Upper Extremity Orthotics By Abdullah Radwan Orthosis a
Upper Extremity Orthotics By : Abdullah Radwan
�Orthosis: a device that is externally applied to the body segment to support or improve the function of that segment.
�Upper extremity orthoses can be classified into: 1. Static orthoses: have no movable joints in the design. 2. Dynamic orthoses: have movable joints that can limit movement (block), increase movement through traction, or substitute for weak muscles using supplemental force (assist). 3. Hybrid orthoses: have features of both static and dynamic orthoses in one device.
� GOALS OF UPPER EXTREMITY ORTHOTIC : 1. Substitute for weak or absent muscles as in: � Cervical spinal injury, � Brachial plexus injury, or � Peripheral nerve injury to the median, ulnar, or radial nerves. 2. Protect damaged or diseased segments as in: � Surgical repairs, � Trauma, or � Rheumatoid arthritis and other inflammatory disorders. 3. Prevention of deformity as in: � Brain injury, � Stroke, � Spinal cord injury, � Brachial plexus injury, � Peripheral nerve injury 4. Correction of contracture due to disease or immobilization as in: � Fractures to help union � Other significant injuries to promote soft-tissue and bony healing. 5. Provide a base for attachment of other assistive devices: � e. g. , a universal cuff, which wraps around the hand to provide positioning of a spoon, fork, or other eating utensils.
Universal cuff or hand orthosis
Principles of UE orthotics 1. BIOMECHANICAL PRINCIPLES. 2. ANATOMICAL PRINCIPLES.
A) BIOMECHANICAL PRINCIPLES: The five principles include: 1. Three-point control concept � � 2. Tissue tolerance to compression forces and shear forces � � 3. The biomechanical forces applied in upper extremity orthotics are most analogous to a class one lever, commonly known as a seesaw, which has a force applied at both ends with a central fulcrum. Selection of materials � � 5. e. g. , 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. The biomechanics of levers and forces � 4. It is the basis of nearly all upper and lower extremity orthotic designs. Generally, a strong force is applied at a joint and a counterforce is applied proximal and distal to that joint. It depends on the flexibility, strength, and durability of the material necessary to achieve the proper outcome. Most orthoses use thermoplastics for most of the structural design. Static versus dynamic control. � � A static orthosis will stabilize or fix one or multiple joints. A dynamic orthosis allows movement across a joint.
B) ANATOMICAL PRINCIPLES 1. The wrist: � should be immobilized in slight extension and neutral pronation/supination. This position facilitates hand prehension activities to reach the face and midline trunk for ADLs. 2. The IP joints of the fingers: � should be immobilized in extension, but the MCP joints should be immobilized in flexion to maintain the length of the collateral ligaments. 3. The thumb: � should be immobilized opposite the fingers in palmar abduction and extension. The web space should be maximized to maintain both gross grasp and fine motor pinch.
�COMMON UPPER EXTREMITY ORTHOTIC DESIGNS �I. Finger and Thumb Orthoses �Static finger orthoses with a flexion or extension block allow motion in one direction, but not the other. The best example of this is the finger ring orthoses, commonly used in RA (The boutonniere's deformity- The swan-neck deformity) �Dynamic orthoses across the IP joints of the fingers are used for the purpose of stretching flexion contracture at the IP joint.
II. Hand-Finger Orthosis (HFO) A) Static HFO: 1. Short opponens orthosis would include a C-bar to maintain the web space between the thumb and the other fingers, and an opponens bar to position the thumb opposite the fingers for gross grasp and fine motor pinch. This is most commonly used for median nerve injuries where control of the thumb and opposition are lost.
2. Thumb spica is a hand-finger orthosis, based on the hand extends circumferentially around the thumb to fix the thumb in opposition. It is used for: � inflammatory conditions of the thumb such as RA � osteoarthritis, � de Quervain's tenosynovitis. � fracture of the first metacarpal to maintain the thumb in a functional position. 3. Other static hand-finger orthoses are commonly used for RA to control or prevent MCP subluxation and ulnar drift.
B) Dynamic HFO: �Dynamic hand-finger orthoses are most commonly used for flexion or extension contracture across the MCP joints. 1. knuckle-bender orthosis is used to stretch extension contracture at the MCP joints when collateral ligaments have been allowed to shorten due to immobilization.
III. Wrist-Hand-Finger Orthosis (WHFO) A) Static WHFO: �Static wrist-hand orthoses are most commonly used for the treatment of carpal tunnel syndrome. �Other uses include: � Traumatic wrist sprain, � Wrist inflammation due to diseases such as RA. � As the first step following injury or repair to flexor or extensor tendons of the hands. �Simple static wrist-hand-finger orthoses can be used for positioning of the hand following: � Stroke, � Brain injury or � Brachial plexus injury.
B) Dynamic WHFO: �A dynamic wrist-hand finger orthosis is used in radial nerve injury to assist wrist extension and finger extension. �The tenodesis prehension orthosis or flexor hinge orthosis is a dynamic wrist-hand-finger orthosis including active wrist extension movement to regain gross grasp and fine motor pinch of the thumb and fingers. This is used in C 6 -level quadriplegia where some wrist extension strength is maintained with little or no long finger flexor strength.
IV. Elbow Orthoses �Static circumferential orthoses across the elbow are often used for fractures at or near the elbow.
�Dynamic elbow orthoses : are commonly used for flexion or extension contracture across the elbow due to immobilization.
V. Shoulder Orthoses �Flexible arm slings have been used for a variety of problems including: �clavicular fracture, �acromio-clavicular joint injury, �proximal humeral fracture, and �glenohumeral subluxation due to hemiparesis. �The primary goal is to maintain glenohumeral integrity and to limit motion across the AC and glenohumeral joints.
�A true static shoulder-elbow-wrist -hand orthosis, such as the airplane splint or arm abduction orthosis, can prevent movement across the glenohumeral joint by stabilizing the arm in abduction. �Care must be taken to mobilize the glenohumeral joint as soon as possible to prevent adhesive capsulitis. �.
�Other specialized orthoses in this category include the balanced forearm orthosis (BFO) for patients with C 5 -level spinal injury.
Thank you
- Slides: 20