Orthoses for Management of Hand Dysfunction

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Introduction[edit | edit source]

Orthosis can be defined as a custom-fabricated brace/splint that supports a weak or deformed body part or restricts motion in injured/diseased part of the body. [1]

There are various types of hand orthoses[2]:

  • Static
  • Static progressive
  • Dynamic (for increasing motion)
  • Dynamic (for function)

Static Orthosis[edit | edit source]

Static orthosis is stiff and holds the specific part in a safe position. It helps to stabilize and support the injured part by immobilizing and restricting motion at a joint. It doesn't create any over-pressure or stretch to part it supports.[2]

Static Progressive Orthosis[edit | edit source]

Static progressive orthosis is different than static in a feature that it provides consistent pressure or stretch at the maximum range the joint can reach. It is used primarily to increase the range of motion hence, when the stretch is no longer felt in the tissue appropriate modification is done to reach desired position of stretch and is continued until the expected range is achieved.[2]

Dynamic Orthosis[edit | edit source]

Dynamic orthosis can be used to increase motion and for function.[2]

Dynamic orthosis that is used for increasing m0tion works by providing continuous stretch to one direction and allows movement in opposite direction.[2]

Dynamic orthosis that is used for function woks by allowing movement at specific part of the hand. It supports the part of hand through allowing motion that may be lost due to injury, surgery or various other conditions.[2]

Assessment[edit | edit source]

Orthotic assessment for hand includes use of clinical qualitative and quantitative means alongside with patho-biomechanics of the hand. Orthotic assessment is goals include evaluating patient for splinting design program and instructions for the wearing times and exercise regimen, donning and doffing, and precautions. Depending on the hand dysfunction, some of the essential patient information to assessed are[3]:

  • Demographic data such as age and individual client factors like vocation/avocation.
  • Chief complaint of the patient such as type of pain during hand and wrist activity in static or dynamic conditionHis.
  • History of previous orthotic treatment and challenges if there is any
  • History of patient medical conditions and further treatment plans.
  • Assessment of hand grip power.
  • Hand and wrist range of motion.
  • Upper extremity reflexes for any abnormalities.
  • Integrity of the skin condition for choice of orthotic splint material.
  • Body temperature and perspiration level of the patient is essential in choosing orthotic splint material and design and provision of hole over orthotic splint.
  • Hand soft tissue injuries/swelling and pain level if there is any.
  • Radiological investigation may be conducted in some instances depending on the suspecting diagnosis for the hand dysfunction. X-ray finding (structure of carpal tunnel and any other involvement).
  • Hand nerve supply integrity check, coordination, and hand dexterity check.
  • Orthotic assessment for Efficient fabrication, and attaining purpose (immobilize, mobilize, restrict motion, or transmit torque).
  • Orthotic assessment effect on joints not included in splint; kinetic effects

Measurement [edit | edit source]

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Fitting[edit | edit source]

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Troubleshooting [edit | edit source]

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References [edit | edit source]

  1. American Society of Hand Therapists.Practice.Coding. Orthoses Versus Splint.Accessed on:2021/06/07. Available from:https://www.asht.org/practice/durable-medical-equipment-dme/orthotics/coding#%22Orthosis%22%20Versus%20%22Splint%22
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Middleton C. Advice From a Certified Hand Therapist: Types Of Custom Orthoses. Handcare-The Upper Extremity Expert. Available from: https://www.assh.org/handcare/blog/advice-from-a-certified-hand-therapist-types-of-custom-orthoses. Accessed on:2021/06/12
  3. Raihan HM, Ghosh P, Lenka P, Equbal A, Biswas A. Orthotic Treatment Overview of Carpal Tunnel Syndrome. InPeripheral Nerve Disorders and Treatment 2020 Jul 8. IntechOpen.