Video Runtime: 172 Minutes; Learning Assessment Time: 19 Minutes
This course is a recording of a previously hosted live webinar event. Polling and question submission features are not available for this recording. Format and structure may differ from standard MedBridge courses.
In many hand therapy clinics and departments around the world, therapists are being asked to evaluate and treat their clients quickly but effectively. Often therapists have little or no time between clients, and in fact, clients often have overlapping appointments. Therefore, there is a need to increase the efficiency of all aspects of hand therapy treatments, including orthotic fabrication.
While the fabrication process and molding of an orthosis on a client should never be rushed, this course will feature simplified fabrication techniques for both complex and simple orthoses, which can help reduce the time needed to fabricate each orthosis.
The course will cover descriptions of seven clinical diagnoses, discuss orthotic interventions for each, and show a live orthotic fabrication session highlighting a specific orthotic design. Client wearing schedules will be discussed, as well as tips for increasing client compliance. Topics and orthotic fabrication demonstrations will include the following:
1. Limitation of forearm rotation with a Muenster orthosis
2. Clinical conditions requiring the use of thumb orthoses (both short opponens and long opponens orthoses)
3. Proximal interphalangeal joint orthoses: static and dynamic orthoses to manage PIP flexion contractures, anti-swan-neck deformities, and simple finger immobilization
4. Clinical conditions benefiting from the use of relative motion orthoses
5. Creation of cost-effective hinges out of thermoplastic material that allow motion in a desired direction while limiting or preventing motion in an undesired direction
Meet Your Instructor
Deborah A. Schwartz, OTD, OTR/L, CHT
Deborah A. Schwartz is a hand therapist with more than 34 years of experience as a practicing clinician. She has worked at Orfit Industries America for the past ten and a half years promoting product awareness and offering a variety of educational programming on orthotic fabrication. Debby is an active member of the American Society…
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1. The Muenster Orthosis: An Orthosis That Limits Forearm Rotation
Certain clinical diagnoses require the stabilization of the forearm bones and prevention of forearm rotation in order for injured structures to heal. Distal radial ulnar joint injuries, TFCC injuries, and complex forearm bone fractures are typical diagnoses in which immobilization of the forearm in neutral is specified. The Muenster orthosis, as demonstrated here, can be made effectively and quickly from an innovative material that contributes to overall client comfort and compliance.
2. Thumb Orthoses: Short Opponens and Long Opponens Orthoses
Multiple clinical diagnoses require thumb immobilization for healing after injury or for improved function. The most common conditions that benefit from the use of a short thumb opponens orthosis might be osteoarthritis and/or rheumatoid arthritis. Thumb sprains, tendinitis, fractures, and arthritic conditions involving the thumb and the wrist might require a long opponens orthosis. There are multiple design options for these two orthoses. In this chapter, a quick and effective method using an innovative material will be featured.
3. Proximal Interphalangeal Joint Orthoses
Due to the complex anatomical structures of the proximal interphalangeal joint, complications are typical after injury. Edema, stiffness, and loss of motion are common. Early detection of injury, appropriate treatment protocols, and use of the correct orthosis can help restore function. Orthoses can also help when there are range-of-motion deficits in the joint or limited joint stability.
4. The Relative Motion Orthosis
The relative motion orthosis offers an easy orthotic intervention for a variety of clinical issues involving the fingers. By placing one or two MCP joints in relatively more or less extension than adjacent fingers, force can be transmitted distally for improved PIP joint range of motion. Or the tension on repairs of extensor tendons and/or sagittal bands is decreased. Patients report less pain and improved function while wearing this simple finger-based orthosis.
5. Thermoplastic Hinges in Mobilization Orthoses
Thermoplastic hinges can easily connect distal and proximal components of an orthosis, allowing motion in desired directions at the joint in between. When placed appropriately, these hinges can block wrist flexion and extension but allow motion in the dart thrower’s plane, a motion that occurs at midcarpal range and eliminates movement of the proximal carpal row. Hinges can also be used with a long thumb opponens orthosis by allowing flexion and extension but blocking ulnar and radial deviation, and in this way play an important role in the treatment of de Quervain’s syndrome.
6. Question and Answer Session
This section is a viewer-submitted question and answer session facilitated by Deborah Schwartz.