Upper extremity orthoses

By Dr. Om Prasad Biswal (P&O)

1. Upper Extremity Orthoses
Dr. Om Prasad Biswal (P&O)
Clinical Prosthetist & Orthotist
B.P.O (N.I.L.D)

2. Introduction
Objectives of upper limb orthosis:
1) Protection : -
•Stabilization
•Dynamic control
2) Correction
3) Assistance

3. •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

4. Nomenclature
On basis of –
•Joint they cover
•the function they provide
•condition they treat
•by appearance
•name of the person who designed them

5. On basis of anatomical regions:
•Finger Orthoses
•Hand Orthoses
•Wrist Hand Orthoses
•Forearm Orthoses
•Elbow Orthoses
•Elbow Wrist Hand Orthoses
•Humeral Orthoses
•Shoulder Elbow Wrist Hand Orthoses
•Shoulder Orthoses

6. AmericanSocietyofHandTherapistspublishedASHTsplintclassification
system(SCS)whichgivesfunctionandbodypartwise-
Thereareatotaloftenjointlevelsintheupperextremity.Theseinclude
theshoulder,elbow,forearm,wrist,fingerMP,fingerPIP,fingerDIP,
thumbCMC,thumbMP,andthumbIPlevels.Thetypeelementrequires
countingthesecondaryjointlevels.Itiscriticaltounderstandthatonly
thejointlevelsarecounted,nottheindividualjoints.

8. 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

9. Non-articular splint
E.g. Thumb Spica splint

10. Static
CTS-stop splint for carpal tunnel syndrome, with the wrist position 0-5
degree of extension, distal palmar crease free to allow MCP motion

11. Serial static splint
•Itisalsostaticbutisperiodicallychangedtoalterthejointangleat
whichthesplintispositioned.Thesplintsareappliedwiththetissueat
itsmaximumlength.

12. Static motion –blocking
•Permitsmotioninonedirection
butblocksmotioninanother.
•Forexample,aTripointsplint.

13. Static progressive splint
•Mostcommonlyusedforregainingjointmotion.
Unliketheserialstaticsplint,theorthosisisnot
remoldedtoincreasejointmotion.
•Thesesplintsdifferfromserialsplintsinthatthey
usenonelasticcomponentssuchasstaticlines,
hinges,screws,andturnbucklestoplaceaforce
onajointtoinduceprogressivechange.
•E.g. WHO with MCP extension assist.

14. Dynamic splint
•Providesanelasticforcetohelpregain
jointmotion.
•Anexampleofsuchanorthosisisafinger
extensionsplint,whichusesaspringcoilor
wiretensionassisttoincreaseextensionin
aPIPjointwithamildcontracture.

15. Dynamic motion-blocking splint
•Allowscertainmotionsbutblocksothers.
•Itusesapassive,elasticlineofpullinthe
desireddirection,butpermitsactivemotionin
theoppositedirection.
•AnexampleisaKleinertpostoperativesplint
forflexortendonrepairs

16. Dynamic traction splint
•Offerstractiontoajointwhileallowingcontrolledmotion.
•Anexampleisasplintforanintraarticularfracture.Thisahand-based
PIPextensionsplintwithanoutrigger.

17. Tenodesis splint
•Facilitatesfunctioninahandthathaslost
motionbecauseofnervoussysteminjury.
•AnexampleistheRIC(Rehabilitation
InstituteofChicago)tenodesissplint,which
assiststhepatientwithaC6levelofspinal
cordinjurytoachieveafunctionalpinch.
Activeextensionofthewristproduces
controlledpassiveflexionofthefingers
againstastaticthumbpostthrougha
tenodesisaction.

18. Continuous Passive Motion Orthoses
•Continuouspassivemotionorthoses
areelectricallypowereddevicesthat
mechanicallymovejointsthrougha
desiredrangeofmotion.
•Thiskeepsthejointssuppleand
maintainsarticular,ligamentous,and
tendinousstructuremobilityduring
thehealingphasesafterinjuryor
surgery.

19. Adaptive or functional usage splints
•Promotefunctionaluseoftheupperlimbwithimpairmentresulting
fromweakness,paralysis,orlossofabodypart.
•Anexampleistheuniversalcuff,whichencompassesthehandandholds
varioussmallitemssuchasafork,apen,oratoothbrush.
•EnhancesADLactivitiesanddegreeofselfindependence.

20. Clavicular Orthoses
•Regional name: shoulder orthosis
•Common names: figure of four harness, clavicular brace/ harness
•Indications:
Clavicular fractures
Pectoral contractures
Cumulative trauma disorder
Slouched shoulder posture
•Functions:
Restricts motions to promote healing
Increase/maintain PROM
Reduced scapular myofascial pain
Improve posture

22. Arm sling
•Regional name: Shoulder orthosis
•Common names:
figure of eight slings
universal sling
Northern ring sling
Cuff sling
Hemi sling
Orthopaedic sling
Flail arm sling
Homemade Bandanna-Type sling
Glenohumeral support
Hook hemi harness
Rolyan hemi Arm sling(vertical arm sling)

23. •Indications:
ACjointinjury
Scapular,humeralfractures
POshoulderrepair/arthroplasty
POtendon,artery,ornerverepairs-Rotatorcuffinjury-Bicipital
tendinitis
Brachialplexuslesion
Uppermotorneuronlesion:hemiparesiswithsubluxation
•Functions:
Immobilizetopromotetissuehealing
PreventoverstretchingofGHmusculature/ligaments
Decreasedshoulderpainrelatedtoarmdistractionandshoulderhand
syndrome
Keephandandforearmelevatedtoreduceedema

24. Wilmer Carrying Orthosis
•Indication-Shouldersubluxation,BPI
•Effectiveneutralizationofshoulder
subluxation.
•Regainsomeofthearmfunctions.
•Reducedchanceofedemaformation
inhand,fingersandforearm.
•Reducedpainanddiscomfortinarm
andshoulder.
•Noneckloading.
•Canbewornfullyunderneathclothing
•Lightweightconstruction.

25. Arm abduction orthosis:
•Regionalname:Shoulderelbowwristhandorthosis
•Commonname:Airplanesplint
•Axillaryburns-Postoperativeshoulderfusion-Postoperativescar
release-Shoulderdislocation
•Burns–contractures
•Immobilizetopromotetissuehealing
•IncreasePROMbysofttissueelongationvialowloadprolonged
stretch(serialstaticsplinting)

27. Gunslinger Orthosis

28. Non-articular fracture orthosis-humeral
fracture brace

29. Elbow-forearm wrist orthosis:
•Regionalname:Elbowwristhandorthosis
•Commonname:Sugar-tongsplint
•Indications–
CTD
Forearmfractures
Postoperativeelbowarthroplasty
Postoperativeulnarnervetransposition
•Functions-Immobilizeelbow/forearm/wristtopromotetissue
healing.

30. Elbow Fracture Braces

31. Radial Fracture Brace

32. Bivalve Ulnar Fracture Brace

33. Elbow SplintGolfer Elbow Splint

34. 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

35. •Indi
cations-
Contracture
Post operative scar release
Burns
Fracture (late phase) Radial nerve lesion
Spinal cord injury
Brachial plexus lesion
Polio
•Functions-
Increased PROM by soft tissue elongation via low-load prolonged
stretch
Replace or assist weak wrist extensors to enhance ADL

36. Biomechanical efficacy:
Twodistinctmethodscanbeusedtostretchsofttissue,
therebyencouragingtissueelongationandincreasedPROM.
1)Serialsplinting:Withlowtemperaturethermoplastics
(progressivestaticsplinting)orserialcasting.
•Advantages:goodconformity,littleshifting
•Disadvantage:potentialskinbreakdown
2)Traction:(viaelastics,coils,orsprings)isappliedacross
thejoint(oftenahingedjoint)
•Advantage:amountofloadcanbeadjusted
•Disadvantage:forcescancauseshiftingoforthosissuchsplints
aremoredifficulttofabricateunlessprefabricationsareused.

37. Dynamic Supination and Pronation Splint
INDICATIONS:
-Peripheral or central nerve lesions.
-Distal radio-ulnar joint stiffness.

38. Wrist-Hand orthosis
•Regional name: Wrist-hand orthosis
•Common name:
Long opponens splint
Thumb whole wrist cock up splint
Wrist extension splint
Static wrist splint
Thumb spicaBunnell dorsal wrist splint
Bunnell spring cock up splint
Neoprene or leather prefabricated wrist extension splint

39. Half Cockup Long Cockup Splint Dynamic Cockup

40. Thumb Spica CTS Splint Kleinert Splint

41. Functions Indications
Immobilize to promote tissue healing CTS
Flexor/extensor tendinitis
Arthritis
Forearm/wrist fractures
Post operative extensor tendon repair
DQ Tenosynovitis
Thenar Tendinitis
Substitute for weak wrist extension SCI, BPI, Klumpke Palsy, Saturday Night Palsy
Prevent overstretching of wrist extensors
Stabilize the wrist for maximal grasp and pinch
prehension/strength
Radial nerve lesion
UMN lesion: CVA, TBI, CP
Immobilize wrist / forearm to maintain PROM
Restrict motion to prevent harmful wrist
postures during activities
Burns -wrist contractures
Elongate soft tissue via low-load prolonged
stretch (serial static splinting)
Burns
Post operative scar release

42. Pan Cake Splint/Resting Hand Splint

43. Ulnar Gutter Splint

44. Knuckle Bender Splint-For Klumpke Palsy

45. Finger orthosis
•Regional name: Finger orthosis
•Common name:
•Silver ring splint
•Swan neck splint
•Gutter splint
•Figure eight splint
•PIP hyperextension block splint
•Murphy ring splint
•Boutonniere splint
•Mallet finger splint
•Pulley ring
•PIP extension stop

46. Mallet Finger Splint

47. Dr. Om Prasad Biswal(P&O)
Clinical Prosthetist & Orthotist
B.P.O (N.I.L.D, Kolkata)
Email Id: [email protected]
Phone No: 7978450567 (Call)
7044519795(What’s App)