Questions and Answers for the – Dysfunction

How much time does it takes to recover if we use this? It takes the same amount of time to recover. It will make a difference in what the patient can do and how he/she can function during this recovery.

Is the Orficast soft when it hardens? I am asking this in light of using it with elderly people who are vulnerable to pressure injuries. We usually use padding, but it is not always possible. Orficast gets somewhat rigid after activation so you may still need padding.

When there is no IP flexion with claw, is there a way to tell if the injury is a high ulnar nerve injury or early sign of a low injury? You should do muscle testing!

How does the prevalence of vary by age? Not sure about the answer to your question. Please read the evidence-based articles.

What conditions can cause hyperextension of MCPJs of all digits to use anti claw splint for all digits? Combined median and ulnar nerve palsy? Correct!

In relation to the question already posted and answered - how do you affix padding to Orficast material? Use a heat gun!

Should we use MCP block splint for 4th & 5th finger for patient who have cubital tunnel syndrome? If they exhibit MCP joint hyperextension, clawing and difficulty with PIP extension.

Can you also use the Functional Web Spacer for clients with spasticity in de hand/webspace? Yes!

Combined medial and ulnar paralysis are mainly found in which conditions? As described in the presentation: patients with spinal cord injuries, ALS, Charcot Marie Tooth syndrome and trauma.

How many hours a day should the patient wear the orthosis? Functional assist orthoses should be worn during functional activities.

All day as a functional assist for most of these examples- maybe a resting hand at night or the web spacer.

Do we need to provide padding while using Orficast ? Not usually but depends on each patient.

What can be used as padding for sensitive skin? We do have self-adhesive padding materials in foam and or fabric. Check our website please! https://www.orfit.com/physical-rehabilitation/accessories/#!/padding-lining

Should we use anti claw splint for 4th & 5th finger for patients who have cubital tunnel syndrome? If fingers show signs of clawing and or difficulty with PIP extension.

How do you reinforce the cross over area in the palm for the ulnar nerve splint? I have a lot of clients who work with this splint on but after a couple of weeks the area in the palm pops. Even though I scratch it up and make sure there are no seams. Any ideas? Heat and pinch together and roll into tubular shape.

At what angle should the MCPs be? 45-60 degrees of flexion is good, as long you prevent hyperextension.

Can I ask about a splint for Posterior Interosseus nerve palsy? Index finger and little fingers extend and middle + ring flexed won't extend? That is a compression so it is a different topic – can be addressed with a dynamic extension orthosis.

Can we make this splint in aqua plastic material? Yes, if necessary.

Do you find that the rolled bar in the palm gets in the way of patients' picking up objects? And if yes, do you attempt to mold it flatter? Yes, roll it as much you can into a tubular shape. I find pinching in a tubular shape takes up very little of the palmar area and does not interfere.

Could you please share some attachment tricks of strapping on a splint? Please see our blog on attaching straps to Orficast: https://www.orfit.com/blog/using-hook-and-loop-straps-in-orthotic-fabrication/ https://www.orfit.com/blog/attach-hook-and-loop-tape-to-wet-orficast/

When it's difficult to maintain desired hand position can we do orthoses on plaster mould or on master mould? Not sure what is meant here. Sorry.

Any differences between ulnar claw orthosis with and without strap? Which one is better or how to decide which one is more suitable for our client? No real difference. It may be easier and more adaptable with a strap.

Can we use Knuckle bender orthosis? Which model do you refer to?

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How long does it take the median nerve to heal? Depends on the injury.

What is the best orthosis for compound radial median ulnar nerve dysfunction? An orthosis that includes all 4 fingers and the thumb.

For the second web spacer, won't the material irritate the skin it tries to stretch? Especially when the splint is used to push apart the thumb and the index? No, it really does not irritate the skin. Try it!

Can we use the thumb spacer for stroke patients who have difficulty doing abduction of thumb and extension of index finger that is usually necessary for gripping and releasing objects? Yes.

When a person has a complete claw hand, do you recommend use an intrinsic plus splint at night too? Resting splint at night, yes.

Can the thumb orthosis be used to CP patients with cortical thumb/clenched fist? Yes, this works for that condition as well.

Sometimes it’s hard to fit the orthosis on patient due to stiffness or clawing of fingers. Do you have any techniques to help fit the orthosis properly? Try heat and passive stretch prior to orthotic application. Can make in separate parts and connect after with the heat gun.

Is it recommended if the patient's hand is still edema? Yes, but you may need to re-evaluate and check fitting as edema decreased.

Can you do the whole dynamic splint with one material? Yes, you could use the same material for both parts.

Is there a specific thickness of the wire? It is the Orfit Spring wire: https://www.orfit.com/physical-rehabilitation/accessories/stainless-steel-spring-wire/

What is the duration of wear for anti claw for ulnar based injury? Is by weeks or months? Depends on the progress of nerve regeneration!

Will Orfit cast stick to the Orfit colors nicely without dislodging? Yes, with the heat gun to both components.

Do you know if all Orfit material is available in Brazil? Please contact our distributor in Brazil : www.efective.com.br

What is the difference between the last orthosis and the one with thumb attaches? In term of using these orthoses for cases. The dynamic thumb piece allows for a bit more active flexion and thumb activity.

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Can a spiral wire be more helpful/strong enough as compared to a straight/bend wire (dynamic component) in anti claw splint with thumb component? Maybe- not sure what is meant here.

I am having problems handling Orfilight 1/12" It gets sticky and i am unable to mold it to the client. I work in the Caribbean and cannot store the material in an air-conditioned room. Any tips? I have tried using powder with some success the end product is not pretty. Use our coated Orfilight products : Orfilight Black NS and Orfilight Atomic Blue NS and check the water temperature to make sure it is not too hot…. 65 C.

Do you have any preparatory exercises that you can recommend for patients due for splinting for median nerve problems prior to splint fabrication and wearing? Maybe heat and stretch- passive range of motion prior to make the patient comfortable.

In case of old ulnar nerve injury. Can splinting still assist? Depends on what the problem is. An orthosis cannot replace the nerve but may help with positioning.

Which wrist orthosis can we provide for contracture? Wrist orthoses are the topic of the next webinar, please join us!

Regarding Orfit splinting materials, how easily can they be available in my country Kenya in Africa?? Or do you have suppliers’ agencies? Mail : [email protected] Website : www.physicaltherapy.co.ke

Which Orthosis is best suited when the patient is having scalenus anticus syndrome (cervical rib), which in turn is causing tingling and numbness, sometimes on the ulnar side, other times in median and also pain and numbness at the wrist joint to a different level. Which Orthosis you would suggest and duration. Please evaluate the patient’s condition and select the appropriate orthosis based on the evaluation. The orthosis does not eliminate nerve pain and does not provide sensory input. I would suggest treatment procedures for - nerve glides, etc.

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