upper ext orthotics

Stabilization of the Wrist and Hand

  • Focus on stabilizing the wrist and hand, including the MCP joints.

  • Utilize small devices such as little finger loops to enable basic prehension (the ability to grasp).

  • Primary focus is on fine motor control rather than heavy lifting.

  • Initial device created in a short time (20 minutes) using heat moldable, low-temperature thermoplastic.

  • Patient leaves first session with enhanced hand function.

Carpal Tunnel Syndrome

  • Common condition affecting the median nerve in the wrist.

  • Symptoms include weakness and tingling in the first three digits (thumb, index, and middle fingers).

  • Patients often self-diagnose and resort to splinting.

Splinting Protocols

  • Typical recommendation: use a splint to keep the wrist in a neutral position to alleviate pressure in the carpal tunnel.

  • The cock-up splint is a misnomer; wrist shouldn’t be overextended as this increases pressure.

  • Proper angle: wrist positioned between 0° to 30° extension, allowing full motion of the digits.

  • Usage: during repetitive activities or while sleeping to maintain neutral wrist position.

Stroke and Hemiplegia Treatment

  • Discussion about stroke patients potentially suffering from hemiplegia, often presenting with wrist and hand positioning challenges.

  • Importance of splinting in inpatient rehabilitation units, which is often overlooked by physicians.

  • Patients typically develop a flexor position due to lack of voluntary motor control and might need splinting to maintain skin integrity and prevent edema.

Design Options for Splinting

  • Two notable designs:

    1. Pancake Design:

    • Wrist slightly extended, thumb opposite fingers, MCP joints at 90°, PIP and DIP joints fully extended.

    1. Cone Design:

    • Fingers wrap around a cone, slight flexion at MCP, with PIP and DIP joints extended, maintaining thumb positioning.

Managing Contractures with Orthotics

  • Addressing contractures, especially of long flexor tendons.

  • Use of dynamic wrist-hand orthoses with PIP extension.

  • Important to identify tendon attachment points and what joints are being stretched or stabilized.

  • Progressive devices may require ongoing modifications based on contracture improvements.

Dynamic Wrist-Hand Orthoses for Repairs

  • Importance of maintaining motion while healing flexor and extensor tendons after surgery.

  • Hybrid orthoses that provide static stabilization of the wrist and dynamic control of MCPs and fingers.

  • Allow limited motion to prevent tendon adhesions within the tendon sheath post-surgery.

Radial Nerve Injury Treatment

  • Radial nerve injuries can result in wrist drop and inability to extend fingers.

  • A dynamic wrist-hand orthosis can provide extension assist to regain function, employing outriggers and rubber bands.

Advanced Therapeutic Devices

  • Bioness Device:

    • Designed to assist with electrical stimulation for grasping.

    • Can be expensive and often not covered by insurance.

    • Operated through proximal triggers or button mechanism for hand flexion and extension.

Treating Elbow Contractures

  • Elbow contractures can develop post-surgery or injury due to immobilization in casts.

  • A dynamic elbow orthosis can provide adjustable tension to aid in stretching these contractures over time.

  • Commonly used DynaSplint allows graduated pressure to assist recovery regimes.

Shoulder Joint Stabilization Methods

  • Discussion of shoulder stabilization post-surgery or trauma, involving rigid splints versus softer cushioned devices.

  • Shoulder joints often require support to prevent dislocation or subluxation, especially post-stroke when muscle tone may be impaired.

Preventing Subluxation in the Glenohumeral Joint

  • Subluxation can occur due to improper handling or low muscle tone in hemiplegic patients.

  • Premade cuffs or elastic supports can help stabilize the humerus and prevent dislocation.

Addressing More Complex Upper Extremity Issues

  • In case of significant injuries, adjustable devices are available that cater to individual needs.

  • These devices can be custom fitted, allowing for a range of motion while providing support.

Hand Rehabilitation in Spinal Cord Injury Patients

  • Tenodesis orthosis exploiting wrist extension for functional grasping in C6 spinal cord injury patients.

  • RIC design facilitates this movement through a heat moldable system that connects the wrist and fingers.

Use of Universal Cuff

  • Universal cuffs enable patients to utilize assistive devices like utensils, enhancing independence in self-care tasks.

Conclusion

  • A myriad of devices exist to support upper limb rehabilitation, dependent on specific injuries and needs, contributing to function and independence overall.