Introduction To Orthotics: Tammy J. Lesage Mot Otr/L, CHT Elisabeth Mcgee DPT, Mot, PT, Otr/L, CHT, MTC

Introduction to Orthotics
Tammy J. LeSage MOT OTR/L,

CHT
Elisabeth McGee DPT, MOT, PT,
OTR/L, CHT, MTC
Guess Who???
Splint or Orthosis
What are your thoughts about the terms?
http://www.asht.org/practice/l-codes
Why Orthotics for OT?
Uses of Orthoses for OT
How can you use ?

Client-Centered Bio-
occupational Approach
Rehabilitation of the Hand and Upper Extremity, 2011

History of Orthotics
Physical rehab WWII (1939 1945)
Sterling Burnell MD
Splints/orthotic devices commercially
available 1940s
Splints/ orthotic devices for function
1950s polio
Low temperature thermoplastics
(temps 135 180 degrees) 1960s
Anatomical Structures of
Importance for Orthotics
Wrist Blood Supply
Digits Arches of the Hand
Thumb Creases of the Hand
Muscles and Prehension and
Tendons Grasp Patterns
Nerve Supply
Wrist Joints and Ligaments
Joints
Radiocarpal Joint
Midcarpal Joint
Distal Radioulnar Joint
Ligaments
IntrinsicLigaments
Extrinsic Ligaments
The Hand Examination and Diagnosis, 3rd Ed., 1990
Digits MCP, PIP, DIP Joints
Metacarpals two joints each
Carpal bone articulation
Metacarpophalangeal joints MCP/ MP
joints.
Ligaments
CollateralLigaments
Volar Plate
MCPs extension = shortening
of laxed collateral ligaments
contraction and adherence of
volar plate
***Contracture of the MCPs in

extension results in decreased
flexion of the MCPs and
decreased function of the hand.
Proximal Phalanx & Distal
Phalanx
Both are hinge joints flexion/
extension
Ligaments
Collateral Ligaments
Volar plate
Position of the PIP/ DIP joints
to prevent contracture is
opposite of MCP joint.
The PIP joint is very susceptible to

adhesion and flexion contracture.
Safe Position Orthotic Device
MCP flexion with IP

(PIP/DIP) extension
Why????

To prevent deformity!!
Especially if edema is present.
** there are some injuries/

diagnoses that state differently
and are exceptions to this
Thumb
Joints and Ligaments
Joints
Carpometacarpal (CMC) Joint
Metacarpophalangeal (MP) Joint
Interphalangeal (IP) Joint
Ligaments
Collateral ligaments
Muscles and Tendons of the
Hand
Extrinsic Muscles of the Hand

Intrinsic Muscles of the Hand
Extrinsic Muscles of the Hand
Two groups: Extensor muscle group
Flexor muscle group
Each has a retinacular system
Extensor retinacular system
Flexor retinacular system
Digital pulley system

Extrinsic Extensor Tendons
APL,EPB
ECRL, ECRB
EPL
EDC, EIP
EDM
ECU
Extrinsic Flexor Tendons
FDS index small

FDP index small
FPL
What is Tenodesis?
How can this affect design of

orthotic device??
Decreased wrist motion, due
to joint or extrinsic tendons?
How can you evaluate? How

would you position in orthotic
device to increase motion???
Intrinsic Muscles of the Hand
Organize them in three compartments
Thenar eminence
OP, FPB, APB, AP
Hypothenar eminence
ADM, FDM, ODM, PB
Central Compartment
Lumbricals x 4
Interossei 4 dorsal, 3 palmar
What is an intrinsic plus
position?
Intrinsic minus hand?

How would you position in
orthotic device?
Intrinsic Vs Extrinsic Tightness
Digits
Extrinsic Flexor Tightness
What is it? How would you position it?
Extrinsic Extensor Tightness
What is it? How would you position it?
Intrinsic Tightness
What is it? How would you position?
Nerve Supply Considerations
with Orthotic Devices
Areas of pressure by orthosis upon

nerves
Decrease sensation due to peripheral
nerve disruption.
Decrease peripheral nerve motor
function leading to muscle imbalance
and dysfunctional posturing of the hand.
Common areas of pressure
When fabricating an orthosis, you want
to avoid applying pressure over sites
where the nerve is superficial and prone
to compression.
Ulnar nerve a) elbow b) guyons canal
Radial nerve a) elbow b) dorsal/ radial
anatomical snuffbox
Digital nerves lateral borders of fingers
and thumb
Decrease Sensation
Peripheral Nerve Disruption
Sensory Nerve Distribution

Radial, Ulnar, Median Nerves
Care must be taken with orthotic device
Monitor skin, check for area of abrasion or
irritation.
Decreased Peripheral Nerve
Motor Function
Leads to muscle imbalance and dysfunctional
posturing of the hand.
Radial Nerve wrist drop, decreases MP
extension digits, thumb extension.
How would you position?
Ulnar Nerve Flat hand, claw hand ring and small
fingers
How would you how would you position?
Median nerve Decreased thumb function
How would you position?
Radial Nerve Orthosis
Used with permission from Sammons Preston

Ulnar Nerve Orthosis

Median Nerve Orthosis

Blood Supply to the Hand
Ulnar Artery, Radial Artery
Superficial Palmar Arch, Deep Palmar
Arch
Common digital arteries, digital arteries
Care must be taken when splinting not
to compress on arteries to compromise
circulation
Arches of the Hand
The intrinsic musculature has an important
relationship with the arches. Collapse of the
arches can contribute to severe disability and
deformity
Proximal Transverse Arch
Distal row of carpal bones
Fixed arch without much motion
Distal Transverse Arch
Distal palmar crease
Mobile arch
Longitudinal Arch
Longitudinal axis of each finger
Rigid and mobile portions
Creases of the Hand
Distal Digital Crease
Middle Digital Crease
Proximal Digital Crease
Distal Palmar Crease
Proximal Plamar Crease
Thenar Crease
Distal Wrist Crease
Proximal Wrist Crease
Functional Prehension, Grasp
Patterns, and Manipulation
Skills
Functional Prehension
Patterns
Prehensilemovements: incorporate
grasping of an object and can be
subdivided into having two purposes,
precision grasp and power grasp.
Precision grasp: uses opposition of the
thumb to the fingertips
Power grasp: uses the whole hand with
thumb flexion or abduction according to the
control needed for the task
Functional Grip Patterns
A position of the hand that facilitates contact
of an object against the palm and palmar
surface of the partially flexed digits.
Cylindrical grip
Spherical grip
Hook grip
Intrinsic plus grasp
Disc grasp
Manipulation Skills
Finger-to-palm translation
Palm-to-finger translation
Shift
Demonstrated when an object that is being held
on the radial aspect of the hand is moved linearly
on the finger surface in order to reposition it on the
finger pads (e.g. repositioning a pen after grasping
it)
Rotation
E.g. Rotating a pen to use the eraser
In-hand manipulation with stabilization

E.g. Picking up coins while holding them in their palm

Introduction To Orthotics: Tammy J. Lesage Mot Otr/L, CHT Elisabeth Mcgee DPT, Mot, PT, Otr/L, CHT, MTC

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Introduction To Orthotics: Tammy J. Lesage Mot Otr/L, CHT Elisabeth Mcgee DPT, Mot, PT, Otr/L, CHT, MTC

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Introduction to Orthotics

Tammy J. LeSage MOT OTR/L,

How can you use ?

Rehabilitation of the Hand and Upper Extremity, 2011

Distal Radioulnar Joint

***Contracture of the MCPs in

The PIP joint is very susceptible to

MCP flexion with IP

The Hand Examination and Diagnosis, 3rd Ed., 1990

** there are some injuries/

Interphalangeal (IP) Joint

Extrinsic Muscles of the Hand

Digital pulley system

FDS index small

How can this affect design of

How can you evaluate? How

Intrinsic minus hand?

Areas of pressure by orthosis upon

Sensory Nerve Distribution

Used with permission from Sammons Preston

Used with permission from Sammons Preston

Used with permission from Sammons Preston

In-hand manipulation with stabilization

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