UPPER LIMB ORTHOSIS

Contents:

 Introduction
 Objectives of upper limb orthosis
 Nomenclature
 Classification
 Biomechanics of orthosis
 General principles
 Special principles
 Objectives of upper limb orthosis:
1) Protection :
- stabilization
- Dynamic control
2) Correction
3) Assistance
 To immobilize a body part to promote tissue
healing
 Prevent contractures
 Increase ROM
 Correct deformities
 Strengthen muscles
 Reduce tone
 Reduce pain
 Restrict motion to prevent harmful postures
Nomenclature
:
 On basis of
- joint they cover
- the function they provide
- condition they treat
- by appearance
Classification
:
 On basis of anatomical regions:
- Shoulder and arm orthosis
- Elbow orthosis
- Wrist orthosis
- Hand orthosis
 Based on function:
- Supportive
- Functional
- Corrective
- Protective
- Prevent substitution of function
- Prevent weight bearing
- Relief of pain
 Based on design:
- non-articular
- Static
- Serial static
- Static motion-blocking
- Static progressive
- Dynamic
- Dynamic motion-blocking
- Dynamic traction splints
- Tenodesis
- Continuous passive motion orthoses
- Adaptive or functional usage
 Non-articular splint – gel shell splint
 Static – wrist splint for carpal tunnel syndrome,
with the wrist position 0-5 degree of
extension, distal palmar crease free to allow
MCP motion
 Static motion – blocking – swan neck splint
 Static progressive – forearm based splint with
both static line pull and MERIT component
for increasing MCP flexion
 Dynamic – capener splint for increasing joint
extension in the proximal IP joint of the finger
 Dynamic motion-blocking – Kleinert post
operative splint for flexor tendon repairs
 Tenodesis – Rehabilitation Institute of Chicago
tenodesis splint to achieve functional pinch
General
principles:
1) Uses of force
2) Limitation of movements- pain
3) Correcting the mobile deformities
4) Fixed deformity
5) Adjustability
6) Pressure reduction
7) Heat
8) Weight
9) Maintenance and cleaning
10) Application
11) Sensation
12) Gravity
13) Comfort
14) Cosmesis
Description of
orthoses:
1) Calvicular orthoses:
 Regional name: shoulder orthosis
 Common names: figure of four harness,
clavicular brace/ harness
 Functions Indications

- Restrict motion to Clavicular fractures

promote tissue healing
- Improve posture - Forward shoulder posture
- TOS
- Reduced scapular - Cumulative trauma
myofascial pain disorder
- Increase/maintain PROM - Pectoral contractures
2) Arm sling
 Regional name: shoulder orthosis
 Common names:
 figure of eight slings
 universal sling
 Nothern ring sling
 Cuff sling
 Hemi sling
 Orthopaedic sling
 Flail arm sling
 Glenohumeral support
 Functions indications
- Immobilize to promote tissue - AC joint injury
healing - Scapular, humeral fractures
- PO shoulder repair/arthroplasty
- PO tendon,artery, or nerve repairs
- Rotator cuff injury
- Bicipital tendinitis

- Prevent overstretching of GH - Brachial plexus lesion

musculature/ligaments
- Decreased shoulder pain related - Upper motor neuron lesion:
to arm distraction and shoulder- hemiparesis with subluxation
hand syndrome

- Keep hand and forearm elevated

to reduce oedema
3) Arm abduction orthosis:
- Regional name: shoulder elbow wrist hand
orthosis
- Common name: airplane splint
 Functions Indications
- Immobilize to promote - Axilary burns
tissue healing - Post operative shoulder
fusion
- Post operative scar release
- Shoulder dislocation

- Increase PROM by soft - Burns

tissue elongation via low - contractures
load prolonged stretch(
serial static splinting)
Functional arm orthosis Arm suspension sling – deltoid aid

Balanced forearm orthosis- gun slinger Arm supports- wheelchair arm trough
Nonarticular fracture
orthosis- humeral
fracture brace
4) Elbow- forearm wrist othosis:
 Regional name : elbow wrist hand orthosis
 Common name: sugar-tong splint
 Functions Indications

- Immobilize elbow/forearm/wrist - CTD

to promote tissue healing - Forearm fractures
- Post operative elbow arthroplasty
- Post operative ulnar nerve
transposition
5) Elbow or wrist mobilization orthoses:
 Regional name: elbow orthoses or wrist
orthoses
 Common name:
- Dynamic elbow
- Wrist flexion/extension splint
- Dynasplint
- Ultraflex splint
- Static progressive splint
- Phoenix wrist hinge
- Turn buckle splint
 Functions Indications
- Increased PROM by soft tissue - Contracture
elongation via low-load prolonged - Post operative scar release
stretch - Burns
- Fracture (late phase)
- Replace or assist weak wrist - Radial nerve lesion
extensors to enhance ADL - Spinal cord injury
- Brachial plexus lesion
- polio
Posterior elbow splint Epicondylar straps

Articulated elbow orthosis

Dynamic supination/pronation splint
6) Forearm-wrist orthosis:
 Regional name: wrist-hand orthosis
 common name:
- Thumb whole wrist cock up splint
- Wrist extension splint
- Static wrist splint
- Bunnell dorsal wrist splint
- Bunnell spring cock up splint
- Serpentine splint
- Neoprene or leather prefabricated wrist extension
splint
- Gutter splint
 Half cock up splint

Dynamic cock up splint

Spring cock up splint

Functions Indications
Immobilize to promote tissue healing CTD
CTS
Flexor/extensor tendinitis
Lateral/medial epicondylitis
Wrist sprain/contusion
Arthritis
Forearm/wrist fractures
Post operative extensor tendon
repair
Post operative wrist fusion
Post operative skin grafting

Substitute for weak wrist extension SCI

BPL
Prevent overstretching of wrist ALS
extensors Radial nerve lesion
Stabilize the wrist for maximal Polio
grasp GBS
and pinch prehension/strength Arthrogryposis
UMN lesion: CVA, TBI, CP,MS
Immobilize wrist / forearm to -Burns
maintain PROM -Post operative scar release
Restrict motion to prevent harmful -CTD
wrist postures during activities - arthritis

Elongate soft tissue via low-load -Burns

prolonged stretch( serial static - wrist contractures
splinting)
7) Forearm-wrist- thumb orthosis:
 Regional name: wrist-hand-forearm orthosis
 Common names:
- Long opponens splint
- Thumb spica
Functions Indications
Immobilize thumb/wrist to promote -CMC/MP synovitis/ arthritis
tissue healing -CTD
- de Queryain’s disease
-Tenosynovitis
-Thenar tendinitis
-Thumb sprain
-CMC/MP collatral ligament injury(
gamekeeper’s thumb)
-Scaphoid/ thumb fracture
-Post operative thumb
- ORIF
- Surgical CMC/MP fusion
- arthroplasty or
reconstruction
- tendon transfer
- tendon/ligament repair
- nerve repair
- postoperative
trapeziumectomy

Substitute for weak thumb muscles, Median/ ulnar nerve lesion

stabilize thumb in opposition for UMN lesion: CVA, TBI, CP
three jaw chuck pinch
 Maintain thumb prom burns

Restrict motion to prevent harmful CTD

thumb positions during activities Arthritis
Athletes or performing artists

Elongate soft tissues via low-load, -Burns

prolonged stretch (serial static splinting) -Thumb contractures

• Placement :
- The orthotic material usually cover 2/3rd of the distal radial
forearm and surrounds the thumb to the IP ( but can extend to tip)
Bunnell knuckle bender Spider splint

Radial gutter splints

Dynamic finger flexion splint

RIC tenodesis othosis

Resting pan splint

 Bobath splint Kleinert flexor tendon repair splint

Short opponens splint Ulnar deviation correction splint

 Finger orthosis
Partial hand opposition splint

Reverse knuckle bender C-Bar splint web splint

8) Ring orthosis :
 Regional name: finger orthosis
 Common name:
- Silver ring splint
- Swan neck splint
- Figure eight splint
- PIP hyperextension block splint
- Murphy ring splint
- Boutonnaire splint
- Pulley ring
- PIP extension stop
Swan neck splint

Boutonniere splint
Functions Indications
Block PIP/DIP hyperextension but Arthritis
allow normal IP flexion Swan neck deformity
/extension PIP/DIP volar palte injury
Prevent overstretching of PIP/DIP
volar plate
Prevent further deformity
Immobilize PIP in extension (DIP arthritis
free)
Prevent deformity Boutonniere deformity
Prevent bowstring of flexor tendons A2 pulley injury(annular pulley for
flexor tendon located on volar
surface of proximal phalanx)
Protect reconstruction/ allow Post operative pulley repair
dynamic motion, without
immobilizing finger
Thank you