Orthosis

Orthosis is an external orthopedic device for stabilizing, unloading, correcting anatomical and biomechanical axes, protecting joints or segments of the musculoskeletal system.

Orthoses are a large and very heterogeneous group, here include tutors, longes, tires, orthopedic devices, bandages, corsets, as well as orthopedic hemp, other attachments in shoes, and orthopedic shoes themselves. Conditionally they are divided into two large groups: static and dynamic adaptations.

Static (immobilizing) orthoses are various tutors, thorns and longes. Their task is to provide the joint or group of joints with an optimal fixed position: either most functionally beneficial or necessary to correct the deformation or prevent its formation. Immobilizing orthopedic devices are usually used in the acute stage of arthritis, as well as in inflammatory processes in the periarticular structures: tendons, articular bags, synovial vaginas.

[1], [2]

Dynamic (functional) orthoses

Designed to provide external support and protection of affected segments of the musculoskeletal system both in the static position and in the performance of certain movements. A classic example is a variety of orthopedic devices (the most complex group of orthoses from the technical point of view). Orthopedic devices consist of several chacha, movably connected by means of special hinges. Most often, orthoses are used for the length of the lower extremities, especially for the knee joints. When using special adjustable hinges in their design, it is possible to provide the protected joint with the amplitude of movements prescribed by the physician.

A special place is occupied by orthopedic devices for the foot, in the first place the insole. This is a unique type of orthoses: structurally static, in practice it performs full-fledged dynamic functions (provides an optimal redistribution of loads not only in the foot, but also in all overlying links of the musculoskeletal system).

Most orthoses can be individually manufactured (in accordance with the peculiarities of the particular patient) and serial (and in accordance with certain sizes). The advantage of individually manufactured orthoses is their strict individuality and a better fit to the anatomical features of the particular patient. There are two technologies for the production of individual orthoses - using or without a positive model of an orthosis segment. As a rule, a gypsum solution is used to make the model. Modeling and assembling of orthosis elements is performed on a prepared gypsum model. This method is very time consuming, which ultimately leads to an increase in the cost of the product. The appearance at the end of the last century of thermoplastic materials capable of changing the shape at relatively low temperatures (up to 60-70 ° C) made it possible to simplify the process of manufacturing orthoses, eliminating the stage of gypsum modeling from it, which led to a reduction in the final cost of the products. With the help of low-temperature plastic materials, the modeling of the orthosis elements is carried out directly on the patient's body. In addition to low-temperature plastics, special non-gypsum-based specialty polymerizing bandages are now widely used. According to the technique of application they resemble traditional gypsum, but considerably surpass them in strength and hygienic properties. Gypsum-free technology is most often used in the manufacture of simple static orthoses - tutors, tires and longets. For the manufacture of orthopedic devices, a gypsum model is usually used. It allows the use of stronger polymeric and composite materials, carbon plastic, and various alloys.

Intermediate between the individual and serial manufacturing of orthoses, the method of using various series-produced modular structures - allows for subsequent individual adaptation of the product, based on the specifics of a particular case.

The main criteria for assessing the effectiveness of orthopedic adaptations are a reduction in the intensity of pain and improvement of the functioning of the joints when they are used. Correction of deformities is possible only if they are not fixed and are mainly due to changes in the periarticular soft tissues, as well as in children during the growth period.

The preventive role of orthosis in the development of joint deformities in adults has not been adequately studied. However, in a number of works it has been shown that the use of static orthoses of the hand in RA patients helps to slow the formation of ulnar deviation of the fingers.

[3], [4], [5], [6]

What is orthosis used for?

The purpose of using orthoses:

• external joint protection;
• correct functional positioning of the joint during movements;
• stabilization of joints;
• an increase in the passive volume of movements in the joints;
• reduction of pain due to immobilization;
• correction of non-fixed deformations (in some cases).

Indications

• Active arthritis, synovitis, tendosynovitis, tenosynovitis.
• Instability of the joint.
• Development. Stabilization and protection of joints after orthopedic operations.
• Decrease in the functional capacity of the joint, in particular, when it is impossible to perform surgical treatment (correction).

A huge number of orthoses was developed (practically for all joints, the final one and the spine). On some of them, most often used in patients with rheumatological diseases of joints, it is necessary to dwell in detail.

Orthosis in the deformation of the fingers of the hand

The destruction of the capsular-ligament apparatus of the fingers of the hand and the muscle imbalance in patients with rheumatoid arthritis lead to characteristic deformations like the "swan neck" (overexploitation in the proximal interphalangeal joint and bending in the distal) or "buttonhole" (proximal flexion and overdistension in the distal interphalangeal joint ).

Goal. Improve the brush function by preventing or possibly slowing down the progression of the deformity.

Indication: unfixed deformities of the fingers such as "swan neck" and "buttonhole" in patients with rheumatoid arthritis.

Contraindications: fixed deformities of the fingers as a result of bone or fibrous ankylosis interphalangeal joints of the fingers.

Preparation is not required.

Methods and follow-up care. The orthosis consists of two rings connected at an angle of 45 °. When he wears one ring obliquely encircles the proximal, and the second - the distal phalanx of the finger. The place of their connection is in the area of the volar fold of the interphalangeal joint. Such a design prevents the overdrawn of the finger in the interphalangeal joint, when we are usually made for the fingers either serially or individually, from plastic or metal (made from precious metals - imitate jewelry). When using orthosis, special attention should be given to matching its parameters with the anatomical features of the patient's hand. The patient can apply it during any manual work, as well as during sleep (to prevent the progression of deformation).

Effect. Improved brush function. Long-term results and a preventive role have not been studied enough.

Factors affecting the effectiveness: the degree of strain, the state of the collateral ligaments and the severity of muscle imbalance between the flexors and extensors of the fingers.

Complications. If the size of the orthosis does not match the finger, contact with the skin may result in the formation of rubbing. In this case, it is necessary to remodel the orthosis.

Alternative methods. Surgical correction - arthrodesis of interphalangeal joints and functionally advantageous position (as a rule).

Orthosis with epicondylitis

With epicondylitis of the shoulder, a decrease in the load at the points where the muscles tendons attach to the humerus should theoretically contribute to a reduction in the pain syndrome.

Goal. Reduce pain and improve the function of the wrist and elbow joint.

Indications: lateral and medial epicondylitis of the shoulder.

Contraindication: violation of blood circulation in the forearm and hand.

Preparation. It should be checked whether the orthosis is not disturbed blood supply in the tissues of the forearm and hand.

Methods and follow-up care. The orthosis in the epicondylitis is a tight tape and pi cuffs 3-4 cm wide, made, as a rule, from a dense, inelastic material. Between these layers in some modifications have a thin insert of plastic material. It gives the product sufficient rigidity, prevents deformation and twisting, contributes to a more even distribution of pressure under the orthosis and the surface of the forearm. Orthosis is placed circularly around the forearm at a distance of 2-3 cm from the elbow joint. It compresses the muscles of the forearm, thus there is a redistribution of axial loads, arising and flexors and extensors of the hand during movement, the force of tension of the tendons at the places of attachment to the condyles and humerus decreases. Orthosis is used during the acute period of the disease.

Efficiency. In patients with epicondylitis of the shoulder, the use of orthosis increases the threshold of pain sensitivity when performing test exercises.

Factors affecting efficiency. There is no exact data.

Complications with proper application are not described.

Alternative methods. Orthotomy can be used in conjunction with local glucocorticoid therapy.

Orthosis for cervical spine

In patients with various chronic rheumatological diseases, the lesion of the cervical spine is observed in 35-85% of cases. As a rule, the ligamentous and muscular apparatus is affected, which leads to functional instability and spasm, which in turn can cause neurological and vascular disorders. In such cases, external support and protection of the spine can be an effective addition to the ongoing medication.

Goal. Protection, stabilization and unloading of the cervical spine. Reduction of spasm of neck muscles.

Indications: pain and instability in the cervical spine.

Contraindication: the surgical instability of the cervical vertebrae.

Preparation. Before using the orthosis it is advisable to perform a roentgenography of the cervical spine with functional tests (to determine the degree of instability).

Methods and follow-up care. Patients prefer softer products (not so effective, but more comfortable). Orthosis is prescribed for a period of acute pain, as well as with static and dynamic loads, sometimes recommended to use and during sleep. With subluxations of the vertebrae, more rigid structures are used.

Effect. Relaxation of pain due to stabilization of the spine and reduction of spasm.

Factors affecting efficiency. It largely depends on the accuracy of the patient's use of orthotic regimens.

Complications. With improperly selected orthosis, there may be a violation of the blood supply to the brain. When using rigid products, cases of dysphagia are described.

Breastfeeding corset

The synonym is the thoracolumbar orthosis for osteoporosis.

External support and protection of the spine in osteoporosis is a method of preventing fractures and alleviating the pain syndrome.

Goal. Reduce the risk of vertebral fracture. Strengthen the back muscles, ease the pain syndrome.

Indications. Osteoporosis of the spine, compression fractures of vertebral bodies.

Preparation. X-ray examination.

Methods and follow-up care. Orthosis - a rigid adjustable structure, captures the lumbar, thoracic spine and shoulder girdle. The upper part of the corset (due to the seizure of the shoulder girdle) creates a dynamic resistance to flexion in the thoracic spine, reduces kyphosis and stress on the front parts of the bodies of the thoracic vertebrae. In some cases, corsets are used without rigid fixation and without gripping the shoulder girdle.

Effect. Despite the fairly frequent use of corsets in osteoporosis, data confirming their effectiveness are not enough.

Complications. With prolonged use, it is possible to develop foot muscle hypotrophy.

Alternative methods are not described.

Orthosis for the lumbosacral spine

Pain in the lower back (due to instability in the lumbar and lumbar spine) can be reduced by using external stabilizing devices. There are data confirming the effectiveness of lumbar orthoses at unexpected loads. Smoothing of the lumbar lordosis due to the use of the corset helps reduce spondylolisthesis. In acute pain and back, the use of the lumbar orthosis weakens the compensatory painful spasm and facilitates the patient's condition.

Goal. Reduction of pain in the lumbosacral spine.

Indications: pain in the lower back; instability of the vertebrae of the lumbar sacral region.

Preparation. The orthosis should be worn in the position lying on the back.

Methods and follow-up care. Orthosis is a wide belt that encompasses the lumbosacral spine. The degree of its stiffness may be a groove: from elastic bandages without ribs of stiffness to heavy-duty designs with reinforcing elements made of metal or plastic. Lumbar orthoses of various sizes are released serially, they are selected individually (based on the characteristics of a particular patient).

Effect. About 42% of patients report a decrease in the intensity of pain when using lumbar corsets.

Factors affecting efficiency. The greatest analgesic effect is noted in patients with vertebral instability.

Complications. Long-term complete immobilization can lead to muscle atrophy. However, when observing the principle of intermittent use of the corset and performing strengthening exercises, this does not happen.

Alternative methods. It is most advisable to combine the use of lumbar corsets and kinesitherapy.