Bioengineering: Orthotics and Splints

1. Dr. Sanjib Kumar Das, PhDDr. Sanjib Kumar Das, PhD

2. Bioengineering
• Bio-Engineering devices developed plays a vital role
in the field of orthopedic and neurological
rehabilitation.
• Such devices improve function, restrict or increase
support to a part of the body (like spine, lower limbs).
• Bioengineering devices like orthotics are an integral
part of the life of persons with disability, (especially
in India, where several adults suffer from the long
term effects of childhood poliomyelitis).

3. Orthotics
• An orthosis is a mechanical device fitted to the body to
maintain it in an anatomical or functional position.
• The basic mechanical principle of orthotic correction is the
“Three point system of Jordan.”
• To remain stable, the body has to have one point of pressure
opposed by two equal points of counter pressure in such a
way that F1 = F2 + F3

4. Three point system of Jordan

5. Biomechanics Of Orthosis
• There are four different ways in which an orthosis may modify
the system of external forces and moments acting across a joint.
• Control of rotational moments across a joint
• Control of translational forces around a joint
• Control of axial forces around a joint
• Control of line of action of ground reaction force by modifying
the point of application and line of action of the ground reaction
force during static or dynamic weight bearing.

6. Classification: According to Function
• Supportive: It stabilizes the joints and supports the body in its
anatomical position, e.g. calipers, gaiters.
• Functional: It stabilizes the joint and also makes up for a lost
function, e.g. foot drop splint in common peroneal nerve palsy
or dynamic cock-up splints in wrist drop.
• Corrective: To correct deformities, e.g. club foot boot in
congenital talipes equinovarus.
• Protective: To protect a part of the body during its healing, e.g.
rigid four post collar for fracture cervical vertebrae.

7. Classification: According to Function
• Prevent substitution of function: In a full length caliper,
substitution of hip flexors by abductors or adductors of hip and
other similar trick movements are prevented.
• Strengthen certain groups of muscles: Tenodesis splint
• Relief of pain: The lumbosacral corset supports the lower
back, preventing painful movement.
• Prevent weight bearing: A weight relieving orthosis,
prescribed for conditions like fracture calcaneum will take
weight away from the injured site to a proximal site like the
patellar tendon bearing area.

9. Regional Classification
They are classified according to the anatomical area fitted with the orthosis.
• Cervical Orthosis
• Head-Cervical Orthosis (HCO)
• Head-Cervical-Thoracic Orthosis (HCTO)
• Lumbo-sacral Orthosis (LSO)
• Thoraco Lumbo-sacral Orthosis (TLSO)
• Upper Extremity Orthosis
– Shoulder and Arm Orthosis
– Elbow Orthosis
– Wrist Orthosis
– Hand Orthosis
• Lower Extremity Orthosis
– Foot Orthoses (FO)
– Ankle-Foot Orthoses (AFO)
– Knee-Ankle Foot Orthoses (KAFO)
– Hip-Knee-Ankle-Foot Orthoses (HKAFO)

10. General Principles Of Orthosis
1. Use of forces: Biomechanics Of Orthosis
2. Sensation: An orthotic device often covers skin areas and decreases
sensory feedback.
3. Correcting a mobile deformity: A flexible deformity (e.g. genu
recurvatum or mobile scoliosis) may be corrected by an orthosis. The
corrective force must be balanced by proximal and distal counter forces
(three point force systems).
4. Fixed deformity: If a fixed deformity is accommodated by an orthosis,
it will prevent the progression of the deformity.
5. Adjustability: Orthotic adjustability is indicated for children to
accommodate their growth and for patients with progressive or
resolving disorders.
6. Maintenance and cleaning: The orthosis should be simple to maintain
and clean

11. General Principles Of Orthosis
7.Application: The design should be simple for easy donning and
doffing. The more complicated the gadget the less likely it is to be
accepted for permanent use.
8.Limitation of movement: Limiting motion to reduce pain, e.g. knee
brace.
9.Gravity: Gravity plays an important role in upper limb orthosis,
especially in those joints where the heaviest movement masses are
present. For example, a Rolyan shoulder cuff (large arm sling) can be
used in hemiplegia to prevent subluxation of the shoulder, which is the
largest joint prone for the deleterious effects of gravity.
10.Comfort: The orthosis should be easy to wear and comfortable to use.
This is possible if the forces meant for correction are distributed properly.

12. General Principles Of Orthosis
11.Utility: The orthosis must be useful and serve a real purpose. If one
hand is functional and normal, an upper extremity orthosis for the
affected side may not be used as most activities of daily living can be
performed with the good hand.
12.Cosmesis: Cosmesis is important especially in the hand. A functional
but unsightly orthosis is often rejected if the patient values appearance
over function.
13.Duration: Use only as indicated and for as long as necessary.
14.Appropriateness: It should allow joint movement wherever
appropriate.

13. Orthosis Used in Specific Conditions
Orthosis used for nerve injury:
-Radial nerve injury—a radial nerve glove is given with the wrist
held in extended position or a wrist drop splint.
-Ulnar nerve injury—Splints that maintain the flexion of
metacarpophalangeal joints and extension at inter-phalangeal
joint with a lumbrical bar, e.g. knuckle duster splint.
-Median nerve injury—Splint is applied to the thumb in an
abducted, opposed position. (Opponens splint).

14. Orthosis Used in Specific Conditions
• Orthosis used for burns: Splinting done to hold the part in
neutral position and this prevents stiffening of the
metacarpophalangeal joints.
• Orthosis used in rheumatoid arthritis: Static three point
proximal interphalangeal orthosis for Boutonniere deformity.
• Orthoses used for stroke and brain injury: In stroke, large
arm slings are used to prevent subluxation of the shoulder.

15. Disadvantages of Orthosis
• Lack of cosmesis: an unsightly orthosis is often the reason for a
patient discontinuing its use.
• Muscles supporting the spine can become weak.
• Wherever segments are immobilized, we find increased
movements at ends of these segments.
• The person becomes psychologically dependent on it.
• Reduction in bone density.
• Skin ulcerations or calluses at the patient orthoses interface.

16. Contraindications to Orthoses
• Severe deformity which cannot be accommodated in the orthosis.
• If it limits movements at other normal joints.
• Skin infections.
• When the muscle power is inadequate to perform its function
because of the weight of the orthoses.
• Where the orthosis interferes grossly with clothing or limits ones
style of living.
• Lack of motivation or other psychological problems.
• Very young or old patients.

17. Calipers
Calipers are orthosis fitted to the lower limb.
They may be
• Foot orthosis (FO)
• Ankle Foot orthosis (AFO)
• Knee Ankle Foot orthosis (KAFO)
• Hip Knee Ankle Foot orthosis (HKAFO).

18. Considerations While Prescribing Calipers
• The stability of the hip and knee should be good
before deciding how high the caliper should be.
This can only be done after doing a muscle power
grading, paying special attention to the hip
abductors, extensors and knee extensors.
• Alignment is checked whether the ankle joint is
over the medial malleoli, the knee joint over the
prominence of medial femoral condyle and the
hip joint permits a patient to sit upright at 90°.

19. Foot Orthoses (FO)
• The essential difference between a shoe and a boot is that a boot
covers the malleoli, while a shoe does not.
• The foot orthoses is nothing but a boot that has components like
supports and wedges to manage different foot symptoms and
deformities.
• These modifications are made of various materials like rubber,
foam or leather.
• The FO can be divided into a lower part and an upper part

20. Components of the Lower Part

21. Components of the Lower Part
• Sole: It is the part of the shoe in contact with the ground.
The inner part of the sole against which the foot rests is the
insole. Bars straps and wedges, which are common
attachments to the foot orthoses get their leverage and
attachments through the sole and exert their forces

22. Components of the Lower Part
• Ball: Widest part of the sole that is located in the region of the
metatarsal heads.
• Shank: Is the narrowest part of the sole between the heel and
ball. The uprights of the AFO attach themselves to a stirrup at the
shank region.
• Toe Spring: It is the space between the outer sole and the floor,
which helps to produce a rocker effect during toe off phase of the
gait cycle.
• Heel: is the posterior part of the sole, which corresponds to the
heel of the foot. Since it is the portion where most of the body
weight is taken it needs to be resilient and thicker so that it can
prevent shoe components from “wearing out” and shift weight to
the fore foot.

23. Upper Part Components
• Quarter: This is the posterior portion of the shoe upper. A high
quarter is referred as a “high top” and is used by runners and
footballers for greater sensory feedback, and to prevent
retrocalcaneal pain.
• Heel counter: In sports shoes there is a reinforcement of the
quarter posteriorly called a heel counter which provides posterior
stability to the shoe and supports the calcaneus.
• Vamp: Vamp is the anterior portion of the upper and is often
reinforced with a toe box anteriorly. In front is the tongue which
protects the upper fore foot behind the lace stays. Extra-depth
shoes allow more room inside the shoe for orthotic intervention.

24. Upper Part Components
• Throat: This is the opening of the shoe located at base of the
tongue, through which the foot is inserted.
• Toe box: It prevents the toes from suffering trauma when the
person kicks as in football. Even normally it is provided in the
shoe to avoid stubbing of the toes.
• Tongue: This is the part of the vamp which extends down in front
of the throat.
• Stirrup: This is a piece on the outer sole in the shank region just in
front of the heel offering attachment to the metal uprights.

25. Modifications of the Orthopedic Shoe
The shoe can be modified according to the deformity, disease
process or congenital anatomical configuration of the patient
to:
• Maintain the foot in anatomical position
• Treat symptoms of fatigability
• Prevent further deformity
• Provide symmetry
• Provide a better stance and gait.

26. Clinical condition Objectives of modifications Modifications
Limb shortening Provide symmetric posture Heel elevation:
If < ½ in: internal
If < ½ in: external
Heel and sole elevation (if > 1 in),
High quarter shoe
Pes plano-valgus Reduce eversion support/
longitudinal arch
Medial heel wedge, Medial
longitudinal arch support, High
quarter shoe.
Pes equinus Provide heel strike, Reduce pressure
on MT head, Contain foot in shoe
Heel lift & Metatarsal pads or bars,
Heel and sole elevation on other
shoe depending on LLD, Wide open
throat, High-quarter shoe.
Pes equinovarus Realign for flexible deformity and
accommodate a fixed deformity.
Increase medial and posterior
weight bearing on foot
Lateral sole and heel wedges for
flexible deformity, Medial wedges
for fixed deformity, High-quarter
shoe.

27. Clinical condition Objectives of modifications Modifications
Pes cavus Distribute weight over entire foot.
Reduce pain and pressure on MT Heads.
Restore antero-posterior foot balance.
Metatarsal pads or bars, Medial and
lateral longitudinal arch,
Support / Molded inner sole, High
toe box, High-quarter shoe.
Calcaneal spurs,
calluses and corns
Relieve pressure on painful area Heel cushion, Inner relief in heel
and fill with soft sponge
Metatarsalgia Reduce pressure on MT heads. Support
transverse arch
Metatarsal pad, Inner sole relief.
Hallux valgus Reduce pressure on 1st MTP joint and
big toe. Shift weight laterally
Metatarsal pad, Soft vamp with
broad ball and toe. Medial
longitudinal arch support.
Hammer toes Relieve pressure on painful areas,
Support transverse arch.
Soft vamp, extra-depth shoe with
high toe box, Metatarsal pad.

33. Ankle Foot Orthosis
(AFO)
The components are:
• Proximal calf band with leather straps
• Medial and lateral bars articulating with medial
and lateral ankle joints help in control of plantar and
dorsiflexion.
• Stirrups anchor the uprights to the shoe.

34. Ankle JointThere are five types of artificial
ankle joints fit to the AFO. They
are:
A) Fixed ankle joint: Sometimes
the foot needs to be protected and
weight is taken off injured portions
as in fracture calcaneus when in
combination with a weight
relieving orthosis it takes the
weight off the foot.
B) Limited ankle joint when the
muscles operating the ankle have
no power.

35. Ankle Joint
C) 90° foot drop stop is when
the ankle joint allows
dorsiflexion but stops at the
neutral position i.e. at 90
degrees. Thus it does not allow
plantar flexion. It is
recommended when there is foot
drop i.e. DF are weak and PFs
are normal, or DF are normal or
near normal and PFs are spastic.

36. Ankle Joint
D) Reverse 90° ankle joint: It
allows PF but stops short at the
neutral position that is at 90
degrees. Thus it does not allow DF
and is prescribed to prevent a
calcaneus deformity.
E) Free ankle: when there is
normal ankle power

37. Knee-Ankle-Foot
Orthosis (KAFO)
• It provides stability to knee, ankle and foot.
• The components are the same as those in a metal AFO.
• Additionally the uprights extend to the knee joint with a lower
thigh band.
• Thigh bands are suspension mechanisms to which the uprights
are attached. They are worn by the patient to fasten the orthoses
to the leg or thigh.

38. Knee-Ankle-Foot Orthosis (KAFO)
Indications
• Muscle Weakness: Weakness of the muscles
of the lower limbs, commonly result from
spinal cord damage or lower motor neuron
disease such as poliomyelitis or injury to a
nerve.
• Upper Motor Neuron Lesions: Upper motor
neuron lesions impair locomotor function.
There is an extensor synergy in the lower
limb, which is used by the hemiplegic to
achieve stance stability. The orthotic device
additionally incorporate knee joints, which
limit hyperextension.

39. Knee-Ankle-Foot
Orthosis (KAFO)
Indications
• Loss of Structural Integrity: This is due to injuries to the main
ligaments of the knee or joint diseases, either due to inflammatory
(septic arthritis) or degenerative (osteoarthritis) processes. The orthotic
prescription is a “weight-relieving”.
• Genu Varus/Valgum: The upright may be on the medial or lateral side
of the leg, depending on whether it is genu varus/valgum to be
controlled.

40. Hip-Knee-Ankle-
Foot Orthosis
(HKAFO)
• The HKAFO is an extension of the KAFO.
• Additionally there is an attached hip joint which allows hip flexion and
extension only.
• The suspension is with a pelvic band, extending posteriorly and
laterally, which fits between iliac crest and greater trochanter and
which is used to control rotational movement at the hip joint.

41. Hip-Knee-Ankle-Foot Orthosis
(HKAFO)
• In the front it is fastened with a soft
Velcro or buckle strap fastener.
• Movement at the hip is with an
uniaxial hip joint with a drop lock,
which is locked during walking.
• In conditions where weight relief from
the lower part of the body is needed,
the body weight is taken away from
the foot or leg and transmitted from
ischial seat through metal uprights to
the ground.

42. Uses of HKAFO
• HKAFO provides improved
posture, balance during standing
and a better controlled forward
leg swing in patients with weak
hip muscles.
• The HKAFO is prescribed
whenever the muscles
controlling the hip and its
stability are weak.
• Muscles controlling the knee
and ankle may also be weak, and
there may be tendency to varus
or valgus of the ankle which can
be accommodated in the
HKAFO.
Disadvantages
• It is difficult to wear and
remove and permits limited
step length.
• There is also an increase in
lumbar spine movements to
compensate for limited hip
motion.

44. Dr. Sanjib Kumar Das, PhDDr. Sanjib Kumar Das, PhD

45. Cervical Orthosis
• Cervical collars are freely
available in 3 readymade sizes—
small, medium and large and may
be soft or hard depending on the
restriction needed.
Uses
• Immobilization of spine helps in relieving pain.
• Reminds the wearer not to move abruptly, thus prescription should only
be done if the neck movement causes severe pain, giddiness or is
injurious to the anatomical structures.
• Long term use is to be discouraged except when severe giddiness or
instability.

46. Cervical Orthoses/Collars(CO)
Soft Collar
• Made from soft foam.
• Provide mechanical restraint (5-15%)
and comfort.
• Relief from minor muscle spasm.
• Relief from cervical strain.

47. Head cervical orthoses (HCO)
Hard collars
• Semi-rigid and rigid plastics.
• Provide more rigid stabilization of
the cervical spine.
• Include Occiput & Chin to decrease
ROM.
• Used in stable spine conditions.
Disadvantages
• Supported chin is a common place
for skin breakdown.
• Clavicle is area HCOs can cause skin
breakdown.
• Long-term use associated with
decreased muscle function and
dependency.

48. Indications for CO/HCO/HCTO
• Crush injuries of cervical spine
• Hyperextension injuries of
cervical spine, collar is used to
hold the neck in a slightly
flexed position- Whiplash
injuries.
• Sprains or strains of the neck.
• Degenerative diseases of the
spine like cervical spondylosis.

50. Philadelphia collar
• Semirigid HCO with a 2-piece system of Plastazote
foam.
• Plastic struts anterior & posterior used for support.
• Upper portion supports lower jaw and occiput, lower
portion covers upper thoracic region.
• Anterior hole for a tracheostomy.
• Thoracic extension can be added to increase motion
restriction and treat C6-T2 injuries.
Indications
• Fracture of the vertebral body.
• Suspected cervical trauma in unconscious patients.
• Cervical strain
• Anterior discectomy
• Anterior cervical fusion
Disadvantages
• Difficult to clean.

51. Miami J collar
• Semirigid 2-piece system made
of polyethylene, with a soft,
washable lining
• Indications are same as
Philadelphia collar
• Thoracic extension can be
added to increase support and
treat C6-T2 injuries.

52. Malibu collar
• Semi-rigid, 2-piece orthosis anterior
opening for a tracheostomy.
• Indications similar to those for the
Miami J and Philadelphia collars.
• Comes in only one size but adjustable in
multiple planes to ensure proper fit.
• Padding around the chin can be trimmed
to ensure proper fit
• Thoracic extension can be added to
increase support and treat C6-T2
injuries.

53. Four Poster Cervical Orthosis (HCO)
• It has padded mandibular and
occipital supports attached to
anterior and posterior plates by four
rigid adjustable uprights. Laterally
leather straps connect the
mandibular and occipital supports.
• Provides greater restriction of
flexion, extension, lateral bending
and rotation than the ordinary
collar.
Indication
• For stable fractures

54. Sternal-occipital-mandibular immobilizer :SOMI (HCTO)
• The SOMI is a rigid, 3-(adjustable)poster
HCTO that has an anterior chest plate extending
to the xiphoid process
• Metal or plastic bars that curve over the
shoulder.
• Straps from the metal bars go over the shoulder
and cross to the opposite side of the anterior
plate for fixation.
• Occipital piece is attached to ant. chest piece.
• A removable chin piece attaches to the chest
plate that can be removed during eating.
• SOMI is ideal for bedridden patients because it
has no posterior rods.

55. SOMI
Indication
• SOMI controls flexion in C1-
C3 segments better than
HCO.
• Atlantoaxial instability.
• Neural arch fractures of C2
(flexion causes instability).

56. Minerva Cast
• It is a suitable modified jacket, which is
applied to the head and trunk.
• Anteriorly, the orthosis has a forehead
strap that secures the upper posterior
shell and a rigid mandibular plate.
• The axillae are also covered by a wool
roll.
Function
• This provides excellent motion
limitation in all directions.
• Rigid immobilization of cervical Spine
Indication
• Cervical spine undisplaced fracture’s
• Compressed fracture of vertebral bodies

57. Halo Vest Immobilization
• Greatest reduction in cervical mobilization.
• Cranial ring secured to the skull using four metal
pins.
• The ring attached by four metal bars to a plastic vest
and is worn continuously.
• The estimated reduction in all cervical motions is 90
to 95%.
• Ability to provide distracting forces aid in
stabilization & reducing the load of head on the
cervical spine.
Function
• Rigid immobilization for C1 through C8 cx spine
Indication
• Cervical spine injuries
• Undisplaced fracture’s
• Compressed fracture vertebral bodies
• T.B Cervical spine

58. Thoraco-Lumbar-Sacral Orthosis (TLSO)
These braces fix the pelvis and shoulder to
prevent spinal movements in all directions.
They may be classified according to
whether they control flexion, flexion-
extension, flexion-extension-lateral
movement and all these including rotary
movements.
Conditions Used
• Compression fracture of the vertebra.
• Intervertebral disc desiccation and prolapse.
• Non-operative and postoperative immobilization of spine.
Uses
Restriction of flexion, extension and lateral flexion of the thoracolumbar
spine.

60. Anterior spinal hyperextension brace (ASH)
• This spinal brace consists of a cross
like frame anteriorly fixed with pads on
the sternum and the pubic symphysis
with the pads at the extremes.
• Posteriorly, in addition (in the Jewett
orthosis) there is a padded support in
the thoraco lumbar region which
maintains the spine extended by the
principle of Jordan.

62. Milwaukee Brace• The Milwaukee brace is given for
growing children with dynamic scoliosis.
• It directs transverse and longitudinal
forces.
• The orthosis consists of a custom
moulded or prefabricated plastic pelvic
girdle that serves as the foundation for
pelvic positioning to control the lower
spine. This is accomplished by flattening
of the abdomen to encourage pelvic tilt
and decrease lumbar lordosis.
• The anterior pelvic girdle is extended
superiorly to just below the xiphoid and
the ribs, providing an anterior
compressive force. The remainder of the
frame consists of anterior uprights
leading to a neck ring. The neck ring has
an anterior throat pad and two occipital
pads that provide an additional
longitudinal distraction force.

63. Milwaukee Brace
• The lateral pads hold the lateral curves, but do
not correct them.
• The pelvic band fixes the pelvis and decreases
lordosis. The collar head-band applies
distracting forces that elongate the spine.
• Further modifications include pads attached at
various levels of the Milwaukee brace to
correct other deformities of spine.
• There are buckles used to distract the brace
according to the height of the child.
• This is thus a dynamic spinal brace that can
‘grow’ along with the children.
• Conditions Used: Any lateral curvature of the
spine - scoliosis and kyphoscoliosis.

64. Milwaukee Brace
Advantages:
• Can be molded or adjusted.
• The average 1-year follow up showed
an average 20 percent correction for
thoracic curves.
Disadvantages:
• Must be worn for 12 to 18 months,23
hours a day.
• Rejection due to psychological issues
and poor acceptance by clients.

65. Lumbsacral Orthosis (LSO)
Knight Brace:
• A short spinal brace consisting of a pelvic band and a thoracic band
joined by two posterior and two lateral metal uprights which, provide
considerably more rigidity than a corset.
Boston Brace:
• Boston brace is an example of modular orthosis that provides varying
control and is useful for the treatment of scoliosis.
• It is made up of semi rigid plastic and supports the lower trunk by
controlling all lumbosacral motion.
Uses:
• The orthosis reminds the wearer to avoid abrupt motion.
• Motion control is achieved by means of various three-point force
systems— support for the spine is also by abdominal pressure.

66. Lumbsacral corset (LSO)
• Lumbosacral corsets may vary in rigidity
based on the amount and type of metal
stays included.
• Longer length corsets used for more
extensive spinal problems.
• A corset has vertical reinforcements or a
rigid posterior plate, but no rigid horizontal
bands.
• They are made of leather or canvas and
contain elastic straps with Velcro fastening
for a close fit, and available off the shelf in
various sizes (28'' to 42'' waist
circumference).

67. Lumbsacral corset (LSO)
Conditions Used:
Painful low back conditions associated with-
• Osteoporosis
• Lumbar spondylosis
• Malignancy
• Bad posture
• Spondylolisthesis
• Lumbosacral strain
• Sciatica.

69. Splints
Splint is an appliance used to support / assist /immobilize part of a
body.
Classification
• Static Splints
Static splints have no moving parts, prevent motion and are used to
rest or rigidly support the splinted part.
• Dynamic Splints
Dynamic splints are moving splints; their parts permit, control, or
strengthen movement.

70. General Functions of Splinting
• To prevent undesirable movements.
• To provide a functional position for the hand.
• To promote grip and pinch.
• To reduce pain.
• To diminish muscle spasm.
• To hold fractured bone ends in position until they are united.
• To maintain the position after reduction of a dislocation until
the joint capsule is healed.
• To strengthen specific muscles.

71. Types of Splints
• Aeroplane Splint
The Aeroplane splint maintains the shoulder in
abduction and external rotation. It immobilizes
shoulder and elbow joint. It consists of chest, arm,
fore arm and wrist pieces joined to one another
almost at right angles.
• Indications
1. Erb’s palsy.
2. Supraspinatus tendon rupture
3. Avulsion of the greater tuberosity of the humerus.
4. Tuberculous arthritis of the shoulder joint.
5. Paralysis of the deltoid muscle.

72. • Cock-up Splint
• The cock-up splint immobilizes or
stabilizes the wrist in dorsiflexion with
volar or dorsal support.
• It may be static or dynamic.
• It allows full metacarpophalangeal
flexion and carpometacarpal motion of
the thumb.
• The splint should be worn all the time
except during exercise and bath.
• Indications
Wrist drop (radial nerve palsy)

73. • Knuckle Bender Splint
Maintains the metacarpophalangeal joint in
90° flexion and interphalangeal joint in
extension.
• Function
1. Immobilization of fingers.
2. It provides support and stabilizes the
wrist in extension.
3. It maintains the transverse palmar arch.
4. It assists in prehension.
• Indication
1. Total claw hand in case of median and
ulnar nerve injury, as in Hansen’s disease.
2. Ulnar claw hand.

74. • C-Splint
This splint maintains the thumb in abduction and partial rotation under the second
metacarpal and supports it. It also stretches the first web space.
• Indications
1. Median nerve injury
2. Contracture
3. Burns.
• Opponens Splints
The opponens splint maintains thumb in abduction and partial rotation under the second
metacarpal. The wrist and other fingers are free.
• Functions
1. Immobilization of the thumb
2. Improves prehension by providing a stable position against which the fingers can
pinch.
3. Protects the joint from pain.
4. Stretches the web space.
• Indications
• Low median nerve injury.
• Opponens transfer (6 weeks after surgery postoperative splint).
• Scaphoid fracture
• Bennet’s fracture
• de Quervains tenosynovitis.

75. Thank You
Dr. Sanjib Kumar Das, MPT (Musculoskeletal),
Fellow (PhD) NITIE- Ergonomics and Human Factors,
Mail: sanjib_bpt@yahoo.co.in
Contact No. +91 8879485847
India