Braddom - Upper Limb Orthotic Devices Flashcards
(161 cards)
1
Q
Orthos means
A
Correct or make straight
2
Q
Any externally applied device used to modify structural and fx characteristics of the neuromuscular skeletal system
A
Orthosis
3
Q
Orthosis alternatively known as
A
Orthotic device
4
Q
Upper limb orthotic applications
Objectives
A
Protection
Correction
Assistance with function
5
Q
Will act as a keystone for hand position
A
Wrist
6
Q
The wrist will act as the keystone for hand p ing and outlines the basis for all splinting, except
A
Isolated digital splinting
7
Q
Weight of the hand pulls the wrist into
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Flexion
8
Q
Flexion of wrist will inc tension in the
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Extrinsic extensor tendons - pulling metacarpophalangeal joints into hyperextension
9
Q
Goal of hand splinting
A
To prevent claw hand
10
Q
How does wrist splinting prevent claw hand
A
Prevent wrist flexion
Inc tension extrinsic extensor tendons, pulling MCP (pulled into hyperextension)
Extrinsic flexor -tension -> PIP and DIP flexion
Metacarpal arch of hand flattens
Thumb- adduction
11
Q
Key for finger function
A
MCP joint
12
Q
When MCP joint are hyperextended
A
IP joints flex
Tension of flexors
13
Q
Hand splinting should
Position
A
Wrist - slight extension - maintain flexor tendon length and improve hand function
MCP -maximum stretch - IP flexed
14
Q
Oppose development of a claw hand deformity
A
Slight wrist extension
MCP max stretch
15
Q
Safe, intrinsic plus
Hand splinting
A
Slight wrist extension
MCP max stretch
16
Q
Fosters the weaker intrinsic motions of the MCP flexion and IP extension that are difficult to obtain
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Slight wrist extension
MCP max stretch
17
Q
2 basic hand grips
A
Power and precision
18
Q
The wrist is held in dorsiflexion with the fingers wrapped around an object held in the palm
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Power grip
19
Q
Holding a screw driver in a cylindrical grip
A
Power grip
20
Q
Is useful for holding a ball
A
Spherical grip
21
Q
Useful for carrying heavy objects
A
Hook pattern
22
Q
The thumb is held against the tip of the index and middle finger
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Precision grip
23
Q
Functional hand splinting is aimed at improving this functional activity of
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Pinch
24
Q
Three of types of pinch
A
Oppositional pinch
Precision pinch
Lateral key pinch
25
Three jaw chuck
Oppositional pinch
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Best to splint towards this type of pinch
Oppositional pinch
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Allows best compromised between fine precision pinch and strong lateral pinch
Splint towards oppositional pinch
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What practical orthosis can substitute or improve thumb adduction
None
29
Splinting thumb
Enhance prehension, do not forced to extend and radial abduction
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When increasing joint range of motion with splinting, the angle of pull needs to be
Perpendicular to bony axis that is being mobilized
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Improvement of range of motion is directly proportional to the length of time a joint is
Held at its end range
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The improvement in range of motion is directly p portional to the length of time a joint is held at its end range.
What principle is this?
TERT principle
33
TERT is used with this type of splinting
Static progressive splinting
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Provides support to a body part without crossing any joints
Nonarticular
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Used for circumferential support to the arm during fracture healing
Humeral fracture splint
| Non articular
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Used to immobilize a proximal radius fracture
Sugar tong splint
| Non articular
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To extert pressure over a healing scar to prevent hypertrophic scarring
Gel shell splint
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Provides static support to hold a joint or joints stationary
Static splint
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Splint for acut carpal tunnel syndrome
Volar wrist splint
| Static
40
Splint to reduce tone in spastic muscles
Volar wrist splint
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Is also a static but is periodically changed to alter the joint angle at which splint is positioned
Serial static
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Serial static are applied with the tissue at its
Tissue of Max length
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Permits motion in one directon but blocks motion in another
Static motion blocking
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Designed to allow flexion but block hyperextension of the PIP joint (rheumatoid arthritis)
Swan neck splint
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One of the most commonly used splint for regaining joint motion
Static progressive
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Orthosis is not remolded to increase joint motion
Static progressive
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They use nonelastic components such as stayic lines, hinges, screws, turnbuckles to place force on a joint to induce progressive chnge
Static progressive
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Decreases the static line length as it turned, thereby inc the range of joint motion
MERit static progressive component
49
Provides the elastic force to help regain joint motion
Dynamic splint
50
Uses a spring coil or wire tension assist to inc extension in a PIP joint with a mild contracture
Finger extension splint
| Dynamic
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Allows certain motions but blocks others
| It uses a passie eslastic line of pull in the desired direction but permits active motion in oppsitve motion
Dynamic motion blocking
52
Splint for flexor tendon repairs
| Passively pulls the finger into flexion with an elastic thread or rubber band
Kleinert postoperative splint
| Dynamic motion blocking
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It allows active digital extension, while parts of the splint block full extension of the MCP joint and the wrist
Kleinert postoperative splint
| Dynamic motion blocking
54
Offers traction to joint while allowing controlled motion
Dynamic traction
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Hand-based PIP extension split with an outrigger which gives constant longitudinal traction while joint is gently flexed and extended
For intraarticular fracture
Type of splint
Dynamic traction
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Facilitates fx in a hand that has lost motion because of nervous system injury
Tenodesis
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Electrically powered devices that mchanically move joints through a desired range of motion
Continuous passive motion orthoses
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Keeps the joint suple and maintains articular, ligamentous and tenginous structure mobility during healing phases after injury or surgery
Continuous passive motion
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Promote functional use of the upper limb with impairment resulting from weakness, paralysis, or loss of a body part
Adaptive or functional usage devices
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Promote fx use the upper limb with impairment resukting from weakness, paralysis or loss of a body part
Adaptive or functional usage devices
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Inflammation at a muscle or tendon origin or insertion
Enthesopathy
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Tendonitis, tenosynovitis, enthesopathy result from
Result from excessive repetitive movement or external stressors
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Tendonitis, tenosynovitis, enthesopathy
Usually involve (upper limb tendons)
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Wrist extensors
Abductor pollicis longus
Extensor pollicis brevis (thumb)
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Wrist extensors
Abductor pollicis longus
Extensor pollicis brevis (thumb)
Tenosynovitis
De Quervain’s stenosing tenosynovitis
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Goal of splinting in tendonitis
Immobilize the affected structures in order to facilitate healing and dec inflammation
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More common enthesopathy of the upper limb
Lateral epicondylitis
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Lateral epicondylitis tx with
Tennis elbow orthosis
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Forearm band that changes the lever arm against which the wrist extensors pull
Tennis elbow orthosis
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Essence of tennis elbow orthosis
Puts the origin of the extensor muscles at rest and dec microtrauma from overuse
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Tennis elbow orthosis is placed
2 fingerbreadths distal to lateral epicondyle and is a firm strap against which the extensors press against when contracting
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Medial epicondylitis brace
Golfer’s elbow
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Causes snapping sensation in the volar surface of the digits on release of grasp
Trigger finger
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Trigger finger is usually a result of trauma to the
flexor tendon sheath of the fingers or thumb (thickened tendinous sheaths and restriction of motion)
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Digit can become locked in flexion
Advanced trigger finger
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Goal in triggerfinger
Halt the repetitive motion temporarily to allow healing
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Hwo to achieve goal in trigger immobilization
Immobilization
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Splint of trigger finger covers
Proximal phalanx and the MCP joint of digit
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Splin for trigger finger
| Mechanism
Dec tendinous excursion through the first annular pulley at the base of the MCP joint, allows inflamed structures to rest
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Momentary subluxations with spontaneous resudction that result in torn ligamentous structures
Sprains
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Sx sprain
Experience pain, swelling and dec function
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Sprains tx
Immobilizartion in a position of fx
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Common sprains include
Dislocation of the IP and MCP joints caused by hyperextension injuries (sports)
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First and second degree ligamentous tear goal is to
Protect and rest the area by applying functional splinting
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Goal of third degree ligamentous tear is
Fully mobilize and approximate the ligaments
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Common splint for digital splints are
Finger extension splints that hold PIP joint extension
Allow flexion DIP
-keeps oblique retinacular ligament and terminal extensor tendon lengthened
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Finger extension splint for digital sprains prevent
Boutonniere deformities
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Ulnar collateral ligamentous injuries at the MCP joint of thumb are tx with
Hand-based thumb spica spint producing immobilization during healing phase
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Wrist sprains management
Wrist splints in slight extension
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Some motion but avoid creating significant stress.
| Limit available range to 40 degrees of total motion
Splints with no splint (metal bar insert)
90
Are helpful for mild sprains at the elbow because they limit the extremes of range but allow limited fx
Lbow neoprene
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Circumferential
Permits motion of elbow, forearm and hand
Arm fractur
Humeral fracture brace
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Humeral fracture of brace prevents
Edema
| Resultant joint stiffness
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Used primarily for phalangeal and metacarpal fractures
Splint extend from the proximal forearm to beyong the dip joint
Gutter splint
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Has been credited woth enhancing cartilage nutrition and preventing intraarticular adhesions
Joint movement
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Most common dse affecting the joins in the upper limb
Osteoarthritis
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Joint dse in this area have most significant impact on fx
Hand
| Wrist
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Chronic inflammatory dse that affects snyovial joints
RA
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RA most commonly affects
Wrist, MCP joint, PIP joint
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RA deformities include
Subluxation, ulnar deviation at the wrist
Swan neck deformity
Boutonniere deformity of fingers
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Deformed position of the finger in which joint closest to tge fingertip is permanently bent toward palm while nearest joint to the palm is bent away from it (DIP flexion with PIP hyperextension)
Swan neck deformity
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PIP flexion with DIP hyperextension
Boutonniere deformity
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Most common form of arthritis
Osteoarthritis
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Osteoarthritis is primarily a disease of
Cartilage, not synovium
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Osteoarthritis most commonly involves the
CMC joint of thumb
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CMC joint osteoA
| Management
Thumb spica hand based or forearm based
Limit motion at base of thumb, splint dec pain, esp pinching
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What deformity is incurred in distal median nerve injury
Simian hand
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Fx most affected by simian hand
Thumb palmar abduction and opposition
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Thumb palmar abduction and opposition
| Nerve
Distal median nerv injury
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Distal median nerve injury
Simian hand
Management
Spring coil design
MCP joint slight extension
Position thumb in palmar abduction
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Most common presentation with radial nerve injury distal to humeral spiral groove
Wrist drop
| Finger drop
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Goal radial nerve injury
Wrist drop
Finger drop
Enhance wrist and finger extension
112
Position of radial nerve palsy splint
Fore-arm based with an outrigger, holds the wrist fingers and thumb in extension and allows flexion digit
113
Benediction hand
Proximal ulnar nerve injury
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Features hyperextension of the 4th and 5th MCP joint
And flexion of PIP
Loss of balance between extrinsic and intrinsic hand muscles
Benediction hand
| Proximal ulnar nerve injury
115
Goal proximal ulnar nerve inury/ benediction
Prevent fixed deformity of 4th and 5th MCP and improve fx
116
holds the MCP joints of the fourth and fifth fingers in slight flexion by a spring coil or figure-of-eight splint design
Ulnar nerve palsy splint
117
Position goal ulnar nerve palsy splint
The spring coil design assists MCP flexion and permits extension of the MCP joints but blocks hyperextension
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This is compromised in low median and ulnar nerve injuries
Thumb position - weakened opposition and palmar abduction
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Incomplete nerve injury by compression median nerve
Carpal tunnel syndrome
120
Purpose of splint
| Carpal tunnel syndrome
Immobilize the wrist to minimize swelling from overuse of the tendons
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Carpal tunnel
| Wrist extension degres
0-5
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Wrong common name of carpal tunnel syndrome splint
Wirst cock-up splint
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Prefabricated wrist splints for carpal tunnel syndrome degree of extension
45, exceeds dec pressure in carpal tunnel
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Carpal tunnel splint should be worn until
4-6 weeks
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Compression of the ulnar nerve in elbow
Cubital tunnel syndrome
126
Cubital tunnel syn tx with
Long arm splints that hold elbow in 45 degrees flexion
Forearm neutral
Wrist in 0-5 degrees extension
Thumb fingers free
127
Brain injury
| Orthotic devices design for
Prevent doformities and to help adjust muscle tone
128
In upper limb paralysis a resting hand splint is commonly used to position the wrist in slight extension, the MCP joints in slight flexion, and the IP joints in extension.
wrist in slight extension, the MCP joints in slight flexion, and the IP joints in extension.
thumb is supported in a position between palmar and radial abduction.
129
vents ligamentous stresses on the thumb, especially in the insensate hand.
Full support of the first CMC joint
130
Now used to dec tone in patients with focal spasticity
Botulinum toxin
Followed by serial and dynamic splinting - normal posture and position
131
Places the fingers and hand in a reflex-inhibiting position and serves to reduce tone
Ball antispasticity splint
132
dynamic orthosis with functional electrical stimulation that is most appropriate for patients who have some shoulder and elbow movement but no hand function (i.e., lack of active finger extension).
positions the wrist and fingers into extension in preparation for functional activities
SaeboFlex
133
mobile arm support
enhance function for patients with proximal upper limb weakness, especially when the weakness is profound and the outlook for recovery is guarded.
134
particularly helpful when performing such activities of daily living as eating and grooming. When attached to a wheelchair with a swivel joint, this is often also called a balanced forearm orthosis.
mobile arm support
135
slings restrict active motion of the shoulder by
keeping the humerus in adduction and internal rotation and placing the elbow in flexion
136
designed to unload the weight of the arm on the s der, but do not approximate the humeral head back into the glenoid fossa
Shoulder sling (brain injury)
137
Slings or half arm trays have not been found to correct the shoulder subluxation completely.
T
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is often preferred because it will not restrict use of the limb, and the humerus is more naturally approximated into the glenoid fossa.
arm trough or half lap board
139
spinal cord injury at the C1-C3 level
| Goal
prevent contractures and to hold the wrist and digits in a position of function with a resting hand splint
140
C4-level injury the goal
use the available shoulder strength, p viding a mobile arm support to enhance function as previously described.
141
C5-level injury the goal
statically position the wrist in extension with a ratchet-type hinged orthotic device to hold devices and use the shoulder musculature for function.
142
C6 tetraplegic goal
enhance finger flexion using a tenodesis flexion effect from wrist extension.
143
Rehabilitation Institute of Chicago tenodesis splint
Thumb position - Palmar abduction
| PIP joints of index and long fingers in slight flexion
144
Produces three point pinch
Rehab tenodesis splint
145
Flexor tendon repair
| Postsurgical and postinjury orthoses
Kleinert and Duran
146
features dynamic traction into flexion, but allows active digit extension within the constraints of the splint.
Kleinert splint
147
statically p tions the wrist and MCP joints in flexion and the IP joints in extension
Duran splint
148
Kleiner + Duran +
a tenodesis-type action splint for a specific, active assisted range-of-motion exercises, can be used only if a specific surgical suture technique has been used.
Indiana Protocol splint
149
Mallet finger injury
Stax splint
150
static splint holding the DIP joint in full extension.
Stax splint
151
Proximal injury
| Extensor tendon
wrist statically in extension with dynamic extension of MCP (allows active flexion 30 degrees) and IP joints
152
Burn patients typically prefer
adducted and flexed p tion of the upper limbs to maintain comfort (loss of fx range motion)
153
Burn dorsak surface of hand
wrist is kept in 15 to 20 degrees of extension, the MCP joints in 60 to 70 degrees of flexion, the PIP and DIP joints in full extension, and the thumb between radial abduction and palmar abduction
154
If tendons are exposed burn)
| burns of the dorsal surface of the hand
wrist is kept in 15 to 20 degrees of extension, the MCP joints in 30-40 degrees of flexion, the PIP and DIP joints in full extension, and the thumb between radial abduction and palmar abduction
MCP 30-40 flexion (slack tendons until wound closure)
155
Palmar hand burns require
maximum stretching to p vent the contracting forces of the healing burn.
15 to 20 degrees of wrist extension, extension of the MCP and IP joints, digital abduction, and thumb abduction and extension.
Open palm
Pancake position
156
Axillary burns
| Goal
Prevent shoulder adduction deformity
157
Axillary burns
| Held in
shoulder should be held in abduction with an airplane splint.
158
tendency toward hypertrophic scarring after a burn is addressed with
compression garments, e tomer molds, facial splints, gel shell splints, and silicone gel sheeting
159
Patients with arthritis who have been taking c steroids for long periods often have fragile skin, so their splints should be
Padded throughout
160
Tells an overly aggressive stretch is being applied to the shortened neurovascular bundles
Blueness or redness of the digits
161
Neurovascular bundles sometimes shorten because of joint contracture
Management
splint tension must be decreased and the contracture stretch should be less aggressive. 20
