Name of the Procedure:

Elbow Wrist Hand Orthosis (Custom Rigid Brace)

Summary

This procedure involves creating and fitting a custom-made rigid orthosis (brace) for the elbow, wrist, and hand. The brace is designed without joints and may include soft lining and straps for comfort and support. It's custom-fabricated to fit the patient's specific anatomy and includes a session for fitting and adjustments.

Purpose

The orthosis is used to provide support, immobilize, and protect the elbow, wrist, and hand following injury, surgery, or due to degenerative conditions. The goal is to stabilize the joint area, promote healing, and alleviate pain.

Indications

• Post-surgical stabilization of the elbow, wrist, or hand.
• Acute or chronic injuries such as fractures or ligament tears.
• Neurological conditions like stroke, leading to hemiplegia.
• Degenerative diseases like arthritis.
• To prevent contractures or deformities in certain neurological or muscular conditions.

Preparation

• No special fasting or medication adjustments are usually needed.
• The orthotist may review recent X-rays, MRI, or other imaging studies.
• Patients should wear clothing that allows easy access to the arm for measurements.

Procedure Description

1. Assessment: The orthotist assesses the patient’s arm to determine the specific requirements for the orthosis.
2. Measurement: Exact measurements of the elbow, wrist, and hand are taken.
3. Fabrication: The orthosis is custom-made based on the measurements and clinical needs.
4. Fitting: The patient returns for a fitting session where the orthosis is checked for comfort and proper fit. Adjustments are made as necessary.
5. Instruction: Patient is educated on how to wear, remove, and care for the orthosis.

Duration

The orthosis fabrication process and fitting session typically take a few hours, with additional time for adjustments if needed.

Setting

The procedure is performed in an outpatient clinic or an orthotics and prosthetics facility.

Personnel

• Orthotist (specialist in making and fitting orthoses)
• Sometimes, physical therapists or occupational therapists may be involved in the assessment or follow-up care.

Risks and Complications

• Skin irritation or pressure sores from the orthosis
• Improper fit leading to inadequate support or discomfort
• Allergic reactions to materials used in the brace

Benefits

• Immobilization and support to aid in healing
• Reduced pain and inflammation
• Prevention of further injury or deformity
• Improved functional use of the arm over time

Recovery

• Patients are typically able to use the orthosis immediately after fitting.
• Follow-up appointments are necessary to monitor progress and make any adjustments.
• Patients may need to perform specific exercises to maintain range of motion in unaffected joints.

Alternatives

• Off-the-shelf or pre-fabricated braces
• Surgical intervention in more severe cases
• Physical therapy alone
• Medications to manage symptoms

Pros and Cons of Alternatives

• Off-the-shelf braces: Less costly but may not fit as well or provide needed support.
• Surgery: Invasive, more risks, and longer recovery but can be more effective for certain conditions.
• Physical therapy: Non-invasive, helps maintain mobility but might not provide needed immobilization.
• Medications: Can help with pain and inflammation but don't provide structural support and can have side effects.

Patient Experience

• Patients may feel some discomfort initially as they adjust to wearing the orthosis.
• Pain is generally managed with over-the-counter medications.
• Regular use leads to improved comfort as the orthosis helps with healing and stability.
• Patients should follow guidance on maintenance and adjustments to ensure comfort and effectiveness.