Upper Limb Orthotics

General Considerations

Upper extremity orthoses are devices applied externally to restore or improve functional and structural characteristics of the musculoskeletal and nervous systems. In general, musculoskeletal problems include those resulting from trauma, sports, and work-related injuries. Upper extremity orthoses also are used frequently on patients who have had neurologic problems, such as stroke, traumatic brain injury (TBI), multiple sclerosis (MS), cerebral palsy (CP), spinal cord injury (SCI), and peripheral nerve injury. They often are used in arthritic conditions as well. The material used in orthotic devices includes low-temperature thermoplastics that can be custom-made for fit and other appropriations. Other materials include casting, metal, strapping, and Velcro. Custom-made upper extremity orthoses may be fabricated by physical, occupational, and hand therapists, as well as orthotists.

General classification

* Static orthoses: As the word static implies, these devices do not allow motion. They serve as a rigid support in fractures, inflammatory conditions of tendons and soft tissue, and nerve injuries.
* Dynamic/functional orthoses: In contrast to static orthoses, these devices do permit motion on which its own effectiveness depends. These types of upper extremity orthoses are used primarily to assist movement of weak muscles. Some dynamic splints have a dual- or bilateral-tension–providing mechanism, safely accommodating for moments of spasms, and, therefore, possibly limiting or avoiding soft tissue injuries.

Functions of upper extremity orthoses

* Increase range of motion (ROM)
* Immobilize an extremity to help promote tissue healing
* Apply traction either to correct or prevent contractures
* Assist in providing enhanced function
* Serve as an attachment for assistive devices
* Help correct deformities
* Block unwanted movement of a joint

Upper Arm Orthoses

Clavicular and shoulder orthoses

* Figure-8 harness/clavicular brace - Used to restrict motion in clavicular fractures to allow for tissue healing and bone remodeling
* Shoulder sling - Used to restrict shoulder motion in subluxated shoulders by providing humeral cuff and chest straps to keep the humeral head in the glenoid cavity
* Overhead sling suspension - Used for patients with proximal arm weakness or paralysis to allow hand or arm use when the muscles are at least antigravity in strength
* Hemi-arm sling - Used for immobilization of the hemiplegic shoulder, which helps to decrease pain and subluxation
* Balanced forearm orthosis
o Used primarily in patients with high-level tetraplegia or severe proximal arm weakness or paralysis
o Supports the weight of the forearm and arm against gravity
o May be attached to a wheelchair or table
o Patients may be able to perform tabletop activities.
o Prerequisites for use of the device include a power source, such as neck or trunk muscles, to shift the trunk center of gravity or adequate scapular movement.

Arm orthoses

* Arm sling
o Used in scapular or humeral fractures, acromioclavicular joint injury, rotator cuff injury, bicipital tendinitis, and hemiparesis with subluxation
o Includes the figure-8 sling, cuff sling, and glenohumeral support

Functional arm orthoses

* Used primarily in patients with proximal arm weakness involving the shoulder and arm
o Comprised of a shoulder saddle suspending a proximal forearm cuff by straps or a Bowden cable
o Used in patients with arm weakness, such as in SCI and peripheral nerve lesions

Elbow orthoses

* Posterior elbow splints - Used particularly for elbow immobilization in patients who have had recent elbow surgery and or inflammation
* Serial cast - Used for prevention or correction of contractures by promoting soft tissue stretch and passive ROM

* Air splint
o Used to maintain or increase elbow extension
o Form of circumferential inflatable sleeve, also used for contractures and elbow immobilization
* Dynamic elbow flexion orthosis - Used to maintain the elbow in 90° of flexion in cases of elbow contractures, burns, and fractures