Board Prep Orthotics
The method used to find the baseline for corset measurements is:
Need to get a waist circumference - waist is found by dividing the distance between the inferior costal margins and the iliac crest
Continuous ______ activities can cause inflammation of the soft tissues, placing pressure over peripheral nerves such as the long thoracic nerve
Overhead
A 47 y.o. y.o. Male sustained an L4 compression fx during a fall. What type of orthosis would you recommend?
Overlap LSO, chairback, Jewett (potentially), corset (Depending on severity)
What is the superior margin of the paraspinal bars in a Taylor TLSO?
The spine of the scapula
In a non-structure curve rotational components of the curve will correct themselves.
True (One definition of non-structural scoliosis is that it is reversible)
Before you can restore hand function in a quadriplegic, what do they require?
Trunk control
Increasing pressure at the interosseous membrane created tension between radius and ulna, which is an effective immobilizer for _____ fractures
Ulna
Clawhand appearance of the hand is due to damage to what nerve
Ulnar nerve (damage commonly occurs where it passes posterior to the medial epicondyle on the humerus)
Trendelenburg gait is cause by weakness in what muscle
gluteus medius (during stance phase the pelvis on the opposite side drops due to weakness on the stance side.
In an LSO what is the superior margin of the paraspinal bars?
The paraspinal bars extend just (appx. 1 in) inferior to the inferior angle of the scapula.
The function of wrist extension is primarily controlled by:
The radial nerve
Suprascapular nerve innervates
supraspinatus and infraspinatus muscles
Wrist driven flexor hinge will capture that extensor motion and translate it into natural tenodesis to grasp objects with three point palmer prehension
when patient still has extensor motion
Injury to the radial nerve will cause what
wrist drop
________ result in potential loss of motor function on the side of the lesion
Brown sequard syndrome
A patient wearing a Dennis Brown orthosis exhibits undesirable eversion, you should:
"Change the angle of the abduction bar to place the patient to decrease eversion - bend convex to the patient to reduce pronation. Clinical Aspects of LLO pg 219 - "Toe out can be varied from zero to a total of 180 degrees between the feet, and the bar can be bent so that the superior surface is concave, discouraging forefoot varus."
Which soft tissue contracture of the hand is most likely to develop following ulnar and median nerve
"Claw hand deformity - Hyperextension of MPs and flexion of IPs. Median and ulnar nerve lesions result in an intrinsic minus hand. Don't have the lumbricals and interossei to flex MCP and extend IPs! "
What is an advantage of adding a ratchet lock at the wrist in a wrist driven flexor hinge orthosis?
"Decrease fatigue associated with grasping objects for a long period of time."
How would you align an LSO to treat lumbar DJD in the sagittal plane?
"Decrease lumbar lordosis, this will decrease pressure on the facet joints
In scoliosis management, lateral flexion radiographs are used to:
"Determine the flexibility of the curves. If the curve can be completely corrected it may be non-structural (e.g. due to muscle spasm or leg length discrepancy). Structural curves are not completely reversible."
Which of the following is a contraindication for a spiral AFO?
"Edema with frequent volume changes. Other contraindications: Significant medial-Lateral instability (especially eversion), (carbon spiral - spasticity) See NYU text "
Which of the following is the best means to accommodate valgus in a patient's lower limb: extend the medial stirrup extension, extend the lateral stirrup extension, medial wedge, scaphoid pad, slight internal rotation in orthosis?
"Extend the medial stirrup extension. If we are accommodating rather than correcting, we need to make space for the valgus deformity in the orthoss. Medial wedges and scaphoid pads would both correct rather than accommodate. "
Extension at the MP joint is produced by:
"Extensor digitorum (communis), extensor indicis, extensor digiti minimi, Lumbricals and interossei flex MCP joints and extend IP joints"
What type of orthosis would you use for an intrinsic minus hand?
"HO (short opponens). Hold thumb in opposition to index fingers, MCP extension stop, IP extension assist. "
An orthotic patient's wrist is positioned in ulnar deviation and flexion. You should try to reposition the patient's wrist
"In 30 degrees wrist extension. (Functional hand position is: 30 deg extension, 30 degrees of MCP flexion, 45 degrees of IP flexion, thumb abducted and in opposition, 5-10 degrees ulnar deviation)"
The lateral orthotic ankle joint should be deflected posterior if the amount of external ankle rotation:
"In anatomical ankle joint alignment the medial upright is bent posteriorly by the amount of tibial torsion measured (distance to medial mall- distance to lateral mall). If the difference is greater than 2.5cm the lateral bar is bent anteriorly (relative to ankle joint) by the remaining amount. (Clinical Aspects of LLO, 2nd ed.) The orthotic ankle joint should be: perpendicular to the mid-sagittal line, at the height of the distal tip of the medial malleolus, centered with the apex of the medial and lateral malleolus and rotated according to the measured amount of tibial torsion - usually between 20 and 30 degrees external rotation relative to the knee axis (Lower-Limb Orthotics, NYU)"
Describe Erb's palsy and make an orthotic recommendation.
"Injury to upper brachial plexus (C5 and C6 nerve roots) - Results in shoulder adduction, internal rotation, forearm pronation, and wrist flexion. Orthotic recommendation: Gunslinger orthosis to position hand and support shoulder "
What is the best position for managing the chronically dislocating glenohumeral joint?
"Internal rotation and abducted (Note: want to restrict abduction). Most dislocations occur anteriorly due to external rotation and abduction - orthotic intervention should avoid these positions. "
What is a contraindication for a PTB unweighting orthosis?
"Limiting axial loading. Indications: RA, septic fractures, plantar surface skin grafts or ulcer, pathologies where max weight bearing is prohibited, charcot ankle, pseudarthrosis, long term non-union fracture. Contraindications of PTB orthoses include: fluctuating edema, poor skin integrity over patellar tendon, knee joint pathology"
Which of the following pathologies will produce a hand deformity most similar to that seen in "burned out" rheumatoid arthritis: ulnar nerve lesion, radial nerve lesion, median nerve lesion, CVA, Parkinson's disease.
"Median and ulnar nerve lesion (e.g. an intrinsic minus hand). In burnt out RA the disease has nothing else to attack and the pain stops, however, there is often significant deformity (e.g. ulnar deviation of fingers, swan neck deformity of fingers). "
What orthosis would be used to manage a patient with a T3 compression fracture?
"Must be contained superiorly to C6 and inferiorly to T6. Need to limit flexion. An anterior control CTO (or TLSO with cervical extension)
In order to control ulnar deviation of the wrist a WHO:
"Must exert a laterally directed force on the shaft of the 5th metacarpal, a medially directed force at the distal radius, and a laterally directed force on the medial forearm proximally. (An ulnarly directed force at the distal forearm band and a radially directed force at the proximal forearm band - BUT need an additional force)"
Mobile arm supports (Balanced forearm orthoses) would be indicated for which patient?
"Non-ambulatory patient with minimal shoulder power. Indicated for: paralyzed shoulder, elbow, and forearm (e.g. C4-C5 SC Injury). Can be attached to a body jacket for ambulatory patients, but frequently attached to a wheelchair. Components: assembly bracket, proximal arm, distal arm, proximal and distal bearings, forearm support, rocker assembly, accessories. (Ch. 9, Atlas of Orthotics 2nd. Ed) "
Which best describes the purpose of the thumb post?
"Positioning for palmar prehension. The Thumb post is an extension of a C-Bar used to position proximal and distal phalanges"
Describe the muscle picture for: radial nerve injury, median nerve injury, ulnar nerve injury.
"Radial nerve - elbow extensors, wrist extension, supination. Median nerve - wrist flexors, opponens pollicis, flexor pollicis, abductor pollicis brevis, 1st and 2nd lumbricals. Ulnar nerve - flexor digiti minimi brevis, abductor digiti minimi, 3rd and 4th lumbricals, interossei "
What residual function would you expect with a complete C-6 cervical lesion?
"Radial wrist extension. (extensor carpi radialis longus and brevis, pronator teres, pectoralis major - clavicular head) "
A cable driven tenodesis orthosis is activated by:
"Scapular abduction (Most tenodesis orthoses tend to be wrist driven prehension orthoses that use wrist extension to generate prehension)"
The primary purpose of a C-bar is:
"Stops (thumb) adduction. The C-bar maintains webspace and facilitate palmar prehension - Maintain distance between first and second metacarpals. "
The opponens bar should be located:
"The opponens bar terminates at the radial border of the thumb metacarpal. (Chapter 9, Atlas of Orthotics 2nd Ed.)A thumb abduction bar terminates proximal to the thumb IP joint.A thumb post terminates at the 1st digit, mid finger nail bed.(The goal of an opponens orthosis is to hold the thumb in a position opposing the index and middle fingers.) "
A balanced forearm orthosis attached to a pelvic suspension unit can be used by ambulatory patients to assist them in placement of the hand. In order to effectively use this orthosis, the patient must have:
"There are no muscle requirements on the affected side. It would be easier to don if the contralateral side is unaffected. "
What are the advantages of using a breakaway torque wrench
"decreased risk of over torquing, smaller in size
What is the recommended torque for a pediatric HALO?
1 inch lb per year of life (4-6 in/lb)
What is the proper clearance of the throat mold on a CTLSO?
1'' below chin (Appx. 2 fingers)
The oblique diameter of a patient's malleoli is 3 ⅝" (90 mm) what should the inside diameter of the ankle joints be?
101 mm
What is normal positon for the wrist and arm in a WHO?
15-30 degrees of wrist extension, neutral pronation/supination, no radial or ulnar deviation
Nerve that innervates the rhomboid muscles and levator scapulae
Dorsal scapular nerve
When fabricating a rancho style HO (hand orthosis), what length would you terminate the thumb post at
1st digits mid nail bed so as to avoid interference with prehensile activities.
With a patient with PVD what common artery can you palpate to assess blood flow
Dorsalis pedis
The pins on a halo should be re-tightened at what interval after initial application?
24 hours
What are the upper and lower limits in degrees for treatment of scoliosis orthotically?
25 degrees to 45 degrees
An inflamed pin-site, pain at pin-site, noise or movement are indications of what?
A loose pin
The trimline of an anterior floor reaction orthosis should be anterior to the malleoli to serve as a:
Dorsiflexion stop (goal of GRF orthosis)
Involves C8-T1, results in decreased hand and wrist function
Klumpke's Palsy
In a conventional AFO what are the malleolar joint clearances?
6 mm medially and 5 mm laterally
HALO application is finished all pins for an adult should be torqued to____________ and between 24-48hours the pins should be______________
6-8 inch pounds, retourqued
Swing phase is ____ percent of gait cycle
40
A metacarpalphylangeal flexion bar sets flexion at these joints at:
45 degrees flexion *** Note: functional hand position is 30 degrees MCP flexion
Ulnar injury will result in
4th and 5th MCP joints extended and the IP joints of the same fingers flexed
In picking up an object from a table what is the best position of the wrist?
5 degrees of flexion
Angulation of the superior vertebra of _______ compared to the inferior vertebra and anterior translation of ____________ compared to the inferior vertebra indicate a surgical candidate in a spondylolisthesis patient.
50 degrees, 50 percent
What percentrage of weight goes through the hindfoot (calcaneaus) and what goes through the forefoot (MTP joints)
50, 50
Stance phase is _____ percent of gait cycle
60
In normal gait, max knee flexion reaches approximately how many degrees
60-65
What percentage of weight on the forefoot is carried through MTP 2-5
66.6
How many cervical neural segments are there?
8
Scapular winging noted with arm abduction greater than ))) degrees
90
The oblique diameter of a patient's malleoli is 3 ⅝" (90mm). What should the inside dimension of the ankle joints be?
90mm +6mm (med. clearance) + 5mm (lat. clearance) = 101mm
Charcot foot should be fit with?
A Charcot Restraint Orthotic Walker (total contact AFO) or PTB orthosis (possibly with patten bottom)
What orthosis is best for treatment of an odontoid fracture?
A HALO CTO
A hemiplegic patient presents with 0 hip extensors, fair quadriceps, zero calf. Which of the following would you recommend?
A KAFO with a locked or stance control knee (LLII notes)
In an attempt to restore upper limb function to a C5 complete quadriplegic, which orthosis should you recommend?
A WHO with externally powered wrist or prehension. May try a ratchet driven prehension orthosis that the patient can bump into place.
Which orthosis would you recommend to a mid-humerus fracture which included injury to the radial nerve?
A WHO with wrist, finger, and thumb extension assist (and a humeral fracture orthosis)
What is the most frequently fit LSO in the US IS:
A corset
The most effective orthosis to prevent spinal rotation is:
A custom molded TLSO body jacket. If a conventional style is used, a Cow Horn TLSO provides rotational control.
All of the following are objectives in treating pes planus except: resist the tendency of the foot to supinate, resist hindfoot valgus, distribute weight over entire foot
A pes planus foot tends to over pronate, so we are NOT trying to resist the tendency of the foot to supinate.
Which metal ankle joint best mimics the control, not including adjustability, of trimlines anterior to the ankle?
A solid ankle (DF and PF resist)
In an attempt to restore upper limb function to a C6 complete quadriplegic, which orthosis would you recommend?
A wrist driven prehension orthosis (WDWHO)
What is your orthotic recommendation for C-6 cervical lesion?
A wrist driven prehension orthosis (WDWHO)
What spinal level would you consider using a CTLSO rather than a TLSO?
Above T8
In a fixed equinus deformity, which of the following shoe modifications is most likely to be used?
Addition of a tapered heel elevation on the ipsilateral side to accommodate the equinus deformity and a heel lift on the contralateral side to maintain leg length.
When radial nerve is injured in the radial groove, which muscles are paralyzed?
All the muscles in the posterior compartment (leading to wrist drop)
What is your orthotic recommendation for a rotator cuff injury.
An airplane splint - immobilize the shoulder in an abducted position
A patient has a compression fx at the T12 level. What type of orthosis is best suited for the stabilization of the fracture?
An anterior hyperextension TLSO - e.g. Jewitt or CASH
The orthotic recommendation for and ulnar nerve lesion at the wrist is an opponens orthosis plus what component?
An extension stop of the 4th and 5th MCPs (lumbrical bar)
Which of the following orthoses is designed to manage spondylolisthesis in an active teenager?
An overlap LSO (e.g. BOB)
A 20 year old female patient presents with flaccid anterior compartment and medial lateral instability in her right lower limb. Which of the following would you recommend?
An rticulated AFO with PF stop (trimlines anterior to malleoli for better ML control)
This stroke results in the leg more affected than the arm and contralateral sensory loss.
Anterior cerebral artery
Muscles activie during swing to achieve dorsiflexion
Anterior tibialis, extensor hallucis longus, extensor digitorum longus
Injury to the median nerve will result in what characteristic appearance when a patient tries to make a fist:
Ape hand (loss of opposition and flexion of the thumb) and the hand of bendiction (injury to the median nerve at the elbow or upper arm
Hangmans fracture: what vertebrae is damage and what is the location of the fracture?
Atlas, lamina (pars interarticularis) C2
The superior portion of the Milwaukee CTLSO should be carefully fabricated so as to:
Avoid excessive pressure on mandibular angle
What is the basic theory of fracture bracing?
Axial loading with and increase of hydrostatic pressure stabilizes the fracture area. Micro-motion promotes healing. Mobilization of proximal and distal joints preserves functional ROM and decreases rehabilitation time.
"This stroke results in what is known as locked-in-syndromecausing quadriplegia with no motor function but preserved consciousness."
Basilar artery occlusion at the pons
The innominate bone of the pelvic girdle is known as:
Bones of the iliums
What orthosis would you recommend for a hand with lumbricals, interossei and thumb abduction out? Why?
C-Bar, MCP extension stop, IP extension assist
Your patient comes into your office with a loose pin. You try to re-tighten and no resistance is met. Your next step would be:
Call the physician
What is the major benefit from a SOMI
Can be donned supine
Anterior tibialias innervated by the _____ nerve
Common fibular nerve (peroneal nerve)
Foot drop seen with injury to _______ nerve
Common fibular nerve (peroneal nerve)
How do you determine which is the primary curve and which is compensatory?
Compensatory curves exist to keep head over pelvis
Describe the etiology of carpal tunnel syndrome.
Compression of the median nerve as it passes through the flexor retinaculum
In scoliosis radiographs, the spinous process is seen to rotate towards the _____
Concavity
Wedged, bar, and hemi-vertebrae are common radiographic findings for _______
Congenital scoliosis
What is torticollis?
Contracture of the sternocleidomastoid muscle, resulting in ipsilateral flexion and contralateral rotation
In scoliosis radiographs, the vertbral body is seen to rotate towards the _____
Convexity
In which of the following conditions is a Milwaukee CTLSO contraindicated: skeletal immaturity, idiopathic scoliosis, thoracolumbar curves, curves greater than 60 degrees.
Curves greater than 60 degrees
Sheurmann's Kyphosis with apex locations of T7 or lower are managed with
Custom CTLSO
Sheurmann's Kyphosis with apex locations of T8 or lower are managed with
Custom TLSO
T/F: At the neural segmental level of the spinal cord lesion there will always be a return reflex action.
False - Need an intact reflex arc
Met pad with elevation of 2nd-5th MTP's have been shown to what?
Decrease tone
Injury to the tibial nerve on right leg causes which gait deviation
Decreased push off during gait, and shortened step length on the contralateral side
What muscle group flexes, abducts, extends, and supports the shoulder joint?
Deltoids
Damage to ulnar nerve where it passes to the medial epicondyle on the humerus results in
Difficulty making a fist due o paralysis of the intrinsic hand muscles and clawhand due to inability to flex the 4th and 5th MCP joint
Which of the following best describes the orthotic objective of the UCBL FO?
Diminish ML instability in calcaneus - Typically addresses pes plano valgus
characterized by rapid loss of muscle, eventually leading to loss of ability to ambulate and death.
Duschenne muscular dystrpohy
What is the function of the interossei
Either adduct or abduct the digits along with pairing with the lumbricals to flex the MC joitns and extend the IP joints
Williams Flexion LSO for spondylolisthesis should be made out of _____ material
Elastic material (to allow for flexion/sagittal plane movement)
What are the biomechanical principles of a Jewett orthosis?
Encourages spinal extension by applying posteriorly directed forces superiorly and inferiorly on the anterior body and an anteriorly directed force posteriorly.
Involves C5-C6, results in decreased shoulder girdle function
Erb's Palsy
A swan neck deformity causes the PIP joint to:
Extend - Swan neck deformity = FEF (MP - flex, PIP -extend, DIP-flex), a boutonniere deformity = EFE
The distal edge of the C-bar should
Extend just proximal to pollocis IP
When erector spinae muscles act bilaterally, what action do they perform
Extend the vertebral column
What modifications can be incorporated into thermoplastic KAFO to prevent severe genurecurvatum
Extending the dist/post thigh trimline more distally, Decreasing the depth of the thigh section, Extending the prox/post calf trimline proximally, Decreasing the depth of the calf section
For a stable compression fx of the cervical spine the head should be positioned in flexion or extension.
Extension to offload the vertebral bodies
What additions are utilized for decreasing excessive pronation
Extrinsic medial wedge, Medial Sab trimline, ST pad
How would you treat a stable 10 day old distal ⅓ femoral fracture with acute signs of swelling and pain absent?
Femoral fracture brace including knee joints and tibial section, free polycentric knee and ankle
Subtalor pronation, plantar flexed first ray, tibial and femoral internal rotation associated with what fixed alignment
Fixed forefoot varus alignment
Primary function of brachioradialis
Flex the elbow
The Taylor spinal orthosis would be classified as a _____________ control ________.
Flexion-extension control TLSO
In general the median nerve serve the ______ of the forearm
Flexors (anterior compartment of the forearm)
What are contraindications for a plastic AFO?
Fluctuating edema, heat sensitivity, allergy to PP/PE
What are 2 common surgical interventions for plantar fasciitis
Gastoc lengthening procedure and plantar fascia release
Proximal weakness in the hips lead to child using arms to walk up their legs
Gowers sign
Rigidity, bradykinesia (slowed movement), tremor, and impaired postural reflexes
Hallmark signs of Parkinsons
In what order should halo pins be tightened?
Halo pins should be tightened in opposing pairs (e.g. right anterior with left posterior) - diagonal pins together.
RGO forward progression is allowed by
Harnessing energy from one's hip extension (translating it to contralateral hip flexion
The calf band is placed 20 mm distal to the neck of the fibula to:
Have the longest lever arm without potentially harming the common peroneal nerve which runs around the fibular neck.
Bunnell (cock-up) splints are frequently used for:
Hemiplegia - Provide wrist extension (usually set at 20 degrees dorsiflexion) - For patients where control of the wrist will suffice to permit active prehension provided the fingers are not directly impaired (pg.168 Atlas of Orthotics, 2nd ed.)
How are burn patients typically treated?
Pressure garments, burn masks (to reduce hypertrophic scarring)
A cane can substitute for which of the following muscle weaknesses: (hip flexors, hip extensors, hip abductors, hip adductors)
Hip extensor and hip abductor weakness
Damage to the femoral nerve will result in weakness of what main muscle group
Hip extensors (L2,L3, and L4)
Duchennes Muscular Dystrophy is seen to ambulate with increased lumbar lordosis secondary to which muscular weakness
Hip extensors, increasing lumbar lordosis allows center of mass to be posterior to the hip, which locs hip against Y-ligament allowing for stability.
How would you treat a mid-humeral fracture with radial nerve lesion?
Humeral fracture orthosis, sling, and WHO to support the wrist (cock-up splint)
What are the boundries of the femoral triangle?
SAIL: Sartorius, Adductor longus, Inguinal Ligament
What is the nost common type of scoliosis?
Idiopathic
A heel wedge is placed (conventional):
If a medial/lateral wedge is placed on the sole of the shoe distal to the stirrups it will affect the knee. In order to affect the ankle joint, the heel wedge must be placed in between the stirrups and the heel.
How do you position for carpal tunnel syndrome?
Immobilized in neutral
A thumb post should holt he thumb in what position?
In opposition to the index finger
Heel lifts will _____ lumbar lordosis
Increase
What modification can you make to an ulnar fracture orthosis to increase its effectiveness at immobilizing a distal 2/3 ulnar fracture:
Increase pressure A/P for increased immobilization
What is the MOST important factor decreasing the vertical loading of the lumbar spine?
Increasing intracavity pressure (abdominal hydroneumatic mechanism)
What could you do to a fracture brace to better align a lateral or medial tibial plateau fracture.
Induce a varus or valgus moment at the tibial plateau to promote better alignment as needed.
Anatomical waist measured by finding the difference between _______ and _______ then dividing by two
Inferior costal margin and iliac creast
Describe a rotator cuff injury.
Injury to supraspinatus, infraspinatus, subscapularis, teres minor
What should one of your primary concerns be in an upper extremity orthotics for spinal injury?
Insensate skin
As an orthotist your primary concern with a spinal cord injury patient is:
Insensate skin - where has sensation been lost
Characteristics of torticollis
Ispilateral head tilt, contralateral head rotation
Front wheeled walker not appropriate for Brown sequard syndrome because
It would require function of both upper extremities.
A patient has a compression fx at the T12 level. What type of orthosis is best suited for the stabilization of the fracture?
Jewett, CASH, body jacket, Taylor TLSO
What would you recommend for a 3 week old tibial plateau fracture?
KAFO fracture brace with polycentric knee and free ankle
Where does spondylolisthesis most commonly occur?
L4 on L5 and L5 on S1
Having a patient walk on their heels screens for what myotomal level
L4-5 myotome
When the erector spinae muscles act unilaterally what action do they perform:
Laterally bend the vertebral column
The pelvic band for an LSO or TLSO should:
Lie halfway between the iliac crest and the greater trochanter
Name and describe two other types of pads for scoliosis (other than thoracic pads)
Lumbar pads and anterior derotation pads
What nerve is afected with Ape Hand deformity
Median
Lesions to the _____ nerve can produce carpal tunnel syndrome, ape hand deformity, benedictine deformity
Median nerve
A median nerve injury at the wrist clinically presents with:
Median nerve innervates (in hand) the thenar muscles, first and second lumbricals. Injury at the wrist would result in an Ape hand deformity (inability to oppose, flex, abduct the thumb) and atrophy of thenar eminence,
Adding a _____ relatively increases the distance between each metatarsal and its adjacent metatarsal, decreasing pressure of shear against the Morton's neuroma
Met pad
Benefits of the Sarmiento humeral fracture orthosis
Micro motion of fracture sites promotes bone growth, movement at elbow during healing minimizes stiff elbows, movement of the arm promotes muscles pump action to aid circualtion
"This stroke results in hemiplegia, arm more affected than the leg."
Middle cerebral artery
Should you put a femoral fracture brace on a proximal femoral fracture?
Midshaft and proximal femoral fractures are at risk of developing varus angulation. Frequently contraindicated due to poor outcomes. If necessary, could consider using a hip joint to reduce varus tendency.
What are biomechanical principles of a Sarmiento fracture orthosis?
Multiple 3-point pressure systems, total contact, long lever arms, and hydrostatic tissue loading
Right lumbar and left thoracic curves are often signs
Neuromuscular scoliosis
At heel strike the knee joint is at ____while the ankle joint is at _____:
Neutral/full extension, neutral/90 degrees
Would you apply a HALO vest to a patient in the ICU without the physician
No
Do you treat functional and structural scoliosis the same?
No, functional curves can be treated with corrective devices
Would you fit a tibial fracture brace on a patient with an open wound on the fibula?
No, it would be contraindicated to compress over an open wound
With forced lateral side bending a _______ scoliotic curve will see rotational correction of the components of the curve
Non-structural
What is the proper placement for a thoracic pad on a Milwaukee?
On the rib or one rib inferior to the apical vertebra (L-shaped)
TOT orthosis not to be used at night/while infant sleeping
Orthosis should be used with direct supervision to avoid injury
Charcot joint, Avascular necrosis of the talus, osteoarthritis of the ankle joint, calcaneal fracture are all indications for which AFO
PTB AFO
Chronic, progressive disease of the CNS with degenerations of dopaminergic neurons
Parkinson's disease
Use more HALO pins and less torque for which population
Pediatrics
Radiculopathy is a _________ nervous system dysfunction
Peripheral nervous system
What type of neural injury normally results in flaccid paralysis
Peripheral neural injury
Appropriate pin/spring configuration for double action ankle joint in patient with flaccid PFs and DFs
Pins in both channels, Springs in posterior and pins in anterior
Lateral 1/3 of eyebrow, slightly superior to eyebrow
Placement of anterior pins on a HALO
Slightly superior to ear, opposing the anterior pin directy, inferior to equator of the cranium
Placement of posterior pins on a HALO
Sciatic nerve provides sensation to most of the leg and motor function to most of the _______leg muscles
Posterior
Tibial innervates muscles on the _______ leg
Posterior (triceps surae, posterior tibialis, etc)
Tarsal tunnel syndrome due to compression of the ________ nerve (through tarsal tunnel) on the medial side of the ankle
Posterior tibial
____________ can present with inversion weakness, inability to perforheel raise, and tenderness under the medial malleoli.
Posterior tibial tendonitis
In order to treat kyphosis with a Milwaukee TLSO, pads should be placed:
Posteriorly - just inferior to the apex of the curve to produce an anteriorly directed force
Guillain-Barre syndrome regains strength in what order
Proximal to distal
This will lock the orthosis in place over the object which will allow the patient to relaxe their wrist extensor muscles
Rachet lock at the wrist
What nerve is affected with wrist drop?
Radial
Patient complains it is too hard to roll over foot during stance with AFO
Recommend rocker sole shoes and/or cutting the foot plate to sulcus length
Having a patient perform a heel raise, screens what myotomal level
S1
The most commonly occurring curve pattern in adolescent idiopathic scoliosis is:
Right thoracic and left lumbar
Why are non-ferrous metals used for HALO systems?
SO that they can be used in MRIs
What is your orthotic recommendation for a patient with an odontoid fx who was just removed from a halo?
SOMI
To control flexion and extension for a stable C3 fracture what type of orthosis would you recommend?
SOMI, 4 post CTO
THe nominate bone of the pelvic girdle is known as:
Sacrum
Sheurmann's kyphosis has deformity in which plane(s)
Sagittal
Orthosis for midshaft humeral fracture (10 deg of varus)
Sarmiento humeral fracture brace
What are the borders of the Scarpa's triangle?
Sartorius muscles, adductor longues, Inguinal ligament (SAIL)
What is the best position for a patient to be in when being fitted for a tibial fracture brace?
Seated with legs at 90 degrees
A 66 year old lady with limited DF and PF. What would you fit her with?
Shoes with SACH heels and rocker bottom soles
For a median nerve injury at the wrist which is the most appropriate orthosis?
Shprt opponens (hand orthosis) with thumb post, The median nerve innervated the intrinsic thenar muscles and first and second lumbricals
These scoliotic scurves progress more given only the location
Single lumbar and thoracolumbar
What type of curve is most liekly to progress?
Single lumbar and thoracolumbar curves
The optimum hip angle of the patient during casting for a Milwaukee TLSO is:
Slight hip (and knee) flexion so as to reduce lordosis
Why is the anterior bar of a Milwaukee made of aluminum?
So that it is transparent on an x-ray
Caused by incomplete closure of one or more neural arches that can cause a wide range of impairments
Spina Bifida
The proper length measurement for a Taylor spinal orthosis is:
Spine of scapula to sacrococcygeal junction
The paraspinal bars of a sagittal control TLSO should extend superior to the:
Spine of the scapula
In a right thoracic curve the spinous processes rotate:
Spinous processes rotate left toward the concavity of the scoliotic curve
Anterior displacement of the vertebral body on the lower vertebrae is called what:
Sponylolisthesis
A patient has flaccid ankle plantarflexors and dorsiflexors and buckles at the knee during loading response/heel strike. What is the best configuration of double action ankle joints?
Springs posterior - provides a dorsiflexion assist and will allow plantar flexion to reduce knee buckling, pins anterior- to stop forward progression of tibia over foot.
Patient with with flaccid ankle plantarflexors and dorsiflexors, also buckles at the knee during loading response/heel strike. What pin configuration to use on double action ankle joint?
Springs posterior to provide controlled plantarflexion during loading response and pins in anterior channels
A patient with a cavo varus foot and peroneal tendonitis should utilize their functional foot orthotics (1st ray relief, extrinsic lateral wedge) with a _______ motion control type shoe
Supinator "cushion" shoe
An anterior control TLSO (e.g. Jewitt or CASH) should be fitted with the patient in a:
Supine position
What two nerves could be compromised with incorrect positioning of anterior pins?
Supraorbital and supratrochlear
This nerve innervates part of the rotator cuff (supraspinatus and infraspinatus) and would not cause winging
Suprascapular
Deltoid muscle acts to abduct the shoulder with what other muscles
Supraspinatus (part of the rotator cuff assists with abduction of the glenohumeral joint)
What level of paraplegia seldom gets braced?
T6 - non ambulatory
What is your orthotic recommendation for a 68 yr old female with osteoporotic kyphosis?
Taylor TLSO
How does a wrist driven WHO function?
Tenodesis (wrist extension resulting in prehension)
The placement of the mechanical hip joint is 24 mm proximal to __________ and __________.
The mechanical hip joint is placed 1in. (24 mm) Proximal and 1/2in. (12 mm) Anterior to the greater trochanter.
Which nerve innervates the wrist extensors?
radial nerve
The pad most commonly used in conjunction with the Milwaukee CTLSO is a:
Thoracic pad. (see Lonstein in Atlas of Orthotics
Name 4 of the six prehension patterns.
Tip, palmer, lateral, hook, spherical, cylindrical
KAFO distal/posterior thigh band and proximal/posterior calf band should be located equidistant from the knee axis why?
To allow for knee flexion and to prevent soft tissue impingement
What is the function of the lumbricals
To flex the MP joitns and extend the IP joints
The purpose of the anterior trimlines on a ground reaction AFO?
To prevent ankle dorsiflexion
Why is a Milwaukee brace carefully molded superior to the iliac crests?
To prevent orthosis migration and maintain control of the pelvs
In a PTB type of orthosis, it is necessary to carefully form the material in the popliteal area to:
To provide an anteriorly directed force to counter the posteriorly directed force on the patellar tendon.
TOT orthosis used to treat
Torticollis
How long does a patient normally wear a scoliosis orthosis?
Until skeletal maturity
What is the purpose of a neck ring on a Milwaukee CTLSO?
Upper corrective force for high thoracic scoliotic curves
Lhermitte's sign can be seen with _________
Upper motor neuron disorders such as MS (not with Parkinson's disease
A patient with left hemiplegia has difficulty with sequencing, producing language, difficulty processing information and will have visuospatial deficits. Maximum use of demonstration and gesture would not be appropriate.
Use simpple verbal cues, minimize open ended questions, simplification of treatment
What is a Risser sign?
Used to indicate skeletal maturity
What is clonus?
Velocity dependent oscillating muscular contractions
The measurement for a TLSO (anterior hyperextension orthosis) should be taken while the patient is in what position?
With the patient supine
Rotator cuff tendonitis
Would not cause winging but could cause flexion weakness
Orthosis for patient with right radial nerve intact and severed median and ulnar nerves
Wrist driven hand orthosis
What action occurs with tenodesis grip
Wrist extension which causes MP flexion
Which orthosis would be recommended for a radial-ulnar nerve injury at the elbow?
Wrist hand orthosis preventing wrist drop and promoting MP extension and 4th and 5th finger IP extension. The radial nerve innervates the wrist extensors (also extends MPs) and ulnar nerve innervates the medial hand intrinsics and 3rd and 4th lumbricals)
How are HALO pins tightened? With what tool?
a torque wrench opposing pins are tightened simultaneously alternating pairs (2 in/lbs at a time) until 6-8 in/lbs is reached
Tissue swelling in the calf
compartment syndrome
MLA arch support with plantar fasciitis
decreased pull across plantar fascia
Decrease in MLA support and an increase in 1st MTP relief with a lateral extrinsic wedge in Jones Fracture
decreases pressure under 5th metatarsal
Decrease in MLA support and an increase in 1st MTP relief with a lateral extrinsic wedge in Peroneal tendon dysfuction
decreases work load of peroneal tendons
MLA arch support with posterior tibialis tendon dysfuction
decreases work load of the patient
Axillary nerve innervates
deltoid and teres minor muscles
Weakness in the serattus anterior can be caused by compression of ______ nerve
long thoracic nerve
Sponylolysis, L5-S1 Spondylolisthesis, and DJD of lumbar facet joints treated by decreasing
lumbar lordosis
Decrease in MLA support and an increase in 1st MTP relief with a lateral extrinsic wedge in Chronic Lateral Ankle Sprains
provides canting to decrease lateral ankle sprains
Decrease in MLA support and an increase in 1st MTP relief with a lateral extrinsic wedge in Cavo Varus Foot
provides neutral alignment
MLA arch support with pes planovalgus
provides neutral alignment
Long thoracic nerve innervates
serratus anterior
Injury to axillary nerve can be cause by
shoulder dislocation
What innervates the gluteus medius
superior gluteal nerve
what are the two divisions of the sciatic nerve
tibial and common fibular portion
MLA arch support with knee osteoarthritis in the lateral compartment
unloads lateral knee compartment
