Orthoses are externally applied devices that modify the structural characteristics and function of the neuro-musculoskeletal system. They are used to immobilize, support, correct deformities, assist weak muscles, and substitute for absent motor function. The document discusses various types of orthoses for the upper limb including static/dynamic orthoses for the shoulder, elbow, wrist, hand, and fingers. It provides examples of orthoses used to treat conditions like nerve injuries, burns, rheumatoid arthritis, and spinal cord injuries. The principles and goals of orthosis prescription for different parts of the body and medical conditions are explained.

1. ORTHOSES
Sunil Bhatt
Moderator:
Mr. Ravi Shankar Reddy

2. Introduction
• The term “Orthosis” adopted by the American
Orthotics and Prosthetics Association (AOPA)
in 1960
• In Greek, Orthosis- “making straight”
[Simon K. M. Wong. Hand Surgery, Vol. 7, No. 2 (
December 2002) 209–213]

3. DEFINITION
• Orthosis is an externally applied device
used to modify structural and functional
characteristics of neuro-musculoskeletal
system.
- ISO of International society for
Prosthetics and Orthotics
• Orthoses are used with the primary goal of
restoration of function.

4. • “Orthosis is a device applied directly and
externally to the patient’s body with the
object of supporting, correcting or
compensating for an anatomical deformity
or weakness, however caused, it may be
applied with the additional object of
assisting, allowing or restricting movement
of the body”
-Department of Health and Social
Services (U.S.)

5. FUNCTIONS
• Primary goal: to improve function either
immediately or as part of a treatment program
that will lead to function in future.
1. To immobilize or support
2. To apply traction

6. 3. To assist weak or partial segments:
should not override weakened muscles.
4. To substitute for absent motor function
5. To permit controlled directional movement
6. To block a segment

7. 7. To allow attachment of assistive devices

8. Types of splints/ Orthosis
• STATIC :
rigid support - fractures
- inflammatory conditions
of tendons and soft tissues
- nerve injuries
• DYNAMIC :assist movement of weak
muscles

9. Considerations in prescription of
Orthoses (General Principles)
• Forces: apply to limit or to assist in motion.
e.g. solid AFO prevent foot n ankle motion.
• Pain: may be reduced by limiting motion.
• Flexible deform.: may be corrected.
• Fixed deform.: may prevent the
progression.

10. • Pressure reduction: shoe insert cushions
the foot.
• Adjustability: for children to accommodate
growth and for pts. with progressive or
resolving disorder.
• Weight: should be as lightweight as
possible.

11. • Sensation
• Gravity
• Comfort
• Simplicity

12. • Durability
• Utility
• Tolerance
• Cosmesis

13. THE UPPER LIMB ORTHOSES
• Principles:
• 1.Assist with residual motor power or
substitute for absent motor power.e.g.pt.
with radial neuropathy can use ulnar &
median innervated muscles more
effectively if an Orthosis supports wrist in a
neutral or slightly DF posn.
pt. with C5 quadriplegia- Orthosis that
provides prehension.

14. • 2. Adequate prehension force but not too
forceful
• 3. Electrically powered Orthosis: pt. able to
control acuator reliably.
• 4. Hand Orthosis obscure tactile sensation
over area that they cover. e.g. pts. with C7
quadriplegia may not wear a wrist hand
Orthosis even though it improves prehension
bcz its bands deprive the indiv. of some of the
residual sensation.

15. • 5. Protect body segment against pain or
deformity. E.g. in RA.
• 6. Pt. may benefit from several Orthoses than
from one complex Orthosis. e.g. a pt. with
quadriplegia need utensil holder to hold a
pencil ; same person may need an opponens
Orthosis
• 7. May correct deformity. E.g. claw hand
deformity may be reduced.

16. Shoulder and arm Orthoses :
• Most common :SLING .
enough pull on the arm
cuff or push-up at elbow
to hold humeral head
against glenoid cavity of
scapula

17. • Airplane splint -static shoulder Orthosis
Parts: a body piece
a static part
an arm support
Use: after burns of axilla and after shoulder
surgery.

19. • Figure of 8 Orthosis :holds shoulder back
when with Trapezius muscle loss shoulder
tends to droop downward and forward

21. • Shoulder dynamic Orthosis :rarely
indicated. bulky, complex, cumbersome &
provide limited additional function.
used as part of mobile arm Orthosis
systems or balanced forearm Orthoses
(BFOs).

22. • Balanced forearm Orthosis:
-can be attached to a wheelchair.
-consists of a forearm trough which is attached
by a hinge joint to a ball bearing swivel
mechanism and a mount.
-supports the weight of the forearm and arm
against gravity.
-primarily used for pts. with severe upper limb
weakness e.g. high quadriplegia or BP lesion.
-sufficient ROM of shoulder and elbow
+adequate trunk stability while sitting.

24. • Humeral Orthosis : -static Orthosis .
-encircles the arm
- fitted in a healing
fracture of
midhumerus.

26. • Functional arm Orthoses
-for proximal arm weakness involving the
shoulder and arm
-shoulder saddle suspending a proximal
forearm cuff by straps or a Bowden cable
-SCI. peripheral nerve lesions

27. ELBOW ORTHOSIS
• Mostly used to increase elbow ROM in
flexion or extension
• Simple volar or dorsal conforming splint
• A three point Orthosis with cuffs and bar
can be used.

28. An elbow Orthosis

29. • Functional dynamic Orthosis: for the Pt.
with weak elbow flexion
• A static elbow wrist Orthosis is used to
stabilize the elbow and prevent supination
and pronation of forearm
used to give rest to elbow region in
inflamm. conditions & after surgery around
elbow and proximal forearm.

30. Dynamic elbow orthosis

31. Static elbow orthosis

32. • Serial cast - for prevention or correction of
contractures by promoting soft tissue stretch
and passive ROM

33. Posterior elbow splints - for elbow
immobilization in elbow surgery or
inflammation

34. • Air splint
– maintains or increases elbow extension
– Form of circumferential inflatable sleeve, also
used for contractures and elbow immobilization

35. • Dynamic elbow flexion orthosis - maintains
the elbow in 90° of flexion in cases of
elbow contractures, burns, and fractures

36. WRIST ORTHOSIS
• Most frequently used upper limb Orthosis
• a dorsal splint: suspend the part
• a volar splint :support the part
• Palmer wrist support should not extend
beyond the distal palmer crease

37. • Static volar wrist orthosis with thumb
cutout

38. • A dynamic wrist Orthosis:support the wrist
and control flexion and extension.
- prevents radial and ulnar deviation.
- used after wrist arthroplasty,
synovectomy and fractures.
- Also to increase ROM of wrist.

39. Dynamic wrist splint

40. Resting wrist hand finger Orthosis

41. HAND ORTHOSIS
• Basic components:
Basic hand component
Web spacer
Thumb flexor and extensor
Finger MP, PIP and DIP
fl. and ext. Orthoses.
• Hand Orthoses are frequently used in
early stages after an injury or surgery

42. • Static hand Orthosis: used to hold the
hand in a particular position or immobilize
a digit or a single joint.

43. • Static wrist hand Orthosis: used to rest
and injured hand, prevent contracture or
stretch a contracture

44. • Dynamic wrist hand Orthosis: complex
and challenging to fit. used to substitute
for absent or weak finger extensors or to
provide traction of finger joints in flexion or
extension

45. • Wrist extension and flexion orthosis

46. • Wrist extension finger flexion reciprocal
Orthosis used in C6 quadriplegia
• patient who can extend the wrist but
cannot flex the fingers.
• called as flexor hinge splint.
• utilizes wrist extension force which is
translated into finger flexion at MP joints of
index and middle fingers.
• consists of a basic hand Orthosis with
wrist and MP joints.
.

47. • Index and middle fingers are held together
in slight flexion at PIP and DIP joints. A
telescopic rod connects the forearm piece
to fingers
• . When the wrist is extended fingers go
into flexion to provide a pulp pinch. When
wrist goes into flexion, fingers open and
release the object.

49. • Gutter splint

50. • Finger gutter splint

51. • Short opponens hand Orthosis: made of
either metal or plastic

52. • Types:
• Bennet type metal hand Orthosis have a
dorsal part that extends over 5th
metacarpal to hand and over lateral aspect
of thumb to act as opponens bar. It also
has a web spacer that extends below
thumb and index finger.

53. • Rancho type also has an opponens bar, a
C bar and a volar strap across hand.
• Engen type- made of thermoplastic
material. These preformed thermoplastic
shells fit in the palm of hand over palmer
arch, extend to base of thumb and are
held by a dorsal strap.

54. • MP flexion Orthosis: commonly used to
stretch out MP extension contractures
• Commonly called “knuckle benders”
Most of the traction force affects the most
contracted or lagging finger. The other
fingers do not get much or even any
traction until the lagging finger improves

56. MP extension Orthosis; is used as a
functional splint in patients with absent or
weak finger extensors and also as a
traction splint for flexion contracture of MP
joint.

57. • IP joint flexion or extension Orthosis: used
to stretch a contracted joint.
must block MP joint to prevent movement
and allow traction force to act solely on IP
joint.
dynamic, non functional, traction splints.

58. • Lumbrical bar: an MP extension bar. Used
dorsally over proximal phalanges to block the
MP joint from hyper extending. e.g. in an
intrinsic minus hand

59. • Thumb Spica Thumb ext. n abd.
splint

60. ORTHOSIS USED FOR HAND
INJURIES
• Flexor tendon inj.: more serious than ETI
emphasis on preventing loss of tendon
excursion caused by adhesions.
postop.- orthosis from forearm to fingers
wrist fl.45, PIP 90, DIP full fl.
finger hook via nylon string n rubber band
to base of forearm.
after 3-4 wks.- no passive pull n allow grad.
increase in wrist n finger ext.

61. Orthoses used for nerve injuries
• Purpose:
1. Prevent deform. from occurring in an
imbalanced hand.
2. Restore full passive ROM in aff. Area n
full active ROM n strength in non-aff.
surr. Area
3. Add mechanical assistance.
4. Substitute for lost muscle power.

62. • Radial nerve injury:
Deform.- wrist drop & drop finger.
Pt. able to make fist if wrist in ext. but unable to
open hand
RADIAL NERVE GLOVE Orhtosis- dorsal wrist
support with dynamic ext. force at MP joint.
• Post. Introssei n. inj.- dynamic MP ext. dorsal
hand orthosis without a wrist support.

65. • Outrigger splint

66. • Ulnar nerve injury:
Deform.- clawing of 4th n 5th digits
Goal- prevent hyperext. of MP jts. of 4th n 5th
two digits to allow proper wrapping of fingers
around an object.
- A dorsal MP block (Lumbrical bar) to 4th n 5th
digits with a soft strap on palmer aspect
• There is no orthotic device that can substitute
for lost function of thumb adductor which is a
major deficit in ulnar neuropathy.

67. Ulnar gutter splint

69. • Median nerve injury:
deformity- ape thumb
splinting principle: to put thumb in
abducted, opposed position.
C bar or thumb post static orthosis or
dynamic thumb orthosis.

70. •

71. Proximal median n. inj.: also loss of DIP fl.
of index n middle fingers.
Buddy splint is used.

72. • MEDIAN+ULNAR n. injury:
Deformity- claw hand or intrinsic minus hand.
hand orthosis with an MP block (Lumbrical
bar)

73. • ORTHOSIS USED FOR INFLAMM. OF JTS.
AND TENDONS
• Acute inflammation of wrist: static wrist
support Orthosis.
• Inflammation of hand: a WHO.
• Tendinitis: a thumb spica WHO Orthosis can
be used with wrist held in neutral position
and with thumb radially abducted. The IP
joint is left free.

74. • Trigger finger: a volar static hand Orthosis
can be used to immobilize MP joint in a
neutral position and allow full IP flexion.
• Gives rest, relieves the flexor force and
reduces friction between tendon and pulley
system by altering the flexor biomechanics
and encouraging differential tendon gliding
between Flexor Digitorum Sublimis and
Profundus muscles.

75. • ORTHOSES USED FOR CARPAL
TUNNEL SYNDROME: a static wrist
Orthosis with wrist in 0-15 degrees of
extension.

76. • ORTHOSIS USED FOR BURNS:
• Aim: to hold the hand in a neutral position
and preventing stiffening of MP joints in an
extended position. position of comfort.
• A static volar WHO is used with the wrist 15
degrees in extension, MP joints in 65
degrees of flexion and PIP and DIP joints in
neutral position.

77. • Burns around elbow joint :volar conforming
splint
• Axillary burns : airplane splint with shoulder
held in abduction and 20 degrees of forward
flexion.

78. • Orthosis used in RA:
• Acute stage: support orthosis
• Chronic stage: orthosis is of little help.
• Anti deformity splints: Controversial
• Anti boutonniere splint
• Anti swan-neck splint

79. Anti swan-neck splint

80. Anti boutonniere splint

81. • A painless MP ulnar deviation deformity:
an ulnar deviation Orthosis with ulnar
block or loop over individual finger can be
used to give a more effective grip.

82. • Orthosis in stroke:
For subluxed shoulder- shoulder sling
• TBI : Spastic UE difficult to treat with
orthosis
A simple static WHO or an anti spastic
orthosis.

83. • Orthosis in SCI:
Depending on level of injury and conditon
of functioning muscles n joints.
• C1-C4: Mouth-sticks
• C4-C5: Mobile arm support
• C5: Overhead slings
Long opponens orthosis (ADL
orthosis)
Dorsal wrist support

84. C6: Wrist ext. finger fl. Reciprocal orthosis
Short opponens orthosis
Universal cuff
C7: Short opponens orthosis
Universal cuff
C8-T1: Built up utensils