Upper Limbs Orthotics

Dr Waleed Khan
 Introduction to Upper limbs
• Upper extremity orthotics describe orthoses, braces and
supports designed for the shoulder, arm, elbow, wrist and
hand and can be used for a range of needs from stability to
immobilization and include three main areas of orthoses:
Upper extremity soft supports, upper extremity positional
supports and upper extremity fracture orthoses.
 Introduction to Upper limbs
• Positional Supports
These orthoses are designed to position the upper extremity, including wrist,
arm and shoulder, so as to prevent unwanted contractures, maintain proper
alignment, and to provide controlled range of motion physical and
occupational therapy.
• Soft Supports
Often referred to as soft goods, these orthoses include those braces that are
fabricated/manufactured from neoprene, canvas, and fabric and can be
reinforced with metal/plastic stays for additional support.
• Fracture Orthoses
The type of the fracture and the location determines what type of orthosis
is appropriate. If the fracture site is near a joint it is often common to stabilize
above and below the affected area to reduce unwanted motion at the
fracture site.
 Hand and wrist-Hand Orthosis
• Assistive and substitutive hand orthosis and wrist-hand
orthosis(WHOs) are widely used in rehabilitation.
• Although many design were developed for patient who had
contracted poliomyelities, the orthosis are currently prescribe
primarily for individual with central and peripheral
neuropathies.
• Assistive orthosis position the hand so that the patient can
make maximum use of residual motor power.
• Substitute orthosis enable the patient to achieve prehension
by moving the wrist or a more proximal body segment to
cause finger movement.
 Protective Orthosis
• Many Protective WHOs are mass produced although nearly all
the design can be custom made of Plaster of Paris Or Plastic
Sheeting
• The wrist hand stabilizer orthosis also termed a resting splint,
is a sheet of semi rigid plastic placed on the palmer surface of
the hand and forearm.
• Sheet extend from distal tips of finger to the middle third of
the forearm and is curved to support the palmer arch and
cradle the forearm.
• Some stabilizer include a thumb component to prevent
motion of that digit.
 Protective Orthosis
• The Stabilizer is widely used by patient with exacerbation of
rheumatoid arthritis and those with burn who are vulnerable to
flexion contracture.
• A thumb stabilizer prevent movement of the first
interphalangeal and metacarpophlangeal joint.
• The orthosis consist of a longitudinal bar along the length of the
thumb with stabilizing straps or sleeve on the thumb and straps
around the hand.
• A finger stabilizing is used for the patient with boutonniere
deformity, which is persistent flexion of the proximal
interphalangeal joint.
• Its include a band that applies palamrly directed force at the
proximal interphalangeal joints.
• Two bands that apply dorsally directed forces to the proximal
and middle phalanges oppose the force.
 Corrective Orthosis
• Corrective orthosis apply low, constant force with appreciate
counterforce's to reduced contracture.
• Such appliance are usually factory made but can also br
custom made.
• The patient who has a flat hand with hand extension
contracture of the metacarpophalangeal joints may be fitted
with finger flexoi Ho.
• It has a dorsal located plate over the matacarpals and another
plate over the proximal phalanges linked to a palmar rod.
• Spring or rubber bands apply tensile force to the orthosis
 Forearm and Elbow Orthosis
• As a group elbow and forearm orthosis are less frequently
prescribe.
• Nevertheless, some patient benefit from protective or
corrective elbow orthoses, Very few tolerate or substitutive
elbow orthosis
 Shuolder Orthoses
• Most shoulder orthoses protect the glenohumeral joints from
subluxation,which usually occur because the patient has
flaccid hemiplegia or injury to the shoulder joints capsule.
 Upper Limbs Orthosis Evaluation/Finger, Wrist,Hand
and Forearm

• Orthoses is comfortable without excessive pressure, especially

at bony prominences.
• Mechanical joints are congruent with anatomical joints.
• Palmar surface of the thumbs and all finger are
uncoverd,except fro the wrist hand stabilizer.
• Forearm bar stabilizes the wrist in the desired position.
• Forearm bar does not restrict elbow motion.
• Patient can open and close the finger completely.
 Upper Limbs orthosis evaluation
Elbow and Shoulder Orthoses
• Orthoses is comfortable without excessive pressure, especially
at bony prominences.
• Mechanical joints are congruent with anatomical joints
• Forearm,elbow,and shoulder have intended range of motion.
• Patient can operate the control mechanism.