Orthoses for Mobilization of the Wrist

presented by Deborah A. Schwartz, OTD, OTR/L, CHT

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Dynamic wrist orthoses that allow specific patterns of motion and block unwanted motion can be extremely beneficial in certain diagnoses and rehabilitation protocols, such as scapho-lunate ligament injuries. And static progressive and/or dynamic orthoses can help clients regain lost wrist joint motion after trauma or injuries have caused joint capsule shortening and stiffness. Therapists require core knowledge in upper extremity anatomy and clinical pathologies and an understanding of the biomechanical principles of orthotic fabrication in order to select the appropriate mobilization orthosis as an intervention for clients requiring mobilization of their wrist joints. Therapists also need hands-on practice to make well-fitting and appropriate dynamic and/ or static progressive orthoses for a variety of diagnoses affecting the wrist. They require awareness of pattern-making guidelines and the fabrication process using thermoplastic materials and advanced knowledge of appropriate dynamic and static progressive outrigger systems to aid in their orthotic design.

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. Anatomy of the Wrist

This chapter will review basic anatomy of the wrist, including the arrangement of the carpal bones, carpal bone kinematics and the significance of the scaphoid in wrist movement patterns. The chapter will briefly discuss clinical conditions of the wrist and their complications that might benefit from orthotic fabrication of mobilization orthoses.

2. Dart Thrower’s Motion Orthosis

This chapter will introduce the viewer to a dynamic wrist mobilization orthosis used pre- and post-operatively for clients recovering from a scapho-lunate ligament sprain and/or following a scapho-lunate ligament repair. The Dart Thrower’s motion is the functional motion of the wrist, incorporating wrist extension and radial deviation moving towards wrist flexion and ulnar deviation. The Dart thrower’s motion appears to limit extensive motion at the proximal carpal row, (specifically between the scaphoid and adjacent lunate bones) and therefore preserves the scapho -lunate ligament while allowing for restricted, yet protected, wrist motion. The Dart Thrower’s motion orthosis is a dynamic orthosis that allows this pattern of wrist extension with radial deviation moving towards wrist flexion with ulnar deviation. The dynamic orthotic fabrication techniques of making this complex orthosis in a simple way along with the relevant rehabilitation protocol will be covered. The chapter will highlight the pattern making process, fabrication steps, important guidelines for adding outriggers and checking the correct fit, and precautions for the use of dynamic orthoses.

3. Static Progressive Wrist Flexion and Extension Orthosis

This chapter will introduce the viewer to a static progressive orthosis used to help regain passive range of motion in the wrist in both directions of flexion and extension. Wrist injuries often result in decreased active and passive wrist motion. A review of the relevant and related anatomy is included. A discussion of the fabrication steps and techniques along with a proposed wearing schedule will be outlined. The chapter will cover the pattern making process and full fabrication steps will be demonstrated. Important guidelines for the outriggers, checking for the correct fit, and precautions for the use of static progressive orthoses will be included in the discussion and video.