Orthosis- Upper limb

Objectives Upon completion of this lecture student will be able to: Define basic terminology for types of orthosis for upper limb. Classification and types of orthosis . Describe different principles in applying upper limb orthosis.

Principles in applying upper limb orthosis Protection of an impaired joint or part by: Restricting the impaired joint, maintaining the alignment and preventing deformity. Stabilize the unstable bony components and promote healing of soft tissue and bones. Correcting joint contractures, subluxation of joints or tendons thus reducing deformity. Assists in improving function by compensating for the deformity, muscle weakness and increased muscle tone.

Classification of orthosis 1. Static Serial static. Static motion blocking. Static progressive. 2. Dynamic Motion blocking. Traction. Tenodesis. 3. Adaptive orthosis

STATIC ORTHOSIS Serial static splint : A static splint but angle of positioning is changed periodically. For example, in flexion contracture of wrist, with serial reposition splints, the range of movement can be improved.

STATIC MOTION BLOCKING SPLINT: Permits motion in one direction and blocks other movement. For example, swan neck splint blocks hypertension and allows flexion at PIP joint. SWAN NECK DEFORMITY SWAN NECK SPLINT

STATIC PROGRESSIVE SPLINT Used to regain range of motion. The joint is placed in a position of stretch and once motion is increased the tension is increased progressively.

Dynamic orthosis Dynamic motion blocking: Utilizes passive elastic pull in one direction and active movement in other direction. This allows to maintain the functioning of the unaffected group of muscles. For example, dynamic cock up splint, active flexion and passive extension is allowed. WRIST DROP DYNAMIC COCKUP SPLINT

Dynamic orthosis Dynamic traction splint: It offers traction to a joint and allows controlled movement only. DYNAMIC TRACTION SPLINT

Dynamic splint Tenodesis Splint : Utilizes active extension of wrist in C6 tetraplegic patient to produce controlled passive flexion of fingers against a static thumb post using the principle of parallelogram. TENODESIS SPLINT

STATIC ARM ORTHOSIS Shoulder and arm Orthosis Slings-figure of 8: it is used to support shoulder, elbow and forearm. This helps in preventing subluxation of shoulder in hemiplegia, tetraplegia. FIGURE OF 8 SPLINT

STATIC ARM ORTHOSIS Shoulder and arm Orthosis Aeroplane splint: it keeps the arm in 90 degree abduction and allows no movement in the glenohumeral joint. it is made of plastic or metal and it is held to the chest wall by straps or elastic bandage. Indicated in Erb’s palsy and burns in the axilla. AEROPLANE SPLINT

ELBOW ORTHOSIS Static positioning elbow orthosis : to hold a damaged or unstable joint in alignment. Static elbow wrist orthosis : it mobilizes elbow, forearm and wrist in functional position. Commonly used in post burns rehabilitation. STATIC POSITIONING ELBOW ORTHOSIS

WRIST ORTHOSIS: Volar orthosis: Cock up splint. Volar wrist hand orthosis 2. Dorsal wrist orthosis: Long opponens splint. Dorsal WHO

Volar wrist hand orthosis

Long opponens splint

Dorsal WHO splint

Hand and finger Orthosis Short opponens orthosis – it maintains wrist in radial extension(corrects ulnar deviation), thumb opposition(thumb in abduction & internal rotation), a plamar arch

Bennet type of metal hand orthosis

FINGER ORTHOSIS Static: Boutonniere orthosis- A static splint corrects hyperflexion at PIP joint by 3-point pressure principle.

FINGER ORTHOSIS 2. Swan neck orthosis A Swan Neck deformity is a condition where the middle joint of the finger, known as the PIP joint, hyperextends or bends backwards and the end joint near the fingernail, known as the DIP joint, flexes or is bent downwards.

Finger orthosis 3. Mallet finger orthosis Mallet finger refers to a condition in which the end joint of a finger bends but will not straighten by itself. In this situation, the joint can be pushed straight but will not hold that position on its own.

DYNAMIC ORTHOSIS

DYNAMIC ORTHOSIS Shoulder orthosis – Balanced forearm orthosis: it is the most useful device to assist both elbow and shoulder function. It can be mounted on a wheel or on a table or occasionally on a belt at the level of iliac crest. It contains of a trough in which the proximal forearm rests. A pivot and linkage system under the trough is adjusted and preset so that the patient learn to produce movement at elbow & shoulder,with the movements of trunk* shoulder girdle

Balanced forearm orthosis

ELBOW ORTHOSIS 1. Functional dynamic elbow flexion orthosis: 2. Functional dynamic elbow extension orthosis

WRIST ORTHOSIS Dynamic wrist orthosis with dorsiflexion assist: it is a modified long opponens splint designed to assist wrist extension and allowing normal flexion of wrist.

DYNAMIC HAND ORTHOSIS To substitute for absent or weak extension. Wrist extension finger flexion reciprocal orthosis.(Flexor hinge splint)

HAND AND FINGER ORTHOSIS 1. Metacarpophalangeal flexion orthosis to prevent the metacarpophalangeal extension.

HAND AND FINGER ORTHOSIS 2. Metacarpophalangeal extension orthosis for finger drop

HAND AND FINGER ORTHOSIS 3. PIP extension stop

HAND AND FINGER ORTHOSIS 4. PIP flexion stop

HAND AND FINGER ORTHOSIS 5. Thumb IP extension assist: indicated in finger and thumb drop in radial nerve or posterior interosseus nerve injury.

HAND AND FINGER ORTHOSIS 6. First dorsal interosseus assist : Keeps the index abducted and in opposition