UE Orthoses

Purpose of Static Splinting

• immobilize or support

• help prevent deformity

• prevent soft-tissue contracture

• allow attachment of assistive devices

• block a segment

Basic Components

• C-Bar

• Connector bar

• Crossbar

• Cuff or strap

• Deviation bar and pan

• Forearm through

• Anatomic bars

• Thumb post

• Thumb through

• Bock

C-Bar

Connector Bar

Cross bar

Cuff or Strap

Deviation Bar

Pan and Thumb through

Forearm Through

Hypothenar Bar

Metacarpal bar

Lumbrical Bar

Opponens Bar

Thumb post

Blocks

Diagnostic Indications

fractures tendon injuries crush injuries amputation arthritis carpal tunnel release arthroplasty

tendon transfer tumor excision reconstruction of congenital defects overuse syndromes cumulative trauma disorders

Treatment Goals

• Prevent or Decrease edema

• Assist in tissue healing

• Relive pain

• Allow relaxation

• Prevent, misuse, disuse, and overuse of muscles

• Avoid joint jamming or injury

• Redevelop motor & sensory function

Finger Orthosis

Type

• Static or Dynamic

Region

• Volar or dorsal

• joint crossed

Function

• Static Volar DIP Extension Splint

Universal Cuff

Wrist Cock-up splint maintains the wrist in _________ position

wrist in the neutral or mildly extended position

Wrist Cock-Up Splint immobilizes the wrist while allowing ____________

full MCP flexion and thumb mobility

Wrist Cock-Up Splint - Contraindications

• Active MCP synovitis

• Joint inflammation resulting to volar subluxation and ulnar deviation

Wrist Cock-Up Splint - Disadvantages

• Interferes with tactile sensibility on the palmar surface of the hand

• Dorsal strap can impede lymphatic flow

Dorsal Wrist Cock-Up Splint - Better tolerated by ___________

edematous hand

Advantages of Dorsal Wrist Cock-Up splint

• stronger mechanical support of wrist and freeing up some of the palmar surface for sensory input

• Distributes pressure over the larger dorsal wrist surface area

Conditions that benefit from Dorsal Wrist Cock-Up Splint

• Carpal tunnel syndrome

• Radial nerve palsy

• Wrist extensor tendinitis

• Colle’s fracture (closed reduction)

• Periods of swelling and joint inflammation

• Reflex sympathetic dystrophy

• Wrist joint synovitis or tenosynovitis

Functions of Resting Hand Splint

• Immobilize to reduce symptom

• Position in functional alignment

• Retard further deformity

Resting Hand splint - Special Considerations

For burns: make adjustments as bandage bulk changes

Preventing infection: when open wound has exudates, clean splints with warm soapy water, hydrogen peroxide, or rubbing alcohol

Patients in the ICU: use sterile materials; follow protocol of the facility

RA patients benefit from thin thermoplast (less than 1/8 inch)

Conditions that benefit from Resting Hand Splint

• RA

• Trauma / Crush injuries of the hand

• Burns

Thumb SPICA splint help stabilize __________

CMC, MCP, IP joints

Conditions that benefit from Thumb SPICA Splint

• De Quervain’s Tenosynovitis

• RA

• Gatekeeper’s thumb

Other Static Splints

PURPOSE OF SPLINTING: DYNAMIC

• To substitute for loss of motor function

• To correct an existing deformity

• Provide controlled directional movement

• Aid in fracture alignment and wound healing

Physiologic Consideration - List

• Too great stretch

• Too little stretch

• Enough Stretch

Physiologic Consideration - Too great stretch

• Fatigued

• Injury

• Failure

Physiologic Consideration - Too little stretch

• Atrophy and weaken

• Skin, tendons, ligaments, and joint capsules will shorten in the absence of habitual tensile forces

Physiologic Consideration - Enough stretch

Three degrees of gain in ROM per week, with a range of 1-10 deg, is acceptable (Cummings et al 1992)

High intensity short term stretching actually promotes _________

stiffness

Physiologic Considerations - The client should sense _____ in the tissues but feel no ___

sense tension but feel no pain

GUIDELINES FOR DYNAMIC SPLINTING

• The stretch should not be perceived as a “stretching” force until at least 1 hour has passed

• Client should remain comfortable with the orthosis for up to 12 hours

• After removal, the client should feel no more than a stiffness or mild ache

Outrigger

Dynamic Assist

Finger cuff

Reinforcement bar

Fingernail attachments

Phalangeal Bar / Finger Pan

Dynamic Finger Extension Splint - Objectives

• Immobilize the wrist in functional position

• Passively extend the MCP to 0*

• Permit full active MCP flexion and unrestricted IP motion

Dynamic Finger Extension Splint - Indications

paralysis of wrist, MCP, finger extensors

Dynamic Finger Extension Splint - Advantages

• Relatively has a less obtrusive shape as compared to the outrigger design

• The hand can be slipped through a loose sleeve with the orthosis on

Dynamic Finger Extension Splint Parts

Dynamic Wrist Extension Splint - Objectives

• passively extends the wrist while allowing wrist flexion

• to prevent contracture of unopposed, innervated wrist flexors

Dynamic Wrist Extension Splint - Indications

weak or paralyzed wrist extensors

Dynamic Wrist Extension Splint - Parts

Tenodesis Training Splint - Objectives

• train tenodesis grasp

• promote a strong tripod pinch with wrist extension

• allows finger opening with wrist flexion

Tenodesis Training Splint - Indication

C6 quadriplegia with grade 3 strength of wrist extensors

Tenodesis Training Splint - Parts

Dynamic Ulnar Nerve Splint is AKA

• Dynamic anti-claw deformity splint

• Wynn Perry Splint

Dynamic Ulnar Nerve Splint - Objectives

• passively flex the 4th and 5th MCPs

• To prevent shortening of the MCP collateral ligaments

• Promote active IP flexion

Dynamic Ulnar Nerve Splint - Indication

ulnar nerve lesion

Dynamic Ulnar Nerve Splint - Parts

Capener Splint

dynamic spring wire splint for PIP extension

Capener Splint - Objectives

• passively extend the PIP

• allow active IP flexion

• Provide stability to PIP

• Promote restabilization of lateral bands and prevent rupture of the central slip

Capener Splint - Advantage

“no profile” minimizing its visual presence

Capener Splint - Indications

• PIP flexion contracture

• PIP dorsal dislocation

• Volar plate injury

• Flexor tendon repair with resulting PIP flexion contracture

• Partial or complete tear of the collateral ligament

• Boutonniere deformity

Capener Splint - Parts

General Precautions

• be aware of and make adjustments for pressure areas

• check for presence of edema

• Timing

• Compliance

• Skin reactions

Initial Fitting

• Worn for about 5 – 30 minutes and inspect for persistent red marks

• Red marks should disappear within 20 minutes.

Materials used of UE Orthoses

• plastic

• Metal

• Leather

• Rubber

• Carbon Graphite