient’s limb without the need for
high-temperature ovens
 High-temperature thermoplastics may be indicated for certain longer-
term or high-stress devices
 Various metals are still used for parts of upper limb orthoses -carbon
fiber materials can be used for very strong and very light designs
 Foam materials are commonly used as padding to improve tissue
tolerance in high-pressure areas
BIOMECHANICAL PRINCIPLES

Biomechanics of any UL orthosis can be defined as

static, dynamic
 A dynamic orthosis allows or enhances movement
across a joint
 Dynamic orthoses -low tissue pressures unless
external forces are applied such as stretching of a
contracture, or when an abnormal increased tone from
upper motor neuron injury
 Static positioning orthosis will simply stabilize or fix
one or multiple joints
PREHENSION
 The hand is used during functional
activities through basic prehension
patterns: to pinch, to grasp, or to hook
objects
 There are two basic types of hand
grips:power and precision
 During power grip the wrist is held in
dorsiflexion, allowing the long flexors to
press the object against the palm
 Lack of mobility or weakness of the
fourth and fifth rays may interfere with
maximal power grip
PREHENSION

• Precision grip is limited mainly to

the MCP joints and primarily
involves the radial side of the
hand

• The intrinsic muscles are more

important in precision than with
power grip

• The thumb is essential for

precision grip because it
provides stability and control of
direction and can provide power
TYPES OF ORTHOSIS:

NONARTICULAR

• A sugar tong orthosis is ideal for

splinting fractures of the
radius,ulna, or wrist
Gel shell orthosis to exert
• It prevents flexion and extension at
pressure
the wrist, limits flexion and
over a healing scar to
extension at the elbow, and
STATIC ORTHOSIS:

• Wrist splint for carpal tunnel

Hand-based static thumb
syndrome, with the wrist in a
splint with interphalangeal
position of 0 degrees to 5 degrees
joint included for
of extension;
immobilization of a distal
• distal palmar crease free to allow
SERIAL STATIC:

 The serial static splint is also

static but is periodically changed
to alter the joint angle at which
the splint is positioned
 The splints are applied with the
tissue at its maximum length
 This serial repositioning provides
a prolonged gentle stretch to
involved structures, helping a
stiff joint regain motion
Serial static prefabricated
hinged proximal
interphalangeal splint that
STATIC MOTION-BLOCKING:

The static motion-blocking

splint permits motion in one
direction but blocks motion in
another
A swan neck splint is
designed to allow flexion
but block hyperextension of
the PIP joint
STATIC PROGRESSIVE

These splints differ from serial splints

in that they use nonelastic
components such as static lines,
hinges, screws, and turnbuckles to
place a force on a joint to induce
progressive
Static progressive flexion splint
change
with a MERiT component The
MERiT static progressive component
(available
commercially) decreases the static
line length as it is turned, thereby
increasing the range of joint motion
DYNAMIC:

• The dynamic splint provides an

elastic force to help regain joint
motion
• Finger extension splint, which
uses a spring coil or wire
tension assist to increase
extension in a PIP joint with a
mild contracture
MUSCULOSKELETAL CONDITIONS:

The thumb spica splint:

forearm based,immobilizes the wrist, the
carpometacarpal(CMC)joint, and the
MCP joint of the thumb
Forearm-based thumb spica
splint used for de Quervain
stenosing tenosynovitis
MUSCULOSKELETAL CONDITIONS:

Trigger finger splint

• The splint covers the p/L phalanx
and the MCP joint of the involved An elbow strap used for lateral
digit epicondylitis
• This splint decreases the tendinous
excursion through the first annular
pulley, at the base of the MCP joint,
MUSCULOSKELETAL CONDITIONS:

Nonarticular type orthosis:

• Humeral fracture Sarmiento
splint
• Provides support to a body part
without crossing any joints and
provides protection

• Ulnar gutter splint to immobilize the

fourth and fifth metacarpal (boxer) fracture
• The term gutter describes a splint that
includes only the radial or ulnar portion of
the limb
BRAIN INJURY AND STROKE:

Rolyan figure-of-eight sling used

for reducing subluxation of
the shoulder joint in a patient with
hemiplegia

• For patients with decreased tone of

the upper limb these slings restrict
active motion of the shoulder by
keeping the humerus in adduction
and internal rotation and placing the
elbow in flexion
• Designed to unload the weight of
the arm on the shoulder,but do not
BRAIN INJURY AND STROKE:

The Ball antispasticity splint places the

fingers and hand in a reflex-inhibiting
position and serves to reduce tone
RESTING HAND SPLINT:
 In upper limb paralysis, a resting hand
splint is commonly used to position
the wrist in slight extension, MCP
joints in slight flexion, and the IP joints
in extension
 The thumb is supported in a position
between palmar and radial abduction
 Full support of the first CMC joint
prevents ligamentous stresses on the
thumb, especially in the insensate
hand
NEUROMUSCULAR CONDITIONS:

The radial nerve palsy orthosis Combined median and ulnar nerve pals
assists with wrist and digit orthosis blocking the metacarpophalangea
extension to improve functional use joint into slight flexion
of the hand
OTHER INJURIES:

The metacarpophalangeal Postoperative splint for a patient with an

arthroplasty postoperative splint extensor tendon
positions fingers in extension with pollicis longus repair
slight radial pull
OTHER INJURIES:

A Kleinert postoperative splint is

designed for flexor tendon repairs It
passively pulls the finger into flexion with
an elastic thread or rubber band
Long arm splint used for cubital
tunnel syndrome hold the elbow in Hand and wrist are positioned to keep the
45 degrees of flexion, the forearm in MCP,joints flexed and the interphalangeal joint
neutral, and the wrist in 0 degrees extended with the wrist in slight extension this
to 5 degrees of extension with is the “safe” or “intrinsic plus” position
thumb and fingers free
A functional carbon tenodesis Electrically powered orthosis
orthosis with wrist ratchet control to that moves the joints through a
adjust for tension desired range of motion
This splint is used for functional pinch
during
activities of daily living; pinching to
ORTHOTIC MATERIALS:

 Most splinting materials are low-temperature

thermoplastics
 Many are known by their trademark names, such as
Orthoplast, Aquaplast, and Orfit
 Low-temperature thermoplastics become soft and
pliable when exposed to relatively low temperatures and
can be shaped in a water bath at 150° F to 180° F (66° C
to 82° C)
 High-temperature thermoplastics are more durable but
require oven heating (up to 350° F or 177° C) and
placement over a mold to achieve the desired shape.
CONCLUSION:

 The most important principle in the prescription of

orthotic devices is gaining the cooperation of the
patient
 Through the attention and concern of the physician
and therapist, the patient must be able to see the
benefit of the orthosis
 It must also fit comfortably and be cosmetically
appealing
REFERENCES:

 Braddoms 5th .4th edition

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and_Practice__Two_Volume_Set__Rehabilitation_Medicine__Delisa_
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