Frequently with neuro-paediatric elbow contractures clients often require a made to measure custom gaiter when a joint cannot be passively fully extended. Adult neuro clients also have the same requirement; although a larger selection of off-the-shelf braces are available, but not all are easily adjusted / fit well.

Recently the Artisan Elbow Immobiliser was trialled for these two groups with mild to moderate hypertonia, and found to yield excellent results from an OTS solution, whilst giving a custom fit.

It is sized from a small paed size to adult from a single measurement. The unique aluminium reinforcement is easily shaped and lightweight for an intimate fit to accommodate any limb shape. It has been especially useful in that it can be reshaped to any ROM changes without tools, and then locked into place with the velcro  L tabs; purely by hand. Other OTS devices are sometimes confusing and tricky with dual hinges to set ROM, time consuming due to fiddly parts at the bedside, and for mild to moderate hypertonia paed clients a little over engineered for the task.

We find that if we need to be very specific with setting our angles due to the absence of a ROM joint to indicate; then using a simple goniometer to measure the final set up was all that was required. Other braces however well they indicate an angle on the hinge, rarely mimic the true position of the clients as they often do not align with the anatomical position very well.

Artisan Elbow Immobiliser

In cases with commonly seen increased forearm pronation we found the long forearm trough especially useful with its high sides shaped well to give some rotational resistance, this is further helped by the reinforced palmar strap, and the ability to have the trough extend into the palm and shaped to almost a wrist hand orthoses whilst allowing prominent styloid to be accommodated by shaping relief. If we did not feel extending to wrist was required we simply either fitted a smaller size, or folded back the pliable aluminium.

The immobiliser is plush lined, and the aluminium internal structure is perforated to allow for moisture wicking. The edges have no aluminium so affords a soft edge in the axilla area, and in cases of unusually short humerus the top can be rolled over to reduce the height. It is supplied with a selection of lay on straps with no pre-determined locations; allowing the clinician to place for best alignment.

Clients and staff to date have found it highly comfortable, and in some cases superior in being able to reliably don correctly due to its simplicity. We are extremely happy we can give a custom fit gaiter solution from a single measure without the burden of waiting for an MTM item to arrive.

There are many other pathologies in which the elbow may need to be immobilised at a pre determined angle, for example cubital tunnel syndrome, fractures, or soft tissue injury. As you can see the Artisan Elbow immobiliser has a much wider reach for the clinician.

For more information about the Artisan Elbow Immobiliser or to arrange a demo please contact the customer services team on 0191 258 8944 or email sales@braceorthopaedic.co.uk 

Off-the-shelf wrist hand orthoses (WHO) have proved limiting and often challenging to adapt, the thermoplastic variety is often too time consuming and not easily done at a bedside of an in-patient. Other padded offerings with internal mouldable reinforcement have not allowed acute MCP angles to be accommodated due to excessive padding and inability of the material to be bent to a small radius; and in some cases the stiffener has to be removed each time to bend or heat. Most have to be ordered with or without a thumb, with the thumb often incorrectly oriented and too long; and the strapping is often set at pre-determined locations.

The wrist hand complex is highly dextrous and encompasses 27 degrees of freedom; 4 for each finger, 5 for the thumb, and 6 at the wrist. Static splinting is often used for bony or soft tissue injuries pre/post-surgery in cases of hyper or hypotonia; to maintain muscles, tendons, ligaments and joints in a stretched and extensible position for increased function, protection, and prevention of deformity.

As a clinician, it feels like you use all 27 when setting up an off-the-shelf WHO; that however is going to change, read on to find out how…

Commonly you position the wrist and hand into the POSI/neutral which places the wrist in 0-30° of extension, MCP joints in 70-90° of flexion and IP joints in full extension, the splint is palmar. Flexor Tendon Injuries splinting is placed dorsally, the wrist is flexed 20-30°, the MCP joints are positioned in 70° of flexion, and the IP joints are flexed slightly. For an Extensor Tendon Injury splinting is palmar and the wrist placed in 20° of extension, the MCP joints are positioned in 10-15° of flexion, and the IP joints should be straight. The thumb if required is often placed in abduction, and depending on the injury the IPJ of thumb may be left free. Often in cases of hypertonia an ideal position cannot be achieved due to spasticity and contracture, and a best position is often held to prevent further loss of ROM.

What the above illustrates is that the hand can present many challenges from a fitting perspective due to angles, orientation of palmar/dorsal, and if the thumb should be encompassed, and to what degree. Furthermore, holding stock of WHOs in left and right, with/without thumb, palmar/dorsal versions can become a department stocking nightmare.

What is the solution? We have found a highly clever and adaptive WHO, with modular thumb and strapping, it is called the Artisan Palmar Forearm Splint.

This unique material has a perforated breathable aluminium structure integrated with a plush lining. It can be manipulated easily, forming acute angles not just in one plane, for example a client post-CVA with a heavily flexed wrist, ulnar deviation, adducting thumb, which can be a common challenge, was easily shape matched with the Artisan. Often lacking in adaptable WHOs is containment at the medial and lateral sides alongside distribution of pressure, rather than the straps doing all the work, the Artisan can be formed into a conventional gutter splint. The material really stood out in one RA client with nodules and a very prominent styloid process. With the Palmar a custom fit was achieved effortlessly in minutes accommodating these prominences, whilst still encompassing the lateral control.

We admired the fact it was universal-sided in 3 sizes, the thumb piece is separate allowing exact positioning of the thumb support, and ease of setting the length of the thumb so that the IPJ was not wrongly immobilised. In addition, individual straps can be positioned for optimum alignment as they are loose too.

The Artisan, although a palmar oriented WHO, paradoxically illustrated surprisingly well that it could be shaped to the dorsal region. The personal account here was not a flexor tendon injury, but in fact a case of a palmar burns client who could not tolerate palmar pressure, the Artisan formed easily in minutes into an excellent dorsal WHO, which confirmed just how adaptable the material is. The Palmar Forearm Splint is an outstanding addition to the clinician’s arsenal, I urge you to try one today.

For more information or to arrange a demo of the Artisan Palmar Forearm Splint please contact the customer services team on 0191 258 8944 or email sales@braceorthopaedic.co.uk