Upper Extremity Orthitics

Introduction

In recent years, increasing numbers of people of all ages have been heeding their health professionals' advice to get advice for all of the health benefits exercise has to offer. But for some people - particularly those who overdo of who don't properly train of warm up - these benefits can come at a price: injuries.

Regular physical activity is probably the most important thing a person can do to stay healthy. Today we know that physical activity reduces the risk of premature death in addition to the risk of cardiovascular disease, high blood pressure, type 2 diabetes, and even some types of cancer.

Our hands are truly complex, active and intricate parts of our bodies, allowing for a variety of functions. They allow us to feel, grasp, perform fine movements and discriminate while displaying exquisite dexterity. The primary function of the entire upper extremity is to place the hand in a position for optimal function. Hand intricacy is attributed to the large portion of the brain dedicated to their control.

The human hand function is indispensable in any human activity. In addition to being an

extremely versatile gripping tool it serves as an emotional communication link through

gestures and caresses. In spite of a fast mechanisation of activities which formerly were performed manually, a good hand function is still a prerequisite to get along in private life as well as in most occupations.

Hand injuries represent 20% to 25% of all injuries that are treated at emergency clinics. The injury panorama ranges from "innocent" sprains to complicated fracture-dislocations.

Orthoses play an important role in the prevention and rehabilitation of wrist and hand injuries. But as with any external implement that can alter the shape and function of the body, there is a fine balance that has to be achieved.

An injury causing stiffness of the wrist that eventually results in a fusion as a consequence of a missed diagnosis or inappropriate treatment, produces greater medical disability than does loss of the anterior cruciate ligament in the knee. Therefore, the orthotist must strive to provide an accurate diagnosis and treatment of hand and wrist injuries.

The first treatment goal of hand injuries is to restore function followed by pain relief and cosmetic appearance. The hand and fingers tolerate injury and immobilization poorly and thus immediate and appropriate medical attention is of paramount importance as delay of treatment can have dire long-term consequences.

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Burns 1

Group: Wrist and hand disorders

Diagnosis: Injuries to soft tissues caused by contact with dry heat (e.g., fire), moist heat (e.g., steam or hot liquid), chemicals, electricity, friction, or radiant energy. (1)

1. Partial-thickness burns. (2)

A. Superficial partial-thickness:

First or second degree burn (i.e., deÐ'¬struction of epidermis and possibly

portions of upper dermal layÐ'¬ers). Appears red, bright pink, blistered, wet,

and soft. Painful. No grafting necessary for healing.

B. Deep partial-thickness:

Deep second degree burn. Destruction of epidermis and greater portion of

dermal layer (hair follicles, sweat glands). Appears red or white, wet, soft,

elastic. Sensation may be diminished. Potential conversion to full thickness

burn.

2. Full-thickness burs

Third degree burn (Fig 1.1). Destruction of entire epidermis and dermal layÐ'¬ers (hair follicles, nerve endings, sweat glands). Requires skin grafting. Appears white or tan, waxy, dry, leathery, non-elastic.

3. Fourth degree burn

Deep soft tissue damage to fat, muscle, and bone.

4. Electrical Burn

Thrombosed blood vessels, destruction

of nerves along pathway,

possible fractures, dislocations.

Requires surgical excision of necrotic

tissue. Possible amputation.

Figure 1.1: Full-thickness burn of wrist and hand

(www.google.com)

Causes: MVA. Accidental. Industrial accidents. Chemical burns. Liqued burns. Electrocution Ð'- inlet and outlet points on the body.

Fabrication criteria Ð'- Orthoses

 Deep partial-thickness burns Ð'- not grafted

Splint in intrinsic-plus position; that is,

wrist 20 degrees to 30 degrees extension;

metacarpoÐ'¬phalangeal (MCP) joints:

70 degrees flexion; interphalangeal (IP) joints

full extension; thumb abducted and extended

(Fig. 1.2).

Figure 1.2: Orthosis designed to be used with dorsal hand burns. (www.othomerica.com)

 Full-thickness burn

Orthosis placed in intrinsic plus position unless the dorsal surface of the hand and fingers are grafted; then splint with fingers in abduction, and consider use of fingernail hooks for proper positioning and tension (Fig. 1.3)

Figure 1.3: Orthosis for dorsal hand and finger grafts.

www.orthomerica.com

Rehabilitation criteria:

 TREATMENT AND SURGICAL PURPOSE (3)

To prevent deformity where burns have occurred and to restore