The document discusses upper limb orthosis, detailing its objectives, classification, nomenclature, biomechanical principles, and descriptions of various types. It highlights the purpose of upper limb orthoses in protection, correction, and assistance, as well as their design and material considerations. Recent advances in orthotic studies indicate improvements in treatment outcomes for conditions like adhesive capsulitis and lateral epicondylitis.

1. UPPER LIMB ORTHOSIS
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2. Contents:
 Introduction
 Objectives of upper limb orthosis
 Nomenclature
 Classification
 Biomechanics of orthosis
 General principles
 Special principles
 Assessment of upper limb
orthosis
 Description of upper limb
orthosis
 Recent advances

3. Introduction
 Mechanical device- anatomical
and functional position
 Orthos – to correct or maintain
straight
 Any externally device used to modify
structural and functional characteristics
of the neuromuscular skeletal system
 Physiotherapist + orthotist

4.  Categorized :
- Upper limb
orthosis
- Trunk orthosis
- Lower limb
orthosis

5.  Objectives of upper limb
orthosis:
1) Protection :
- stabilization
- Dynamic control
2)Correction
3)Assistance

6.  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

7. Nomenclature :
 On basis of
- joint they cover
- the function they provide
- condition they treat
- by appearance
- name of the person who designed
them

8.  Mainly three systems:
1)International Organization for
Standards(ISO) which gives anatomic region
wise names
2)1992, American Society of Hand Therapists
published ASHT splint classification system
(SCS) which gives function and body part
wise.
In that, numbering system – ‘type’
3)McKee and Morgan

9. Common name ASHT splint
classificatio
n system
IOS McKee
and
Morgan
Humeral fracture
brace
Non articular
splints- humerus
Not applicable Circumferential
non-articular
humerus
stabilizing
Tennis elbow
splints or
brace
45 degree
elbow flexion
immobilization
type 1[1]
Shoulder- elbow
– wrist – hand
orthosis
Circumferential
non-articular
proximal
forearm strap
Duran splint,
post operative
flexor tendon
splint
Wrist and
finger flexion
immobilization;
type 0[4]
WHO Dorsal forearm
based static MCP-
IP protective
flexion and MCP
extension
blocking orthosis
Thumb spica splint Thumb MCP
extension
immobilizatio
n type 2[3]
WHFO Volar forearm-
based static
wrist thumb
orthosis

10. Classification :
 On basis of anatomical
regions:
- Shoulder and arm orthosis
- Elbow orthosis
- Wrist orthosis
- Hand orthosis

11.  Based on function:
- Supportive
- Functional
- Corrective
- Protective
- Prevent substitution of
function
- Prevent weight bearing
- Relief of pain

12.  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

13.  Non-articular splint – gel shell
splint

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

15.  Static motion – blocking – swan neck
splint

16.  Static progressive – forearm based splint
with both static line pull and MERIT
component for increasing MCP flexion

17.  Dynamic – capener splint for increasing joint
extension in the proximal IP joint of the
finger

18.  Dynamic motion-blocking – Kleinert
post operative splint for flexor tendon
repairs

19.  Dynamic traction splints- schenck splint
for intraarticular fracture

20.  Tenodesis – Rehabilitation Institute of
Chicago tenodesis splint to achieve
functional pinch

21. Description of orthoses:
1) Calvicular orthoses:
 Regional name: shoulder orthosis
 Common names: figure of four
harness, clavicular brace/ harness

22. Functions Indications
- Restrict motion to
promote tissue healing
Clavicular fractures
- Improve posture - Forward shoulder posture
- TOS
- Reduced scapular
myofascial pain
- Cumulative trauma
disorder
- Increase/maintain PROM - Pectoral contractures

23.  Placement :
- Material goes over clavicles, under arms and
crosses over high thoracic spinous
processes.
 Biomechanical efficacy:
- Restrict movement of the clavicle and to
some extent inhibit scapular protraction
while allowing free movement at the GH
joint.
 Materials :
-Webbing straps
- Padding and velcro
- Prefabricated orthoses often used.

24. 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
 Homemade Bandanna- Type sling
 Glenohumeral support
 Hook hemiharness
 Rolyan hemi Arm sling(vertical arm
sling)

26. Functions indications
- Immobilize to promote tissue
healing
- AC joint injury
- Scapular, humeral fractures
- PO shoulder repair/arthroplasty
- PO tendon,artery, or nerve repairs
- Rotator cuff injury
- Bicipital tendinitis
- Prevent overstretching of GH
musculature/ligaments
- Brachial plexus lesion
- Decreased shoulder pain related
to arm distraction and
shoulder- hand syndrome
- Upper motor neuron lesion:
hemiparesis with subluxation
- Keep hand and forearm elevated
to reduce oedema

27.  Placement :
 Most slings support the forearm with the
elbow flexed, shoulder internally rotated and
arm adducted.
-The Rolyan hemi arm sling supports the
humerus and allows the elbow and forearm to
be free by using a humeral cuff with figure of
eight suspension.
-The hook hemiharness has two humeral cuffs
connected by a posterior yoke and abduct
each arm slightly while allowing the elbow
and forearm to be free.

28.  Biomechanical efficacy :
- Slings may be static or dynamic.
- Dynamic slings use elastic straps and are
designed to allow some motion of the
forearm while supporting the arm.
-The wrist should be supported by the sling
to prevent wrist drop if there is distal
weakness.
- Hand should be higher than the elbow
to decrease the oedema.
- Care must be taken to mobilize the shoulder
SOS possible to prevent adhesive capsulitis.

29.  Materials :
-Cloth
-Webbing
- Elastic
- Metal ring/ fastners
-Velcro
- Prefabricated slings are often
used.

30.  Contraindications:
- Slings have fallen over out of favour with a
neurodevelopment treatment approach to UMN
lesion because they are thought to encourage
flexion synergy, increase flexor tone, and
promote contractures.
-The Rolyan hemi arm slings or the hook
hemiharness may not approximate the GH
joint in a large patient.

31. 3) Arm abduction orthosis:
- Regional name: shoulder elbow wrist
hand orthosis
- Common name: airplane splint

32. Functions Indications
- Immobilize to promote
tissue healing
- Axilary burns
- Post operative shoulder
fusion
- Post operative scar release
- Shoulder dislocation
- Increase PROM by soft
tissue elongation via
low load prolonged
stretch( serial static
splinting)
- Burns
- contractures

33.  Placement :
- Medial arm and lateral trunk with weight of arm borne
primarily on the iliac crest or lateral trunk.
- May be one piece or separate waist piece with arm
attachment.
 Biomechanical efficacy:
-The shoulder should be positioned in abduction with the
degree determined by pathology.
- Care should be taken not to overstretch skin, nerves or
vascular structure.
 Material :
-Casting
-Thermoplastic
-Metal
-Pillow
- Padding
-Strapping
-Velcro

34. Functional arm
orthosis
Arm suspension sling – deltoid
aid
Balanced forearm orthosis- gun Arm supports- wheelchair arm

35. Nonarticular
fracture orthosis-
humeral fracture
brace

36. 4) Elbow- forearm wrist othosis:
 Regional name : elbow wrist hand
orthosis
 Common name: sugar-tong splint

37. Functions Indications
- Immobilize elbow/forearm/wrist
to promote tissue healing
- CTD
- Forearm fractures
- Post operative elbow arthroplasty
- Post operative ulnar
nerve transposition
• Placement :
- Circumferential with elbow in 900 of flexion and forearm/wrist in
neutral.
• Biomechanical efficacy:
- Orthosis should totally restrict elbow, wrist and forearm AROM yet
should allow full active use of all digits.
• Materials :
-Thermoplastics
- Strapping

38. 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

40. 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
Placement :
•Dorsal (posterior), volar (anterior) or
circumferential

41.  Biomechanical efficacy:
 Two distinct methods can be used to stretch soft tissue,
thereby encouraging tissue elongation and increased PROM.
1) Serial splinting:
- With low temperature thermoplastics (progressive static splinting)
or serial casting.
 Advantages: good conformity, little shifting
 Disadvantage : potential skin breakdown
2) Traction :
 (via elastics, coils, or springs) is applied across the joint(often a
hinged
joint)
 Advantage : amount of load can be adjusted
 Disadvantage: forces can cause shifting of orthosis such splints
are more difficult to fabricate unless prefabrications are used.
 Non compliant patients can remove the orthosis.

42.  Materials:
-Casting
-Thermoplastics
- Elastics
- Neoprene
- Metal
-Strapping
-Velcro
-Springs
 Contraindications:
- Dynamic traction put on muscles with high tone
may increase tone.

43. Posterior elbow
splint
Epicondylar
straps
Articulated elbow
Dynamic supination/pronation

44. 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

45. Dynamic cock up
splint
Half cock up
splint
Spring cock up
splint

46. 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 extensors
Stabilize the wrist for
maximal grasp
and pinch
prehension/strength
ALS
Radial nerve lesion
Polio
GBS
Arthrogryposis
UMN lesion: CVA, TBI, CP
,MS

47. Immobilize wrist / forearm
to maintain PROM
Restrict motion to prevent
harmful wrist postures during
activities
-Burns
-Post operative scar release
-CTD
- arthritis
Elongate soft tissue via low-
load prolonged stretch( serial
static splinting)
-Burns
- wrist contractures

48.  Placement:
- This orthoses are volar, dorsal,
circumferential, or gutter based, extending
from the proximal MP to 2/3rd of the distal
forearm.
- If volar based, palmar material should end
1/4th inch proximal to the distal palmar crease
to allow unrestricted MP flexion
 Biomechanical efficacy:
- The wrist can be positioned in flexion or
extension but for optimal hand function,
it should be in 15-30 degrees of
dorsiflexion.
- For CTS, wrist should be neutral.

49.  Materials:
- Rigid: metal, thermoplastics, casting,
straping, velcro
- Flexible: neoprene leather, plastics,
fabric, strapping, velcro

50. 7) Forearm-wrist- thumb orthosis:
 Regional name: wrist-hand-forearm
orthosis
 Common names:
- Long opponens splint
- Thumb spica

51. Functions Indications
Immobilize thumb/wrist to
promote tissue healing
-CMC/MP synovitis/ arthritis
-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, stabilize thumb in
opposition for three jaw chuck
Median/ ulnar nerve lesion
UMN lesion: CVA, TBI, CP

52. Maintain thumb prom burns
Restrict motion to prevent harmful
thumb positions during activities
CTD
Arthritis
Athletes or performing artists
Elongate soft tissues via low-load,
prolonged stretch (serial static
splinting)
-Burns
-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)

53.  Biomechanical efficacy:
- In most cases, the thumb should be positioned
in palmar abduction so that three jaw chuck
prehension is easily achieved , unless
pathology dictates otherwise.
- Material should not restrict motion of digits 2-
5.

54.  Materials :
- rigid: thermoplastics, metal, strapping,
velcro, casting, padding
- Flexible: neoprene, elastics, fabric,
leather, strapping, velcro

55. Bunnell knuckle
bender
Spider
splint
Radial gutter
splints

56. Dynamic finger flexion
splint
RIC tenodesis othosis
Resting pan
splint

57. Bobath
splint
Kleinert flexor tendon repair
splint
Short opponens
splint
Ulnar deviation correction
splint

58. Partial hand opposition
splint
Finger
orthosis
Reverse knuckle C-Bar splint web

59. Shock absorbing
gloves

60. 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

61. Swan neck
splint
Boutonniere
splint

62. Functions Indications
Block PIP/DIP hyperextension
but allow normal IP flexion
/extension
Arthritis
Swan neck deformity
PIP/DIP volar palte
injury
Prevent overstretching of
PIP/DIP volar plate
Prevent further deformity
Immobilize PIP in extension
(DIP free)
arthritis
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 dynamic motion,
without immobilizing finger
Post operative pulley repair

63.  Biomechanical efficacy:
-Rings are custom fitted and worn at all
time. swan neck splint:
- Prevent IP hyperextension via three points
of pressure but allows full IP flexion.
- Lateral or distal supports may be added
for stability.
boutonniere splint:
- Immobilize the IP in extension via three points
of pressure. Needs to remove several times in
a day.

64.  A2 pulley ring:
- Fits firmly around the proximal phalanx from
the PIP volar crease to the MP volar crease.
 Materials :
- Metal
- thermoplastics

65. Recent advances:
1) Ibrahim M et al. did study on Efficacy
of a static progressive stretch device
as an adjunct to physical therapy in
treating adhesive capsulitis of the
shoulder: a prospective, randomised
study
 To compare a static progressive stretch
device plus traditional therapy with
traditional therapy alone for the treatment
of adhesive capsulitis of the shoulder

66.  CONCLUSION:
 Use of a static progressive stretch device in
combination with traditional therapy
appears to have beneficial long-term effects
onshoulder range of motion, pain and
functional outcomes in patients with
adhesive capsulitis of the shoulder. At 12-
month follow-up, the experimental group
had continued to improve, while the control
group had relapsed.
 Physiotherapy. 2013 Oct 3. pii:
S0031- 9406(13)00085-0.

67. 2) Merolla G et al.did study on Efficacy,
usability and tolerability of a dynamic
elbow orthosis after collateral ligament
reconstruction: a prospective
randomized study.
 To assess the efficacy, usability and
tolerability of a dynamic orthosis
compared with a standard plaster splint
after the reconstruction of elbow medial
or lateral collateral ligaments (MCL, LCL).

68.  CONCLUSIONS:
 The dynamic orthosis and the plaster splint
both provided effective and safe elbow
immobilization after MCL or LCL
reconstruction. The orthosis provided
greater pain reduction, faster recovery of
muscle trophism and grip strength, and was
better tolerated.
 Musculoskelet Surg. 2013 Oct 25.

69. 3) Garg R et al.did study on A prospective
randomized study comparing a
forearm strap brace versus a wrist
splint for the treatment of lateral
epicondylitis.
 To compare the clinical outcomes of a
wrist splint with that of a counterforce
forearm strap for the management of
acute lateral epicondylitis.

70.  CONCLUSION:
 The wrist extension splint allows a
greater degree of pain relief than does
the forearm strap brace for patients with
lateral epicondylitis.
 JShoulder Elbow Surg. 2010
Jun;19(4):508- 12.

71. 4) Woo Y et al.did study on Kinematics
variations after spring-assisted orthosis
training in persons with stroke.
 To evaluate the efficacy of training
using kinematic parameters after a
SaeboFlex orthosis training on chronic
stroke patients.
 CONCLUSION:
 The results of this study indicate that a
SaeboFlex training is effective in recovering
the movement of the hemiparetic upper
extremity of patients after stroke.
 Prosthet Orthot Int. 2013 Aug;37(4):311-6.

72. 5) Forogh B et al.did study on The effects
of a new designed forearm orthosis in
treatment of lateral epicondylitis.
 on the design and testing of a new
designed forearm orthosis and explores its
efficacious in comparison to the standard
counterforce orthosis in patients with
lateral epicondylitis.

73.  CONCLUSIONS:
 The new-designed orthosis can significantly
relieve pain, improve function, increase pain
threshold and grip strength after
application. This orthosis seemed to be
more effective than counterforce orthosis
in relieving pain and increasing the pain
threshold probably due to the limitation of
forearm supination.
 Disabil Rehabil Assist Technol.
2012 Jul;7(4):336-9.

74. 6) Chang M et al. did study on Comparison of
Task Performance, Hand Power, and
Dexterity with and without a Cock-up
Splint.
 Men's grip power with the cock-up splint was
found to be significantly decreased compared
to without the splint. Women's grip and
palmar pinch strength with the splint
decreased significantly compared to without
the splint. In the grooved pegboard test, the
dexterity of both men and women with the
cock-up splint decreased significantly
compared to without the splint

75.  Conclusion:
 To assist patients to make wise decisions
regarding the use of splints, occupational
therapists must have empirical knowledge
of the topic as well as an understanding of
the theoretical, technical, and related
research evidence.
 J Phys Ther Sci. 2013 Nov;25(11):1429-31

76. 7) Whelan DB et al did study on External
Rotation Immobilization for Primary
Shoulder Dislocation: A Randomized
Controlled Trial.
 To compare the (1) frequency of recurrent
instability and (2) disease-specific quality-
of- life scores after treatment of first-time
shoulder dislocation using either
immobilization in external rotation or
immobilization in internal rotation in a
group of young patients.

77.  CONCLUSIONS:
 Despite previous published findings, our
results show immobilization in external
rotation did not confer a significant benefit
versus sling immobilization in the
prevention of recurrent instability after
primary anterior shoulder dislocation.
 Clin Orthop Relat Res. 2014 Jan 3.

78. References:
 S Sunder; Text book of rehabilitation;
second edition ; pg no:103-130
 Orthotics: a complete clinical
approach SLACK
 P
. Bowker; biomechanical basis of
othotic management; pg no: 27-37
 John B. Redford, John V. Basmajian,
Paul Trautman orthotics: clinical
practice and rehabilitation technology;
pg no: 103- 130

79.  Randall L.Braddom ; physical medicine
and rehabilitation: third edition; pg no:
325-341
 Joel A. Delisa ; rehabilitation medicine
principles and practice; third edition; pg
no: 635-651
 Jan stephen tecklin ; pediatric
physical therapy; second edition
 ) Whelan DB et al. External Rotation
Immobilization for Primary Shoulder
Dislocation: A Randomized Controlled
Trial Clin Orthop Relat Res. 2014 Jan 3

80.  Ibrahim M et al. ; Efficacy of a static
progressive stretch device as an adjunct
to physical therapy in treating adhesive
capsulitis of the shoulder: a prospective,
randomised study ; Physiotherapy. 2013
Oct 3. pii: S0031-9406(13)00085-0.
 ) Merolla G et al.; Efficacy, usability
and tolerability of a dynamic
elbow orthosis after collateral ligament
reconstruction: a prospective
randomized study; Musculoskelet Surg.
2013 Oct 25.

81.  Garg R et al.; A prospective
randomized study comparing a
forearm strap brace versus a wrist
splint for the treatment of lateral
epicondylitis ; JShoulder Elbow Surg.
2010 Jun;19(4):508-12.
 Woo Y et al.; Kinematics variations after
spring-assisted orthosis training in
persons with stroke; Prosthet Orthot Int.
2013 Aug;37(4):311-6.
 Forogh B et al.The effects of a new
designed forearm orthosis in treatment of
lateral epicondylitis; Disabil Rehabil Assist
Technol. 2012 Jul;7(4):336-9.

82.  Chang M et al. ;Comparison of Task
Performance, Hand Power, and
Dexterity with and without a Cock-up
Splint ; J Phys Ther Sci. 2013
Nov;25(11):1429-31
 www.ottobock.com

83. Thank
you