orthosis

An orthosis is an external orthopedic device for stabilization, unloading, correction of anatomical and biomechanical axes, protection of joints or segments of the musculoskeletal system.

Orthoses are a large and very diverse group, which includes tutors, splints, splints, orthopedic devices, bandages, corsets, as well as orthopedic stumps, other devices inserted into shoes, and orthopedic shoes themselves. They are conventionally divided into two large groups: static and dynamic devices.

Static (immobilizing) orthoses are various tutors, spikes and splints. Their task is to provide the joint or group of joints with an optimal fixed position: either the most functionally advantageous, or necessary for the correction of deformation or prevention of its formation. Immobilizing orthopedic devices are usually used in the acute stage of arthritis, as well as in inflammatory processes in periarticular structures: tendons, joint bags, synovial sheaths.

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Dynamic (functional) orthoses

They are designed to provide external support and protection of the affected segments of the musculoskeletal system both in a static position and when performing certain movements. A classic example is various orthopedic devices (the most technically complex group of orthoses). Orthopedic devices consist of several parts movably connected to each other by means of special hinges. Orthoses for the lower extremities are most often used, especially for knee joints. When using special adjustable hinges in their design, it is possible to provide the protected joint with the range of motion specified by the doctor.

A special place is occupied by orthopedic devices for the foot, primarily insoles. This is a unique type of orthosis: structurally static, in practice it performs full dynamic functions (it ensures optimal redistribution of loads not only in the foot, but also in all overlying links of the musculoskeletal system).

Most orthoses can be either custom-made (according to the characteristics of a specific patient) or serial (and in accordance with certain sizes). The advantage of custom-made orthoses is their strict individuality and better compliance with the anatomical features of a specific patient. There are two technologies for manufacturing custom orthoses - with or without a positive model of the orthotic segment. As a rule, a plaster solution is used to manufacture the model. Modeling and assembly of orthosis elements is performed on a prepared plaster model. This method is very labor-intensive, which ultimately leads to an increase in the cost of the product. The advent of thermoplastic materials at the end of the last century, capable of changing shape at relatively low (up to 60-70 ° C) temperatures, made it possible to simplify the process of manufacturing orthoses, excluding the stage of plaster modeling, which led to a decrease in the final cost of the products. With the help of low-temperature plastic materials, modeling of orthosis elements is carried out directly on the patient's body. In addition to low-temperature plastics, special polymerizable bandages are now widely used for plaster-free production. In terms of application technique, they resemble traditional plaster bandages, but are significantly superior in strength and hygienic properties. Plaster-free technology is most often used in the manufacture of simple static orthoses - tutors, splints and longuets. A plaster model is usually used to manufacture orthopedic devices. It allows the use of more durable polymer and composite materials, carbon fiber, and various alloys.

An intermediate method between individual and serial production of orthoses is the use of various serially produced modular designs - this allows for subsequent individual adjustment of the product based on the characteristics of a particular case.

The main criteria for assessing the effectiveness of orthopedic devices are a decrease in pain intensity and improvement in joint function when using them. Correction of deformities is possible only if they are not fixed and are mainly caused by changes in the periarticular soft tissues, as well as in children during the growth period.

The preventive role of orthotics in relation to the development of joint deformities in adults has not been sufficiently studied. However, a number of studies have shown that the use of static hand orthoses in patients with RA helps to slow down the development of ulnar deviation of the fingers.

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What is the orthosis used for?

Purpose of using orthoses:

• external protection of the joint;
• correct functional positioning of the joint during movements;
• joint stabilization;
• increasing the passive range of motion in joints;
• pain reduction through immobilization;
• correction of non-fixed deformations (in some cases).

Indications

• Active arthritis, synovitis, tendosynovitis, tendovaginitis.
• Joint instability.
• Development. Stabilization and protection of joints after orthopedic surgeries.
• Decreased functional capacity of the joint, especially when surgical treatment (correction) is not possible.

A huge number of orthoses have been developed (for almost all joints of the extremities and spine). Some of them, most often used in patients with rheumatological diseases of the joints, should be discussed in detail.

Orthoses for finger deformities

Destruction of the capsular-ligamentous apparatus of the fingers and muscle imbalance in patients with rheumatoid arthritis leads to characteristic deformities such as “swan neck” (hyperextension in the proximal interphalangeal joint and flexion in the distal) or “button loop” (flexion in the proximal and hyperextension in the distal interphalangeal joint).

Objective: To improve hand function by preventing or possibly slowing down the progression of deformity.

Indications: non-fixed deformities of the fingers such as “swan neck” and “button loop” in patients with rheumatoid arthritis.

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

No preparation required.

Method and subsequent care. The orthosis consists of two rings connected to each other at an angle of 45°. When putting it on, one ring obliquely crosswise covers the proximal phalanx, 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 hyperextension of the finger in the interphalangeal joint, when we for fingers are usually made both serially and individually, from plastic or metal (made of precious metals - imitate jewelry). When using the orthosis, special attention should be paid to the correspondence of its parameters to the anatomical features of the patient's hand. The patient can use it when performing any manual labor, as well as during sleep (in order to prevent the progression of deformation).

Effect. Improvement of hand function. Remote results and preventive role have not been sufficiently studied.

Factors affecting effectiveness: the severity of the deformity, the condition of the collateral ligaments and the severity of the muscle imbalance between the flexors and extensors of the fingers.

Complications. If the orthosis size does not correspond to the finger, abrasions may form in the areas of contact with the skin. In this case, it is necessary to remodel the orthosis.

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

Orthosis for epicondylitis

In case of epicondylitis of the shoulder, reducing the load at the sites of attachment of the muscle tendons to the humerus should theoretically help reduce pain.

Objective: To reduce pain and improve function of the hand and elbow joint.

Indications: lateral and medial epicondylitis of the shoulder.

Contraindication: poor circulation in the forearm and hand.

Preparation: It is necessary to check whether the orthosis worn does not disrupt the blood supply to the tissues of the forearm and hand.

Methodology and subsequent care. An epicondylitis orthosis is a thick band and a 3-4 cm wide cuff, usually made of a thick, non-elastic material. In some modifications, a thin insert made of plastic material is placed between these layers. It gives the product sufficient rigidity, prevents deformation and twisting, and promotes a more uniform distribution of pressure under the orthosis on the surface of the forearm. The 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, thereby redistributing the axial loads that arise in the flexors and extensors of the hand during movement, and reducing the tension force of the tendons at the attachment points to the condyles and humerus. The orthosis is used during the acute period of the disease.

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

Factors affecting efficiency. No precise data.

No complications have been reported with proper use.

Alternative methods: Orthotics can be used in combination with local glucocorticoid therapy.

Cervical spine orthosis

In patients with various chronic rheumatological diseases, cervical spine lesions are observed in 35-85% of cases. As a rule, the ligamentous and muscular apparatus is affected, which leads to functional instability and spasm, and this 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 drug therapy.

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

Indications: pain and instability in the cervical spine.

Contraindication: instability of the cervical vertebrae requiring surgical treatment.

Preparation. Before using the orthosis, it is advisable to perform an X-ray of the cervical spine with functional tests (to determine the degree of instability).

Methodology and subsequent care. Patients prefer softer products (not as effective, but more comfortable). The orthosis is prescribed for periods of acute pain, as well as for static and dynamic loads, and is sometimes recommended for use during sleep. In case of vertebral subluxations, more rigid structures are used.

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

Factors affecting efficiency. It largely depends on the patient's accuracy in following the orthosis use regimens.

Complications. If the orthosis is incorrectly selected, the blood supply to the brain may be disrupted. Cases of dysphagia have been described when using rigid products.

Thoracolumbar corset

Synonym: thoracolumbar orthosis for osteoporosis.

External support and protection of the spine in osteoporosis is a way to prevent fractures and relieve pain.

Objective: Reduce the risk of developing vertebral fractures. Strengthen back muscles, relieve pain.

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

Preparation. X-ray examination.

Methodology and subsequent care. The orthosis is a rigid adjustable structure that covers the lumbar, thoracic spine and shoulder girdle. The upper part of the corset (due to the shoulder girdle coverage) creates dynamic resistance to flexion in the thoracic spine, reduces kyphosis and the load on the anterior sections of the thoracic vertebrae. In some cases, corsets without rigid fixation and without the shoulder girdle coverage are used.

Effect. Despite the fairly frequent prescription of corsets for osteoporosis, there is insufficient data to confirm their effectiveness.

Complications: With prolonged use, foot muscle hypotrophy may develop.

Alternative methods are not described.

Orthosis for the lumbosacral spine

Lower back pain (due to instability in the lumbar and lumbosacral spine) can be reduced by using external stabilizing devices. There is evidence to support the effectiveness of lumbar orthoses for unexpected loads. Smoothing the lumbar lordosis with a corset helps reduce spondylolisthesis. In acute back pain, the use of a lumbar orthosis reduces compensatory painful spasm and alleviates the patient's condition.

Purpose: To reduce pain in the lumbosacral spine.

Indications: lower back pain; instability of the lumbosacral vertebrae.

Preparation: The orthosis must be put on in a supine position.

Methodology and subsequent care. The orthosis is a wide belt that covers the lumbosacral spine. Its degree of rigidity can be variable: from elastic bandages without stiffening ribs to super-strong structures with reinforcing elements made of metal or plastic. Lumbar orthoses of various sizes are mass-produced, they are selected individually (based on the characteristics of a specific patient).

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

Factors Affecting Efficiency: The greatest analgesic effect is observed in patients with vertebral instability.

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

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