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Year 3: Prosthetics and Orthotics > Lecture 6: UE Orthoses > Flashcards

Lecture 6: UE Orthoses Flashcards

1
Q

OT scope of practice in regard to orthotics

A

assessment, design, fabrication, application, fitting, and training in orthotic devices

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2
Q

domains of hand therapy practice

A
  1. assess upper limb and relevant pt characteristics
  2. determine prognosis and individualized POC
  3. Implement POC and therapeutic interventions
  4. basic science and fundamental knowledge
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3
Q

articular vs non articular orthoses

A

articular crosses a joint

nonarticular does not cross or does not have a mechanical joint

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4
Q

purposes of UE orthoses

A

immobilize

mobilize/assist with movement

restrict motion

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5
Q

what characteristics need to be described when talking about an UE orthoses

A

fabrication (custom?)
articular or non?
location
direction of applied forces
purpose of orthoses

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6
Q

what do immobilizing UE orthoses do and examples of possible indications

A

stabilize joints/tissues by preventing excessive/abnormal movement

manage a deformity bu preventing contracture

protect structures from harmful/excessive load

i.e. stabilize unstable/painful joints, reduce inflammation, prevent deformities, facilitate healing, etc

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7
Q

what do mobilizing UE orthoses do and examples of possible indications

A

assist with movement

manage deformity by applying corrective force

i.e. assist with lost movement from nerve injury, elongate shortened tissue

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8
Q

what do restricting UE orthoses do and examples of possible indications

A

protect structures from harmful/excessive load

i.e. prevent joints from unsafe movements

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9
Q

what is a budding taping orthoses used for

A

stringer digital assists with movement of impaired digit

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10
Q

what are blocking splints used for

A

assists AROM by blocking movement of more mobile joints

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11
Q

Anti-deformity position of the UE

A

90 deg shoulder abduction with ER

elbow extension

neutral to slight supination of forearm

20-30 deg wrist ext

70-90 deg MCP flexion

IP extension

thumb and palmar abduction

*important considerations for burns

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12
Q

UE orthoses design principles

A

wear time depends on orthoses/purpose

longer splints = more comfy

wider straps = more even force distribution

contoured edges = for pt comfort

avoid pressure over bony prominences

in dynamic braces, angle of pull should be 90 deg

apply tension only sufficient to take the joint to comfortable end range

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13
Q

design categories of UE orthoses

A

static
dynamic
functional

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14
Q

types of static UE orthoses

A

static
- articular
- non-articular
- motion blocking (dorsal or volar)

serial static

static progressive

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15
Q

purpose of static splints

A

provide passive support

commonly prescribed for immobilization

provides protection for proper positioning

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16
Q

general position for static splints

A

for contracture prevention and healing

resting position = holds tissue in elongated position but not at end range

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17
Q

functional position of hand and wrist

A

20-30 deg wrist ext

40-45 MCP flexion

45 PIP flexion

relaxed flexion of DIPs

thumb abducted and in opposition to fingers

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18
Q

Healing time, non-union rate, and radial nerve palsy rate for pts with a closed humeral shaft fx using a static splint vs surgical treatment

A

non operative
- healing time = 16 weeks
- non union = 11%
- radial nn palsy = 1%

operative
- healing = 14-15 weeks
- non-union = 3-6%
- radial nn palsy = 3-4%

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19
Q

indication for elbow flexor spasticity static splint

A

due to UMN pathology

may be worn at night to maintain elbow extension ROM and prevent flexion contracture

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20
Q

purpose, position, and indication for airplane splint

A

purpose = immobilization

position in abduction

indications:
- axillary burns
- contracture prevention
- humeral neck fx
- brachial plexus injury

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21
Q

indications and position for abduction external rotation shoulder brace

A

indications
- s/p RTC repair
- after shoulder dislocation
- s/p shoulder arthrodesis

position = 30 deg ABD and 30 deg ER most comfy

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22
Q

shoulder sling purpose and indications

A

purpose = immobilization

indications
- post trauma
- post sx
- AC or GH dislocation

long term use can lead to elbow contracture

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23
Q

sling vs abduction brace for s/p RTC repair

A

no difference in effectiveness- function, pain, or healing

sling may be more cost effective

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24
Q

purpose and indications for elbow, forearm, wrist orthoses

A

stabilizes injuries of the forearm and wrist by preventing supination and pronation

typically positioned in neutral

indications:
- distal radius fx
- forearm fx
- triangular fibrocartilage injury
- terrible triad- elbow dislocation with associated radial head and coronoid fx
- contracture prevention

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25
sugar tong splint purpose and indication
purpose = limits forearm supination/pronation, elbow extension, and wrist motion indications - carpal fxs - distal radius fx - distal ulna fx
26
indications for static wrist hand orthoses
burns joint replacements RA peripheral nn injury nn and tendon repair carpal tunnel wrist pain (prevent or manage) contracture prevention
27
what does the carpal tunnel CPG say about bracing
neutral positioned orthoses worn at night can suggest adjusting wear time to include day time, symptomatic, or full time use when night time only use is ineffective at controlling S&S should recommend orthoses for those with CTS during pregnancy
28
purpose and position of dorsal blocking splint
purpose - block wrist and finger extension - protect repaired flexor tendons typically positioned in 0 or 30 deg wrist flexion at neutral position may result in less flexion deformities, complications, and earlier return to activities
29
purpose and indications for volar blocking splint
purpose = block wrist and finger flexion indications: -contracture prevention - spasticity control - distal radius fx
30
indications for ulnar gutter splint
soft tissue hand injuries to 4th/5th fingers 4th and 5th metacarpal fx (i.e. boxers) 4th and 5th phalange fx (extended) positioning for RA
31
indications for radial gutter splint
soft tissue injury to 2nd and 3rd fingers fx to 2nd and 3rd metacarpals fx to 2nd and 3rd phalanges positioning for RA laceration over joints of 2nd and 3rd phalanges or metacarpals
32
symptoms of DeQuervain's Tenosynovitis
pain or tenderness while moving thumb pain when grasping an object or making a fist radiating pain to forearm swelling at base of thumb
33
kinds of splints used for DeQuervain's
short hand based (wrist free) splint including the IP joint of the thumb short hand based splint excluding the IP joint of the thumb long lower arm based (wrist immobilized) splint including the IP joint of the thumb long lower arm based splint excluding the IP joint of the thumb
34
symptoms of gamekeepers or skiers thumb
pain with pinch grasp weakness with pinch grasp difficulty gripping objects swelling or bruising at base of thumb can be a tear or sprain of the UCL
35
purpose/indications for thumb splint
immobilizes the thumb and possibly wrist indications: - scaphoid fx - lunate fx - thumb phalanx fx or dislocation - gamekeeper's or skier's thumb - DeQuervain's tenosynovitis - carpal tunnel syndrome (not standard) - CMC osteoarthritis
36
indications for thumb opponens splint
CMC OA spastic CP congenital deformity of thumb
37
recommendation for CMC joint OA
strong rec for soft or rigid hand orthosis
38
recommendation for other hand joint OA (aside from CMC joint)
conditionally recommendation for orthosis such as finger splints, digital orthoses, soft or rigid
39
what does mallet finger look like
DIP flexion
40
what does Boutonniere deformity look like
PIP flexion and DIP extension
41
what does swan neck deformity look like
PIP extension with MCP and DIP flexion common after trauma or in pts with RA
42
what is Elson's test
diagnostic test used for early detection of injuries to the central slip of the extensor tendon when it becomes noticeable = Boutonniere
43
what are relative motion orthoses
static orthoses - holds the affected finger in relative ext or relative flx compared to adjacent fingers protects or unloads injured or repaired tendon limits excursion of injured or repaired tendon usually made of firm thermoplastic typically worn for 4-7 weeks usually 3 or 4 finger designs
44
what is a relative motion flexor orthosis
15-20 deg MCP flexion relative to adjacent fingers provides laxity in lumbricals while increasing tension on extensor hood
45
indications for relative flexor orthosis indications
central slip laceration Boutonniere deformity digital nn repair flexor tendon repair interosseous repair lateral band sprain/tear post-PIP joint arthroplasty unexplained pain in palm of hand after metacarpal fx improve alignment of fingers with RA
46
how much extension is recommended for a relative motion extensor orthosis for long extensor tendon repairs vs sagittal band injuries
long extensor tendon repairs = 10-15 degrees of relative metacarpal joint extension recommended sagittal band injuries = 15-20 degrees of relative extension recommended
47
indications for relative extensor orthosis
extensor tendon repair zones IV-VIII sagittal band disruption intrinsic tendon transfer limit motion of split skin graft on dorsum of hand swan neck deformity mallet or trigger finger unexplained pain about the MCP joints or dorsum of the hand metacarpal head fracture improve alignment of fingers with RA
48
purpose of a serial static orthoses and how they work
mobilization prolonged low load cast or brace with ROM control worn full time
49
indication for a serial static splint
elbow fracture or contracture s/p biceps tendon repair PIP flexion contracture
50
possible MOI for a PIP flexion contracture
dislocation/hyperextension or hyper flexion torsional injury soft tissue injury
51
comparison of serial static cast, dynamic orthosis, or static progressive splint for PIP flexion contracture
no difference in effectiveness factors to consider: - total end range time - pt comfort - compliance
52
what is a static progressive orthosis and how is it used
single splint that is adjustable worn at least 30 min 3x/day joint held at current end range positioning readjusting each wear
53
possible indications for static progressive orthoses
PIP joint contractures elbow flexion contractures knee flexion contractures
54
purpose of dynamic splints and how they work
purpose = mobilization use elastics, coils, or spring tensioning mechanisms to provide low long prolonged duration stretch in typically one direction shouldn't produce pain not as effective as static tension
55
possible indications for dynamic splint
radial nn injury s/p flexor tendon repair
56
how is a dynamic splint used for s/p flexor tendon repair
dorsal blocking- limited MCP ext elastic bands substitute/protect healing flexor tendons resists finger extension
57
purpose of specialized UE orthoses
act as a substitute for irreversible functional loss
58
purpose of a tenodesis splint
intended to enhance tenodesis grip indications = C6-C7 quadriplegia
59
what does research say is the best intervention to reduce UE spasticity post stroke and level of evidence
static splinting (low) dynamic splinting (low)
60
what does research say is the best intervention to increase hand function post stroke and level of evidence
use of static splinting (moderate) use of dynamic splinting (moderate) manual stretching (moderate)
61
what does research say is the best intervention to improve functional tasks post stroke and level of evidence
static splinting (moderate) dynamic splinting (moderate) manual stretching (moderate)
62
post op protocol for extensor tendon repair
immobilization early passive (controlled) mobilization early active mobilization prior evidence recommends early active mobilization with orthosis (unspecified) or controlled immobilization over immobilization
63
what does research say about UE orthotic intervention for children with CP
lack of evidence to support UE orthoses in kids with CP
64
what does research say about non-pharmacological interventions for spasticity in adults
low quality evidence for non-pharm interventions targeting spasticity, including splinting
65
what does research say about using splints/orthoses for the treatment of RA
insufficient support for use of wrist splints/orthosis for pain management or to improve function in people with RA

Year 3: Prosthetics and Orthotics (10 decks)

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