Etymology: Greek: to straighten, to align
Used in a sentence: The therapist at Reach fabricated a custom orthosis for my wrist pain.
Orthoses are often referred to as splints or braces. Most people are only familiar with the aluminum and blue foam splint that you often see people with sprained fingers wearing or cloth and metal wrist braces you can buy at the
drug store. Therapeutic custom orthoses
fabricated by hand therapists take things to the next level! They are made of low temperature thermoplastic and may also include Velcro, wire, rubber bands, leather and various hardware. The type of material, the position of your hand, and the shape of your orthosis are all purposely thought through by your therapist to create an orthosis that is one of a kind. The anatomy and biomechanics of the hand and wrist are very complex and each joint needs to be placed in a specific position to maximize healing and recovery. The precise mold of your orthosis allows for comfort and support while the thermoplastic material allows for a light, waterproof, adjustable and breathable device. Orthoses can be used to immobilize a body part to allow for healing but also to mobilize specific joints that have become stiff following an injury or surgery.
The goal of a static orthosis is to immobilize or restrict movement of one or more joints to reduce inflammation, protect structures and allow for healing. They can be used after an acute injury (ex: fracture), a cumulative trauma injury (ex: carpal tunnel syndrome) or after a surgery (ex: tendon repair). The orthoses are rigid but comfortable and hold your injured joints or tissue in a safe position.
A dynamic orthosis refers to the use of dynamic or moving parts which is usually achieved with the use of rubber bands or springs. Dynamic orthoses can be used for two main purposes. First, they are used by hand therapists to provide a constant light stretch to a stiff joint to help regain range of motion and maximize tissue healing. The orthosis stretches the joint in one direction via the elastic component while allowing the joint to actively move in the opposite direction.
The other common use of dynamic orthoses is to improve function of a specific joint or body part. This is often seen after a severe injury involving nerve damage. The dynamic orthosis compensates for weak or absent muscles and helps maximize hand function during recovery.
Static-progressive orthoses are used to correct joint deformities or severe stiffness following an injury or surgery. They allow for a consistent stretch in one direction. The theory behind these orthoses is what we call “Low Load Prolonged Stretch”. This suggests that a low force applied to a joint for a long period of time will result in permanent elongation of the tissue and improvement in range of motion and function. Static-progressive orthoses are one of the most powerful tools used by hand therapists and create impressive outcome.
Traction orthoses require high level splinting skills and advanced understanding of the biomechanics of the hand. Traction is used with severe comminuted and compacted fractures of a finger joint. These fractures are usually caused by high impact injury (often seen in ball sports) resulting in severe damage to a joint. The traction orthosis is used to rebuild the joint space, help restore the joint’s cartilage and promote range of motion. The traction itself is applied via a rubber band attached from the orthosis to the finger either via a hook glued to the nail or a surgical wire placed through the finger. Traction orthoses can look scary but they are a non-invasive to minimally-invasive technique to restore finger movement after a very severe finger fracture.