Upper Limb Orthotics - Dr Sanjay Wadhwa

Orthotics – Upper Limb
Dr. Sanjay Wadhwa
Professor,
Department of Physical Medicine and Rehabilitation,
AIIMS, New Delhi – 110029.
(wadhwadr@gmail.com)
PMR Refresher Course 23 Sept. 2017, Jaipur Dr. Sanjay Wadhwa

This topic can be covered in more than one
ways:
• Orthosis centric
• Condition centric

• Definition(s)
• Objectives
• Indications
• Classification
• Nomenclature
• Biomechanical and Anatomical Considerations
• Evidence-base…

• Orthosis
• Brace
• Splint

• Orthosis – An externally applied device used
to modify the structural or functional
characteristics of the neuro-musculo-skeletal
system.
(International Standards Organization, 1987)
• Orthoses
• Orthotics
• Orthotist

Objectives:
• Support
• Prevent
• Align
• Relieve
• Correct

Conditions:
• Rheumatoid Arthritis,
• Trauma,
• Dupuytren’s Contracture,
• Carpal Tunnel Syndrome,
• Stroke, TBI,
• Spinal Cord Injury,
• Neuropathy/ Nerve or Plexus Injury,
• Burns,
• Hansen’s Disease...

Types:
• Static
• Dynamic
• Hybrid

Types:
• Assistive or substitutive
• Protective, or
• Corrective

Complications/ Problems:
• Skin damage,
• Joint stiffness,
• Muscle weakness or atrophy,
• Nerve compression,
• Vascular compromise,
• Psychological dependence…

Features of a Good Orthosis:
• Achieves the objectives for which prescribed,
• Available,
• Affordable,
• Acceptable,
• Easily applicable,
• Aesthetically appealing,
• Light weight,
• Durable,
• Free of complications…

Types (Task force of ISPO):
• FO
• HO
• WO
• WHO
• EO
• SO
• SEO
• SEWHO

• Over the past 17 years, there has been a
strong effort to name all orthoses by the joints
they cross, and then specifying any design
features related to those joints.
• Better universal terminology would simply
include the five common joints of the upper
limb including finger, hand, wrist, elbow, and
shoulder.

• The options or control features at each joint
are then described.
• The four common options for a joint include
o fixing the joint in one position,
o flexion/extension block,
o flexion/extension traction, and
o flexion/extension assist.

• Block – a limitation in the range of motion of
the joint created by the orthosis;
• Traction – an external force applied across a
joint for the purpose of stretching soft tissues
(e.g., contracture)
• Assist – an external force applied across a
joint to substitute for weak muscles.
• This relates to finger, MCP joint, and elbow.

• Additional joint features will need to describe
thumb positioning due to its unique function in
opposing the other fingers.

Upper Limb Orthosis Prescription
Patient’s Name: Reg. No.: Diagnosis:
Prescribing Physiatrist: Material/Padding: Duration of Need:
Finger 2 3 4 5 (Circle as needed)
DIP Static at Flexion block at Flexion traction Flexion assist at
PIP Dynamic Extension block at Extn. traction Extn. assist at
Thumb Static in opposition Flexion block at Flexion traction Flexion assist at
Dynamic Extension block at Extn. traction Extn. assist at
MCP Static at Flexion block at Flexion traction Flexion assist at
Hand Circumferential Dorsal Volar
Wrist Static at Flexion block at Flexion traction Flexion assist at
Forearm Circumferential Dorsal Volar
Elbow Static at Flexion block at Flexion traction Flexion assist at
Humerus Circumferential Dorsal Volar
Shoulder Static at Flexion block at Flexion traction Flexion assist at
Special design Tenodesis BFO Universal Cuff
Signature of Physiatrist………………………………. Date…………………

• Very wide range
• Finger Orthoses to Airplane splint
• Articulated or non-articulated Orthoses

• Tenodesis splint – a dynamic wrist-hand
orthosis used in transmitting active wrist
extension to achieve finger prehension.
• Used for spinal cord injury patients with
residual wrist extension capabilities.
• The thumb is held in functional position and
the first two fingers are moved against it by
orthosis.
• Relaxing the wrist allows gravity to open the
grip.

• Knuckle bender – dynamic hand-finger
orthosis, applies a three-point pressure system
to aid flexion of the MCP joints. Rubber bands
or springs are used to assist flexion.

Swan neck Splint

Universal Cuff with spoon fitted

Forearm based thumb spica Splint for de Quervain tenosynovitis

Trigger finger Splint

Splint for a patient with lateral epicondylitis

Hinged Elbow Splint for limited ROM after a fracture

Radial nerve palsy Orthosis

Combined median and ulnar nerve palsy Orthosis

Ulnar nerve palsy Orthosis

Wrist Hand Orthosis –
compare wrist angle with CTS

Resting hand splint

Antispasticity Orthosis

Figure of 8 sling

Joint Jack – a progressive Splint to increase extension at PIP joint

Postoperative flexor tendon Splint: tenodesis flexion – extension exercises

Postoperative Splint for a patient with extensor pollicis tendon repair

Postoperative Splint for a patient with MTP arthroplasty

Cochrane Database Syst Rev. 2003;(1):CD004018.
Splints/orthoses in the treatment of rheumatoid arthritis.
Egan M1, Brosseau L, Farmer M, Ouimet MA, Rees S, Wells G, Tugwell P.
Author information
Abstract
BACKGROUND:
Splints/orthoses are often recommended to patients with rheumatoid arthritis
(RA) to decrease pain, decrease swelling and/or prevent deformity. These
orthoses include resting hand splints, wrist supports, and finger splints.
OBJECTIVES:
To assess the effectiveness of splints/orthoses in relieving pain, decreasing
swelling and/or preventing deformity and determine the impact of
splints/orthoses on strength, mobility and function in people with RA.

REVIEWER'S CONCLUSIONS:
There is insufficient evidence to make firm conclusions about the
effectiveness of working wrist splints in decreasing pain or increasing
function for people with RA. Potential adverse effects such as
decreased range of motion do not seem to be an issue, although
some of these splints decrease grip strength and dexterity. Similarly,
preliminary evidence suggests that resting hand and wrist splints do
not seem to affect range of motion or pain, although patients preferred
wearing a resting splint to not wearing one. There is evidence that
extra-depth shoes and molded insoles decreases pain on weight-
bearing activities such as standing, walking and stair-climbing. Posted
insoles may be effective in preventing progression of hallux abductus
angle but do not appear to have an impact on pain.

Upper Limb Orthotics - Dr Sanjay Wadhwa

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