Upper Limb Orthotics/Metacarpophalangeal and interphalangeal orthosis

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Describe your case study
The client is an 8 year old male who presents with an acute soft tissue injury to the right index finger. The injury was sustained during a fall from a tree. The injury presented as a puncture wound inflicted by a splinter of timber. Timber remained in situ in the acute setting. Client attends school and is currently in grade 3. He plays soccer recreationaly and enjoys playing video games in his spare time.

Treatment to date has included surgical removal of timber by a Senior First Aid qualified adult. An open wound remains and surrounding tissue shows signs of inflammation. Local tenderness with no active bleeding at the site.

Range of motion (ROM) restricted at the distal and proximal interphalangeal joints due to pain. Achieves 30 degrees of flexion and -15 degrees of extension at the proximal interphalangeal joint. Metacarpophalangeal ROM within normal limits. Nil other deficits identified.

Written information

 * Equivalent to 1500 words
 * This will be marked on the level 4 marking matrix.

Evidence
Write this section based on “Orthotic Treatment of (insert your pathology/case study here) in the Upperlimb”. Anatomy and Pathology: give an outline of the area and specific muscle groups affected. A summary of the pathology with specific reference to the upper limb. Don’t forget to reference.

Orthotic treatment options
(this may include post-surgery)

Comparison of orthotic treatment options
(or orthotic treatment vs surgical intervention)

Functional Aims and Goals
Give a detailed description of the goals outlining the specific movements/activies that your orthosis is required to provide use the evidence described above to support this.

Design
Outline the design of your orthosis, this should include but is not limited to: technical drawings, force system diagrams (3 planes), materials of choice, attachment methods, trimlines and manufacturing procedure. Within this section, if you would choose to make your device from something other than LTT explain why and how this may affect the function of the device you manufacture.

Manufacturing process
Document the manufacturing process of your device. This should be a step by step “how to guide” including photographs, patterns, fittings, adjustments etc.

Based on measurements of finger circumference and extension of wound, a suitable bandage is selected. Using best practice infection prevention techniques including hand washing, use of sterile gloves and sterile bandage, and antibacterial solution applied to the site.
 * 1) Selection of bandage
 * 1) Sterile preparation of site
 * 1) Removal of packaging
 * 2) Modification if required
 * 3) Application of bandage

Critique of fit
You should base this critique on the your understanding of the critique process and the lecture you will receive in week 8. You will need to provide photographic or video evidence of the fit, function and operation of the force systems. Written support for your critique is fine if you choose to not video this.

"It fits super good." was the subjective response from the client, however it failed to meet the minimum fitting standards according to the Periwinkle rubric

For a video depicting the donning of the orthosis see this youtube clip

Outcome measures
There are a variety of outcome measures available for the upperlimb functional ability. Choose an appropriate measure (if you are having trouble finding some the TAC website for clinical resources here may be useful.

Complete this for your client (using your clinical knowledge and judgement) for before and after the client receives the orthosis. Choose activies that you believe the client would have improved on and video your client undertaking these whilst wearing their orthoses. Outline your finding. Provide images of the completed Outcome measure on your wikipage.

References and Resources
Test Edit

Direct Link to ULO Main Page
ULO Main Page