Anatomy
Describe functional position
Wrist: 30 degrees of extension, neutral in the coronal plane.
MCP joints: 35-40 degrees of flexion.
PIP joints: 30 degrees of flexion.
Thumb: Opposed to digits 2 and 3, with the IP joint extended and the web space maintained.
What is a thumb abduction assist used for
radial nerve injury: abductor pollicis longus weakness
most basic immobilization device
sling
Mallet finger presentation & orthosis goals
Cause: flexion DIP
Goal: prevent DIP flexion and maintain extension/hyperextension
Hand of benediction
median nerve injury resulting in loss of flexion of digits 2&3
Describe Intrinsic Plus position and its cause
caused by imbalance between spastic intrinsic (interossei and lumbricals) weak extrinsic (safe position)
Position: 30 wrist ext, 70-90 MCP flex, PIP/DIP ext
What is a C Bar used for
AKA Adduction stop
- tight web space
Median and radial nerve injuries
What orthosis would you use for someone with limited voluntary shoulder control and endurance for UL positioning (e.g., spinal cord injury, ALS, muscular dystrophy, Guillane Barre, Polio)
mobile arm supports
Boutonniere deformity presentation & orthotic goals
Presentation: PIP flexion and DIP hyperextension
Orthosis: hold the PIP in extension while allowing movement at the DIP and MCP joints
Wartenberg's sign
tests ulnar nerve; fifth finger held abducted from fourth finger
Describe intrinsic minus position and its cause
caused by imbalance between strong extrinsic is and weak intrinsics
Position: MCP hyperextension, PIP/DIP flexion
what is a thumb extension assist used for
radial nerve injury --> weak extensors of thumb
Name the true joints of the shoulder
Glenohumeral
Acromioclavicular
Sternoclavicular
Swan neck presentation and orthosis goals
Presentation: PIP hyperextension, DIP flexion
Goals: A dorsal orthosis holds the PIP in slight flexion, preventing hyperextension and promoting proper movement at the DIP joint
Froment's sign
identifies ulnar nerve dysfunction; tests adductor pollicis
Origins of
- wrist extensors
- wrist flexors
- triceps insertion
- biceps insertion
Lateral epicondyle: extensors
Medial epicondyle: flexors
Olecranon: triceps insertion
Radial tuberosity: biceps insertion
What is a thumb post used for
no MP/IP control
-Ex: complete SCI, intrinsic minus hand, nerve injuries
Name the rotator cuff muscles and their main actions
Supraspinatus - abduct
Infraspinatus – externally rotate
Teres Minor – externally rotate
Subscapularis – internally rotate
Brachial plexus injury orthotic management
glenohumeral stabilization --> stepLock joint
Rock
Paper
Scossors
OK
Rock: median; wrist and finger flexors
Paper: radial (posterior interosseous); wrist and finger extensors
Scissors: ulnar; palmar and dorsal interossei
OK: anterior interosseous (median)
Demonstrate all thumb motions (AB/ADD, Flex/Ext, Opp)
visual
Describe ratchet vs wrist driven and what spinal cord injury levels they are good for
Wrist-driven: Often used for individuals with C6 or C7 spinal cord injuries, these orthoses harness tenodesis to allow for grasp and release functions.
Ratchet-driven are also used for individuals with higher-level spinal cord injuries (C5).
name the types of joints of the GH, AC, SC
GH: ball and socket; synovial
AC: plane; synovial
SC: saddle; synovial
largest population with soft tissue contractures
SCI
Spinal Cord Injury (SCI) Levels and Functional Deficits
C4: sip and puff, positional orthoses
C5: ratchet driven ; No extension force at all (Ratchet driven à can change the amount of extension required for tenodesis and what extension position they will be in when reaching tenodesis)
C6: wrist driven ; Some extension force (Wrist driven) --> more likely to have ECRL
C7: wrist driven ; Most or all extension force --> also will have ECRB
C8: static HO or no ox ; intrinsic hand muscle weakness but retain all wrist