Orthosis Evaluation and Treatment

Standardized outcome measures

DASH/QuickDASH

COPM

Patient Related Wrist Evaluation (PRWE)

Moberg Pick-up Test

Jebsen-Taylor Hand Function Test

Provocative Tests

techniques that reproduce specific symptoms

Top-down approach

occupational performance analysis

client-centered frame of reference

Bottom up

evaluate pathology

attempt to connect impairments in body functions/structures to performance difficulties

How are the arches of the hand related to function?

balance stability and mobility, allowing the palm to cup, grip objects of various shapes, and execute fine motor skills

Features of the snuff box

extensor pollicis longus

abductor pollicis longus

extensor pollicis brevis

You dont want to over immobilize the snuff box because...

you want to preserve movement and function where you can

When possible it can be really helpful to compare...

both sides

Wrist joint

ulna, radius and 8 carpal bones

pronation/supination

ligament support

Finger and thumb joints (palmar surface)

thick

immobile

hairless

sensory

Finger and thumb joints (dorsal surface)

thin

mobile

edema accumulates

Shoulder complex

high mobility at cost of stability

scapulohumeral rhythm

Elbow joint

2 degrees of freedom

ligament support

*considerations during splinting

Following surgery, the targets of orthosis intervention are to...

protect nerve computation

reduce edema

control pain

Factors that determine the duration of immobilization for nerve conditions

operative procedure

location of nerve

amount of nerve movement

concomitant procedures

patient/surgeon related factors

A nerve repair is typically immobilized for up to _ _______ compared to nerve transfers/grafts

3 weeks

Nerve regeneration is approximately _____ per day

1 mm

Sometimes its takes up to ________ for initiation of regeneration

one month

Ulnar nerve dermatome

Median nerve dermatome

Radial nerve dermatome

Potential causes of radial nerve injury

saturday night palsy

honeymoon palsy

crutch palsy

humeral fracture

entrapment at elbow

elbow fracture

entrapment at wrist

Symptoms of radial nerve injury (axilla)

weakness

tingling and numbness from back of arm to hand

Symptoms of radial nerve injury (spiral groove)

weakening of brachioradialis

interferes with ability to bend wrist back and straighten fingers

Symptoms of radial nerve injury (posterior interosseous nerve)

muscle weakness

inability to extend ones fingers

Purpose/goals of orthotic intervention for radial nerve conditions

position for healing, comfort and function

facilitate extension

Fabrication considerations for orthotic intervention for radial nerve conditions

lack of motor control

posting to assist fabrication

provide "just right" tension

Wearing schedules/functional considerations for orthotic intervention for radial nerve conditions

static for comfort and positioning

dynamic for functioning

Precautions for orthotic intervention for radial nerve conditions

dorsal pressure areas

decreased sensation

client centered wear schedules

Potential causes of ulnar nerve injury

fracture at medial epicondyle

fracture of olecranon process

compression at epicondylar groove

compression at wrist

Froment's sign

thumb IP flexion during lateral pinch attempt.

Froment's sign indicates weakness in...

adductor pollicis

deep head of flexor pollicis

first dorsal interosseous

Purpose/goals of orthotic intervention for ulnar nerve conditions

prevent nerve compression/pressure

assist with function

Fabrication considerations for orthotic intervention for ulnar nerve conditions

cubital tunnel (anterior elbow orthosis as 45 degrees)

claw hand (90 degrees MCP flexion)

Wearing schedules for orthotic intervention for ulnar nerve conditions

cubital tunnel = night

claw hand = function

Precautions for orthotic intervention for ulnar nerve conditions

pressure areas

decreased sensation

client centered wearing schedule

Potential causes of median nerve injury

humeral fracture

elbow dislocation

distal radius fracture

carpal tunnel syndrome

Phalen's test

provocative test for carpal tunnel

You hold Phalen's test for

one minute

Phalen test is positive and indicates carpal tunnel if there is...

tingling in thumb, index, middle and lateral hand of ring finger

Purpose/goal of orthotic intervention for median nerve conditions

prevent nerve compression/pressure

assist with function

Fabrication considerations for orthotic intervention for median nerve conditions

CTS = neutral

pronator syndrome = prevent pronation/supination

Wearing schedule for orthotic intervention for median nerve conditions

night or during tasks that aggravate

Precautions for orthotic intervention for median nerve conditions

pressure areas

decreased sensation

client centered wearing schedule