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Orthoses For Rheumatoid Fingers

RICHARD D . KOCH, C . O .

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DAVID A . BIRD, A . B . , C . O .

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T

will l i m i t its s c o p e p r i m a r i l y t o t h e fitting
he boutonniere deformity o f the
o f o r t h o s e s f o r these t w o d e f o r m i t i e s ,
f i n g e r ( F i g . 1 ) , p r e v a l e n t with rh­
a l o n g with s o m e considerations for a
e u m a t o i d arthritis, is c h a r a c t e r i z e d b y
t h u m b o r t(hPo. sI i. sP. . ) j o i n t a n d h y p e r t e n ­
f l e x i o n tightness o f t h e p r o x i m a linterphalangeal
s i o n o f t h e distal i n t e r p h a l a n g e a l ( D . I . P . )
W h y d o these d e f o r m i t i e s n e e d o r t h o t i c
j o i n t , a n d c a n usually b e h e l p e d b y a p p l i ­
t r e a t m e n t ? I n s o m e cases they d o n ' t ,
c a t i o n o f o r t h o s e s . T h e figuratively o p p o ­
b e c a u s e they s i m p l y c a n n o t b e c o r r e c t e d
site d e f o r m i t y , t h e swan n e c k ( F i g . 2 ) ,
(Fig.
3 ) . But m a n y
cases c a n b e
also c a n usually b e h e l p e d . T h i s p a p e r
c o r r e c t e d , a n d skeletal r e - a l i g n m e n t p r o ­
v i d e d b y a n orthosis allows m u c h relief

Fig. 1. an example of the boutonniere deformity.

3. M a n y types o f orthoses. in­ c l u d i n g off-the-shelf i t e m s . e v e n t h o u g h P . 2. f r o m the c r u d e t o the s o p h i s t i c a t e d . from pain. . Dorsal surface view of a "Boutonniere" or­ thosis in place. f l e x i o n is p r e v e n t e d w h e n the b o u t o n n i e r e orthosis ( F i g .Fig. 4. reduces e d e m a . and provides a d e t e r r e n t to further d e f o r m i t y . h a v e b e e n used f o r the t r e a t m e n t o f these t w o d e f o r m i t i e s . a n o t h e r a d v a n t a g e f o r the p a t i e n t is greater use o f the finger t h r o u g h stabilization. An example of the swan neck deformity. P . a n d s o m e o f Fig. A boutonniere deformity that is not amen­ able to correction by application of an orthosis. I . 4 ) is u s e d . Fig.

j o i n t a n d the d o r s a l b a n d is l o c a t e d o v e r the P . A view of the knuckle bender. T h e s e orthoses are light in w e i g h t a n d are accepted from a cosmetic standpoint. F o r the p a t i e n t w i t h a severe b o u t o n ­ niere d e f o r m i t y . A l l o f these devices i n v o l v e the three-pointpressure system n e e d e d to a c h i e v e stabili­ zation and correction. swan n e c k . P .i n . c a r e b e i n g t a k e n to p r o v i d e the p r o p e r c o n t o u r s a n d a v o i d u n d u e pressure o v e r the fingers a n d h a n d . the b o u t o n n i e r e r e d u c t i o n orthosis ( F i g . 7) is fitted w i t h the v o l a r p r o x i m a l b a n d 1 / 8 . I . a n o u t r i g g e r i n v o l v i n g an M P stop a n d a P . a n d t h u m b orthoses that a c h i e v e c o r r e c t i o n are o u t l i n e d b e l o w . will refuse to w e a r a finger orthosis that is b u l k y a n d "uncosmetic". b u t must b e c o s m e t i c a l l y a c c e p t ­ able. l o w e r a n d u p p e r l i m b s . dynamic extension unit.Fig. c o r r e c t i o n will n o t o c c u r w h e n the orthosis is n o t w o r n . j o i n t so as to a p p l y pressure o n the . 5 ) . n o m a t t e r h o w severe the de­ f o r m i t y o r h o w great the p a i n . d y n a m i c e x t e n s i o n unit m a y b e a p p r o p r i a t e ( F i g . for the very severe. I . T h e p r o c e d u r e f o r fitting b o u t o n n i e r e . P . O b v i o u s l y . b u t m a n y patients.P. and not bulky. distal to the w e b s p a c e . cer­ vical s p i n e . N o t many orthoses d e s i g n e d for these t w o d e f o r m i ­ ties m e e t these s t a n d a r d s ( 1 ) . a truly successful orthosis m u s t n o t o n l y p r o m o t e a d e t e r r e n t to an i n c r e a s e in de­ f o r m i t y . H o w e v e r . T h e three-point-pressure system is utilized. T h e distal v o l a r b a n d is p l a c e d at the D .P. I . 5. Fitting the Boutonniere Orthosis T h e fitting o f orthoses f o r the fingers involves the s a m e c a r e a n d p r o c e d u r e c o m m o n to all orthoses f o r the trunk. a d y n a m i c reverse finger knuckle bender m a y b e used (Fig. An outrigger orthosis with an M. P .I. nontoxic. dynamic reverse finger these h a v e b e e n successful. T o reduce a boutonniere deformity. stop and a P. 6. 6 ) . Fig.

b u t specially d e s i g n e d o r t h o s e s are o f t e n used as well ( F i g s . e x t e n s i o n is restricted. P . T h e orthosis s h o u l d b e c o n t o u r e d so that pressure f r o m the distal b a n d tends to flex the D . joint. 1 3 ) in f l e x i o n stabilizes a n d p l a c e s the t h u m b in a f u n c t i o n a l p o s i t i o n ( F i g .Fig.I. j o i n t a n d the b a n d m u s t n o t i m p i n g e o n the P. 9 a n d 1 0 ) . P .P. P . I . Courtesy of Camp In­ ternational. I . T h e distal e d g e o f the distal d o r s a l b a n d s h o u l d b e at the D . j o i n t so as to a l l o w P . I . P . A schematic showing system of forces provided by the "boutonniere" orthosis. d o r s a l s u r f a c e . P . I . T h e volar b a n d should be just p r o x i m a l to the P . Fitting the T h u m b Orthosis T h e orthosis f o r d e f o r m i t i e s o f the IP j o i n t in h y p e r e x t e n s i o n a n d M P j o i n t ( F i g . . e x t e n s i o n ( F i g . P . P . Fitting the S w a n N e c k Orthosis T h e s w a n n e c k orthosis is o f t e n a b o u t ­ o n n i e r e orthosis r o t a t e d 180 d e g . I . j o i n t . I . T h e v o l a r pressure a p p l i e d b y the distal b a n d w h i l e P . Inc. the p r o x i m a l d o r ­ sal b a n d s h o u l d b e 1/8-in distal t o the M P j o i n t a n d m u s t n o t i m p i n g e o n the P . e x t e n s i o n is a t t e m p t e d en­ c o u r a g e s D . I . j o i n t w i t h the P . 11 a n d 12). 8 ) . 7. f l e x i o n w i t h the orthosis w h i l e P . P . I . P . I . j o i n t b e i n g h e l d in the c o r ­ rected position (Fig.

P. joint is allowed while the P.P. a r e d u c ­ t i o n o f p a i n a n d e d e m a will usually f o l l o w w h e n a well fitting. n o n t o x i c . Flexion of the D. Fig. it is diffi­ cult to k e e p it s i m p l e a n d at the s a m e t i m e p r o v i d e an orthosis that is a c c e p t ­ a b l e f r o m the c o s m e t i c s t a n d p o i n t . Courtesy of Camp In­ ternational. T h e orthosis is c o n t o u r e d to the t h u m b . T h e third p o i n t o f pressure is the wrist strap w h i c h applies a laterally directed force. c o r r e c t l y d e s i g n e d o r ­ thosis is a p p l i e d . T h e b a n d s h o u l d b e p r o x i m a l t o the IP j o i n t b u t n o t c a u s e i m p i n g e m e n t in the w e b s p a c e . 8. W i t h the b o u t o n n i e r e a n d swan n e c k d e f o r m i t i e s that are c o r r e c t a b l e . thus c a u s i n g the I P j o i n t to flex. a n d c o s m e t i ­ cally a c c e p t a b l e . Pressure is a p p l i e d to the M P j o i n t w h i l e the b a n d is b r o u g h t a r o u n d in c o n t o u r so as to a p p l y pressure in a dorsal d i r e c t i o n . . S u c h an orthosis m u s t b e light. 9. Discussion W h e n treating r h e u m a t o i d arthritis w i t h intrinsic h a n d d e f o r m i t i e s . It m u s t b e c a p a b l e o f b e i n g adjusted easily w i t h o u t fear o f Fig. joint is held in the corrected position. A palmar view of the "boutonniere" ortho­ sis.I.1 4 ) .I. Inc. n o t b u l k y . A schematic showing the system of forces provided by the "swan neck" orthosis.

or deforming stainless breaking steel orthosis the orthosis. P . orthotic principles not only meets designed A around these r e q u i r e m e n t s b u t will b e s e r v i c e a b l e for m a n y years. Flexion o f the P . A stainless steel orthosis f o r these two d e f o r m i t i e s is a v a i l a b l e f r o m C a m p I n t e r ­ national. T h e a l u m i n u m or plastic t u b e f o r s w a n n e c k c o r r e c t i o n is m o r e dif­ ficult to a d j u s t a n d w i t h t h e aluminum Fig. A volar view o f a "swan neck" orthosis. joint is allowed while exten­ sion is restricted. I . Medial view o f the "swan neck" orthosis.Fig. 10. 11. Inc. It can be fashioned from a tube o f either aluminum or plastic. .

Fig. A dorsal view of a "swan neck" orthosis. 13. Fig. P . 14. . I . Fig. joint. T h e distal band encourages extension o f the D . 12. A n example of the boutonniere deformity in the t h u m b . View of the "thumb boutonniere" orthosis in p l a c e .

. University of Michigan Hospital Ann Arbor. for his early work in this area. With a plastic orthosis bulk definitely is a prob­ lem. Michigan 48109 2David A . Footnotes 1Richard D . Rene. 1:5. O . C . B . p. . Michigan 48109 has been found to be the best material for the reasons stated above. A ." Arthritis and Rheumatism. Koch. . breakage is a factor. "Orthotic devices to pre­ vent deformities on the hand in rheumatoid arthri­ tis. Chapter V . Fow­ ler. C . Hand Pain and Impairment. Director of Orthotics and Prosthetics References (1) Bennett. Credit should be given to Ben C . 120. (2) Cailliet. 1965. Oct. Robert L . C . For the t h u m b orthosis stainless steel University of Michigan Hospital Ann Arbor. . O .orthosis. O . Bird.

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