osteo support

PRODUCTS OF OSTEO SUPPORT, ktm Nepal

2009-12-23T08:28:00.000-08:00

osteo support Nepal is a business firm, which is providing prosthetic and orthotic services. Osteosupport provide prefabricated and costume made Soft orhthosis, prefabricated and costume made hard orthosis, costume made prosthesis.

soft prefabricated orthosis widely used items.

Lumber sacral belt
Abdominal belt
pelvic belt
Hernia belt
cervical collar soft
cervical collar hard
New pouch arm sling
post plast sling
clavicle brace
Tenis elbow support
knee brace
Foot-drop splint
wrist splint
cock-up splint
wrist binder
wrist binder with thumb
Ankle binder

Head hulter
Cervical traction set
Lumber traction set
Skin Traction Aids
Gallow"s skin traction
Orthopedic stockinet
wooden Crutches
Chest guard

These all items are available in different size and measurement. We are providing custom made service for special measurement.

We provide custom service for orthotic management.

Any stockist, whole saller can contact on following address

Kushibu,Nayabazar-16
kathmandu,Nepal
Tel. 977-01-4 381469
Mobile. 9841 275627

SHORTENING AND COMPENSATION

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Shortening may be either true or apparent shortening.Due to different pathological reasons shortening may happen as secondary deformity if particular diseases are not treated at the time e.g Polio, cerebral palsy,spina bifida,burn,osteomyelitis,fracture,myopathy etc.

True shortening or bony shortening is due to shortening of anatomical structure of the bone either shortening of femur or tibia. It may be due to congenital or pathological or accidental. Where as apparent shortening is false shortening or visible shortening. To find out the true shortening the patient will be kept on straight supine position. Measurement will be from ASIS to medial malleolus of both lower limbs. The different in the measurement will be the true shortening. For apparent shortening measurement will be from umbilicus to the medial malleolus of both lower limbs. The different in the measurement will be the apparent shortening. However most of the people have shortening up to 5 mm which is acceptable.

Anatomical structure of the body is affected by the shortening. The patient feel tired soon, energy will consume more, and gait will be ugly. Weight distribution of the body will unequal. Gradually shortening affect on spine which slowly develop scoliosis.If it become severe and chronic, internal organs like lungs and heart also affected.

Due to different pathological reasons shortening may happen. These shortening must manage to prevent from further complication. During assessment of the patient, it should be confirmed that shortening is correctable or not. For example fixed equines or fixed planter flexion may have more shortening and not correctable, which must accommodate in appliance (alignment in 90 degree).If the equines is correctable then it should be correct during casting and remaining shortening should accommodate in the appliance.sometime it may need to accommodate contra lateral shortening

Inside the appliance or inside the shoe shortening can be accommodate up to 4 cm, more than that shortening should be accommodate outside the shoe.

POP model of 3 cm shortening ( 1 cm heel height)

Foot orthosis( 3 mm tape foam) with 3cm padeline foam compensation (1 cm heel height)

Positive model with Foot orthosis ( 1cm heel height)

In case of fixed equines, shortening should be compensate accordingly and align the appliance on 90 degree.In those cases contra lateral compensation may needed.

The pop model of 7 cm fixed equines

7 cm Shortening compensating with padeline foam ( 1cm heel height with allign on 90 degree)

7 cm Shortening compensating with padeline foam ( 1cm heel height with allign on 90 degree)

If shortening is more than 12 cm, then patient may need orthoprosthesis to compensation the shortening.

Orthoprosthesis with 15 cm compensation ( medial view)

Orthoprosthesis with 15 cm compensation ( frontal view)

ORTHOTIC MANAGEMENT OF DIFFERENT DISEASES

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1. POLIOMYELITIS

Poliomyelitis is a viral infection of nerve cells in the anterior gray matter of the spinal cord, leading temporary or permanent paralysis of the muscles that they activate.

Cause:

It is caused by infection with a polio virus.

Sign & symptoms:

Fever

Permanent motor paralysis-Flaccid

Irreversible muscle atrophy

Paralysis in lower limb (gluteus medius, gluteus minimus, quadriceps, tibialis anterior, triceps surae)

Complications:

Drop foot

Genu valgum with pes cavus

Severe wasting of thigh and lower leg

External rotation of foot on leg

LLD

Trendelenburg gait adopt to counter gluteus medius weakness

Hyperlordosis to counteract gluteus maximus weakness

If not treated it may lead to:

Hip abduction contracture

Knee flexion contracture

Ilio tibial band contracture

Long C cure scoliosis

Pelvic obliquity

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

HKAFO- If hip flexor/ extensor are weak, hip adduction abduction weakness.

Ischial bearing KAFO – If femoral bone fractures, femoral head dislocation along h

Along with hip flexors, extensors weakness

KAFO- If knee extensors/extensor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weaknes

In case of AFO- If muscle grading is 3- , Solid AFO

- If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint

If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

KAFO with different joints

Free Knee: This design is provides medial-lateral stability to knee joint while allowing free motion in flexion and extension.

Posterior Offset Knee Joint: The posterior offset knee joint is used to aid in knee extension for those patients who exhibit minimal quadriceps weakness. The placement of the mechanical knee joint is just posterior to the anatomical knee joint providing for increased knee stability when walking.

Stance Control: Provide for stability during weight bearing and free flexion (bending) during the swing phase of gait or non-weight bearing. Allowing the knee to bend during the swing phase of gait provides for a more normal gait pattern, is more energy efficient. Locked Knee: Provide maximum stability to the patient. These orthoses are locked during the entire gait cycle and can be unlocked for sitting. The locking mechanism is done by a drop lock, bail or French lock, or trigger lock.

Drop Lock: This design incorporates a ring that slides down over the knee joint providing for a mechanical lock.

Bail or French Lock: This style of knee joint incorporates a loop that connects the posterior of both knee joints. Rather than locking each knee joint individually this allows both to be unlocked via a bail or loop design.

Trigger Lock: A trigger lock design is similar to the bail or French lock. This design often uses cables and a trigger switch allowing patients to unlock the knee joint via a point at the proximal edge of the orthosis. It is commonly used for patients with limited dexterity, balance and for increased safety and stability.

AFO

Posterior Leaf Spring–PLS: Allow the patient to overpower the orthosis during the push-off or plantar flexion phase and yet allowing dorsiflexion position of the foot during swing phase. It is typically used for flaccid foot drop.

Semi-rigid plastic AFO -with trim lines just behind the malleoli will allow for increase dorsiflexion of the foot and mediolateral stability of the ankle. This design is most commonly used for patients that have foot drop with some extensor tone and/or with mediolateral instability of the ankle.

Rigid or solid plastic AFO – The trim line at the malleoli or anterior to the malleoli with no motion allowed at the tibiotalar or subtalar joint. This orthosis is typically used for patients with the highest levels of spasticity, early to moderate Charcot joint, and for postoperative immobilization of the foot or ankle.

2. BURN

A burn is a type of injury that may be damaged the muscle, bone, blood vessel, nerve and epidermal tissue.

Causes:

Heat, steam, electricity, chemicals, light, radiation

Sign & symptom:

Redness

Painful on touching

Formation of blister

Loss of soft tissue

Gangrene

Complication:

Infection

Septicemia

Contracture

Functional or cosmetic damage

If not treated the complication may lead to:

Amputation

Deformity (contracture of joint, contracture of muscles)

Dupuytren's deformity

Orthotic/Prosthetic treatment:

Burn usually lead different contracture, so according to location of burn severity of deformity the orthotic treatment should be given. If the amputation done as secondary complication (septicemia), the prosthesis should be given according to the level of amputation. The main purpose of the orthotic treatment is to prevent further potential deformity and to get functional activities.

Orthosis - AFO, KO, EWHO, WHO

Prosthesis-Partial foot, TTP, TFP, TRP, THP

3. CLUB FOOT

A clubfoot, or talipes equinovarus (TEV), is a birth defect & commonly occurring in about one in every 1,000 live births. Approximately 50% of cases of clubfoot are bilateral. This occurs in males more often than in females. The ratio is 2:1

Causes:

Genetic factors

Sign & symptoms:

High arched foot that may have a crease across the sole of the foot.

Heel is drawn up.

Toes are pointed down.

Bottom of the foot (heel) is pointed away from the body thus, the foot is twisted in the Foot and leg may be smaller in comparison to a comparatively normal child.

Foot will lack motion and be noticeably stiff.

Calf muscle may also be smaller.

Complications:

Arthritis

Affected foot may up to 1 ½ shoe size smaller than unaffected foot

May walk on the balls of the feet the outside of the feet or even the top of the feet in severe cases.

The patient may also experience corns, hard skin and in growing toenails.

If not treated, the complication may lead to:

Fixed talipes equinovarus

The main purpose of orthotic treatment

Correct the deformity early.

Correct the deformity fully

Hold the correction until growth stops.

Orthotic treatment:

Dennis Brown splint-Straight-last shoes separated by a metal bar keep the calcaneus in valgus, the forefoot in abduction and the ankle dorsiflexed - all in an attempt to straighten out the child with Club Foot. AFO

KAFO -90 degree flexion

4. CEREBRAL PALASY

Cerebral palsy is a group of disorders characterized by loss of movement or loss of

Other nerve functions.

Type:

Spastic- most common

Athetotic-5:1 ratio

Ataxic-Least common

Causes:

Idiopathic

Injuries to the brain (cerebrum) –during fetal development or near the time of birth

Premature delivery

Sign & symptoms:

Usually apparent before age 2 and in severe cases may appear as early as three months.

Delayed development of motor skills, such as reaching, sitting, rolling, crawling, walking

Mental retardation

Speech Visual hearing abnormalities

Spasticity

Limited range of motion

Muscle contractions

Difficulty sucking or feeding

Complications:

Fall injury/ Accident

Reduced mental functions

Progressive joint contracture

Limited ROM

If not treated the complication may lead to:

Upper limb- Flexion contracture of the elbow, pronation deformity of the forearm. Flexion of the wrist, and adduction of the thumb.

Lower limb- adduction of the hip, flexion of the knee, and equines of the ankle.

Orthotic treatment:

The main purposes of orthotic treatment are to prevent from potential deformities & provide mobility.

Type and design of orthosis is depend on MUSCLE GRADING, RANGE OF MOTION & JOINT STABILITY.

HKAFO

KAFO

AFO

WHO

EWHO

Compensation should provided as required in case of LLD, equinus

AFO -are provided to support, proper joint alignment to the foot and ankle, assist or substitute for muscle weakness, and protect the foot and lower limb. Different type of AFOs can used according to need these are Semi-Solid AFO, Solid Ankle Foot Orthosis, Articulated Ankle Foot Orthosis.

KAFO:

These Orthoses are designed to provide stability & mobility to the knee joint. The KAFO are facilitate by using different joints according nature of need of patient these are

Free Knee, Posterior Offset Knee Joint, Stance Control Locked Knee Drop Lock Bail or French Lock, Trigger Lock

5.FRACTURE

Fracture is a break in a bone causing loss of continuity in its alignment

The severity of fractures increase with age. Children's bones are more flexible and less likely to break. Older adults suffer from fractures more than children because their bones are more likely to be brittle. There are many types of fractures: simple, stress, comminuted, impacted, compound, complete and incomplete.

Symptoms:

Swelling

Loss of function

Bruising

Deformity of a limb

Causes:

Fractures occur when a bone can't withstand the physical force exerted on it.

Complications:

Septicemia

Gangrene

Loss of movement

Instability

If not treated complication may lead to:

Amputation

Arthritis

Leg length discrepancy

Ortho/prosthetic treatment:

The main purpose of orthotic treatment in fracture are to stabilize the fracture site and help promote callus formation by allowing weight bearing and joint movement after initial healing of pain and edema. It helps in minimize joint stiffness and reduce complications such as nonunion. Circumferential compression of the soft tissue can be used to prevent undue bony motion at the fracture site.

Fracture Orthosis- Fracture braces according to location and severity of fracture

PTB weight bearing fracture orthosis if fracture of tibia

Ischial weight bearing fracture orthosis if fracture of femur

Prosthesis (If fracture leads to amputation) — PF, TTP, TFP, HD, TR, TH

6. MUSCULAR DYSTROPHY

It is a group of genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles which control movement. There is no specific treatment for any of the forms of muscular dystrophy.

Types of muscular dystrophy are:

Duchenne muscular dystrophy- Onset is between 3-5 years and progresses rapidly. Most boys become unable to walk at age12 and their life expectancy usually not more than 20.

Facioscapulohumeral muscular dystrophy- appears in adolescence and causes progressive weakness in facial muscles and certain muscles in the arms and legs. It progresses slowly.

Myotonic muscular dystrophy- characterized by prolonged muscle spasm in the fingers and facial muscles; a floppy-footed, high-stepping gait; cataracts; cardiac abnormalities; and endocrine disturbances.

Complications:

Joint contracture

Foot drop

If not treated the complication may lead to:

Equinus

Lordosis

LLD

Scoliosis

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

Semi-rigid plastic AFO with trim lines just behind the malleoli will allow dorsiflexion of the foot and mediolateral stability of the ankle.This design is most commonly used for patients that have foot drop with some extensor tone and/or with mediolateral instability of the ankle. During independent ambulation, interventions generally should be confined to nighttime. AFO in an attempt to slow the progression of Equinus contractures.

KAFO- These Orthoses are designed to provide stability & mobility to the knee joint. The KAFO are facilitate by using different joints according nature of need of patient these are

Free Knee, Posterior Offset Knee Joint, Stance Control Locked Knee Drop Lock Bail or French Lock, Trigger Lock

Compensation should be adjusted if there leg length discripency.

7. SPINA BIFIDA

Spina bifida (SB) is a neural tube defect, involving incomplete development of the brain, spinal cord, and/or their protective coverings. The most common location of the malformations is the lumbar and sacral areas of the spinal cord.

Myelomeningocele is the most significant form and it leads to disability in most affected individuals. The terms spina bifida and myelomeningocele are usually used interchangeably

Causes:

Failure of the fetus's spine to close properly during the first month of pregnancy.

Sign & symptoms

Sign & symptoms are appear according to location of the affect on spine

Permanent damage of nerve leads to paralysis of lower limb.

Weakness of lower limb

Difficult to keep spine in erect position

Bowel and bladder problem

Curvature of spine

Intellectually disable

Complications:

Paralysis (partial or complete)

Bowel and bladder uncontrolled

Orthopedic problems - scoliosis, kyphosis and clubfoot

Flexion contracture

Orthotic treatment:

Patients will require lifelong assistance from wheelchairs, braces, or crutches to help them get around.

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

SPINAL ORTHOSIS

AFO

KAFO

HKAFO

HKAFO-The orthosis consists of two-molded plastic knee-ankle-foot Orthoses (KAFO) attached to a metal pelvic control band and upright thoracic supports. The posterior section of the pelvic band/thoracic component is fit with either a rocker bar system or cable system. Both function in a similar manner; the rocker system functions much like a seesaw. Shifting weight from one side of the body to the other allows one limb to be stable on the ground while advancing the contra lateral limb

KAFO: These Orthoses are designed to provide stability & mobility to the knee joint. The KAFO are facilitate by using different joints according nature of need of patient these are Free Knee, Posterior Offset Knee Joint, Stance Control Locked Knee Drop Lock Bail or French Lock, Trigger Lock

Thoraco-Lumbo-Sacral Orthoses (TLSO): TLSOs or body jackets are fabricated effective for treating thoracic and sacral vertebrae from levels of T7/8-L3-4. They are typically fabricated from hard plastic with a soft interface.

8. MULTIPLE SCLEROSIS

Multiple Sclerosis is a disease of the central nervous system which may affect any area of the brain and spinal cord. Multiple sclerosis does not affect nerve cells but affects on transmission of electrical signals to nerve cells. Multiple sclerosis is the most common cause of chronic neurological disability in young adults.

Causes:

The exact cause is unknown

Inflammation of the nervous system

Sign & Symptoms:

In general it affect on sensory or motor function

Muscle spasm

Fatigue, numbness, tremor, loss of vision, pain, paralysis, loss of balance,

Numbness in the entire body

Complications:

Loss of mobility and spasticity

Osteoporosis

Bowel and bladder dysfunction

Cognitive disorder

Depression

Speech Problems

If not treated complication may lead to:

Joint contracture

Limited ROM

Equinus

LLD

Scoliosis

Orthotic treatment:

The type of orthosis should provided according to ROM, muscle grading and joint stability

If lower limb is affected AFO, KAFO, AFO, KO

If upper limb is affected wrist hand orthosis

If spine is affected spinal orthosis

9. DIABETIC

Diabetes is the results of defects in insulin secretion, insulin action, or both. In diabetes, glucose level increase in blood. Insulin is a hormone that allows blood glucose (blood sugar) to enter the cells of the body and be used for energy.

Sign & symptoms

Excessive thirst

Excessive urination

Extreme hunger

Unusual weight loss

Extreme fatigue

Irritability

Nausea

Vomiting

Sweet smelling breath

Complications:

Rapid bony destruction,

Recurrent ulceration and infection

Heart disease, Kidney disease

Amputation

Stroke

Diabetic retinopathy, diabetic neuropathy

Sciatica

If not treated complication may lead to:

Gangrene, Amputation, Joint contracture, Arthritis

Orthotic /prosthetic treatment:

As soon as the active stage of the disease is recognized, the patient must be immediately and aggressively protected from excess weight bearing. During orthotic or prosthetic treatment of the patient, appliance should be carefully finished and skin friendly soft in liner should be used.

FO-Silicone gel Foot orthosis

AFO-Many of these patients already have trouble in walking, so prefer not to lock the ankle against plantar flexion unless hind foot problems exists. A spring dorsiflexion assist is sometimes useful to reduce foot slap or aid toe clearance. The rocker sole is individualized since these feet are generally ulcer-free due to the weight bearing restrictions.

In case of Prosthesis – Any prosthesis must use skin friendly soft in liner e.g derma seal, silicon gel etc.

10. LEPROSY

Leprosy is an infectious disease characterized by disfiguring skin lesions, peripheral nerve damage, and progressive debilitation. Leprosy is common in many countries in the world

Causes:

Leprosy is caused by the organism Mycobacteriumleprae.

Sign & symptoms:

Decreased sensation to touch, heat, or pain

Skin lesions that do not heal after several weeks to months

Numbness or absent sensation in the hands and arms, or feet and legs

Muscle weakness

Complications

Cosmetic disfigurement

Nerve damage in the extremities

Sensory loss in the skin

Muscle weakness.

Direct injury

Ischemia

Mechanical force on open wound

If not treated complication may lead to:

May lose their hands or feet due to repeated injury resulting from lack of sensation

Amputation

Orthotic treatment:

The leprosy patient usually loss their sensory, so any appliance either orthosis or prosthesis should be made in such a way that there should not be any soft tissue damaged by appliances.

Prosthesis – according to level of limb loss.

Orthosis – according to loss of function and mobility.

11. HEMIPLEGIA

Hemiplegia is a condition in which one-half of a patient's body is paralyzed caused by a disruption in the blood flow to part of the brain.

Causes:

Cerebral palsy

Diabetic

Stroke

Brain tumor

Sign& symptoms:

Aphasia

Ataxia

Difficulty walking

Unable to perform daily task.

Visual impairments

Bladder and bowel problem

Decreased sensation

Memory loss

Depression

Complication:

Deformity of upper limb-flexion contracture of hand

Deformity of lower limb -flexion contracture of ankle, knee, hip

Leg length discrepancy

Pes Equinus

If not treated complication it may lead to:

Upper limb

Lower limb

Clenched fist attitude-Spastic contracture of Hand

Contracture of wrist

Contracture of elbow

Pes Equinus

Knee flexion contracture

Hip flexion contracture

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

For Lower limb

HKAFO- Hip flexion/extension instability,Hip adduction/abduction weakness, Hip internal rotation/external rotation instability

KAFO- If knee extensors/flexor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weakness

In case of AFO- If muscle grading is 3- , Solid AFO

If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

HKAFO if Hip flexor or extensor weakness 3- or less.

For upper Limb

Wrist hand orthosis

Elbow wrist hand orthosis

12. PARAPLEGIA

Paraplegia is impairment in motor and/or sensory function of the lower extremities

Causes:

Trauma (acute spinal cord injury)

Tumors (chronic compression of the cord)

Multiple Sclerosis.

Spina bifida

Sign & symptoms:

Weakness of lower limb

Unable to walk

In continence of bowel and bladder

Complications

Lower body paralysis

Bladder & bowel problem

If not treated complication may lead to:

Pressure sores, thrombosis, Pneumonia

Deformities-

Pes Equinus

Knee flexion contracture

Hip flexion contracture

Scoliosis

Lumbar lordosis

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

HKAFO- If hip flexor/ extensor are weak

KAFO- If knee extensors/extensor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weakness

In case of AFO- If muscle grading is 3- , Solid AFO

If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint

If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

For Spine:

Spinal orthosis – TLSO

13/14 TETRAPLEGIA/ QUADRIPLEGIA

Involvement of the four limbs, the trunk and the head. The great majority of these individuals will not be able to stand up or walk.

Causes:

Traumatic injury of spinal cord -accident, gunshot wound, fall, or sports injury

Disease- polio or spina bifida

Signs and symptoms

If injury above cervical region-

Motor/ sensory function of upper limbs are lost

Uncontrollable hand motions

Difficulty in Speech, swollen

If injury below cervical region-

Motor/ sensory function of lower limb are loss

Unable to maintain balance body posture

Bowel & bladder problem

Complication:

Aphasia

Ataxia

Difficulty walking

Unable to perform daily task.

Pressure sores, thrombosis, Pneumonia

If not treated complication may lead to:

Upper limb

Lower limb

Spine

Elbow flexion contracture

Wrist flexion contracture

Leg length discrepancy

Pes Equinus

Knee flexion contracture

Hip flexion contracture

Scoliosis

Kyphosis

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

For Lower limb

HKAFO- Hip flexion/extension instability

Hip adduction/abduction weakness

Hip internal rotation/external rotation instability

KAFO- If knee extensors/flexor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weakness

In case of AFO- If muscle grading is 3- , Solid AFO

- If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

HKAFO if Hip flexor or extensor weakness 3- or less.

If Leg length discrepancy or Equinus compensation should be given accordingly.

For upper Limb

To protect from potential deformity should treat with

Wrist hand orthosis

Elbow wrist hand orthosis

15. MONOPLEGIA

It is paralysis of one arm or one leg as a result of a brain injury. It is frequently associated with cerebral palsy.

Causes:

Cerebral palsy

Injury to the brain

Sign & symptoms:

Unable to walk properly-(if lower limb affected)

Unable to perform any activity-(if upper limb affected)

Complications:

Contracture-hip, knee, ankle

Spinal problem

Elbow contracture

Wrist contracture

If not treated complication may lead to:

Pes equines

Shortening

Severe contracture

Scoliosis

Loss of function

Orthotic treatment:

For Lower limb

KAFO- If knee extensors/flexor affected

AFO-If quadricep weakness with genu recurvatum

Rigid AFO- If tibialis anterior and tricep surae weakness

In case of AFO- If muscle grading is 3- , Solid AFO

- If muscle grading is 3+, AFO with Ankle joint

In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock

For upper Limb

To prevent from potential deformity should treat with

Wrist hand orthosis

Elbow wrist hand orthosis

16. ARTHRITIS

An inflammation or swelling of the joints. There are many different types of arthritis, the most common being osteoarthritis and rheumatoid arthritis.

There are many kinds of arthritis. Common, arthritis are

Osteoarthritis

Rheumatoid

Gout

Sign & Symptoms:

Joint pain

Joint swelling

Joint stiffness

Tenderness or pain when touching a joint

Problems using or moving a joint normally

Warmth and redness in a joint.

Causes:

Joint instability

Age-related changes

Altered biochemistry

Hormonal factors

Genetic predisposition

Environmental factors

Complications:

Ankle joint MT Joint pain

Knee joint pain

Hip joint pain

Lumber spine pain

Cervical spine pain

Shoulder joint pain elbow joint pain

Wrist and MCP joint pain.

If not treated complication may lead to:

Ankle valgus/varus

Knee valgus/varus

Lumber Spondylosis

Scoliosis/ Kyphosis

Cervical spondylosis

Elbow joint contracture

Hand contracture- boutonniere deformity

Orthotic treatment:

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.

FO, AFO, KO, KAFO, SO- lumber corset

CO, TLSO, EWHO, WHO

KAFO: These Orthoses are designed to provide stability & mobility to the knee joint. The KAFO are facilitate by using different joints according nature of need of patient these areFree Knee, Posterior Offset Knee Joint, Stance Control Locked Knee Drop Lock Trigger Lock

17.SUBLUXATION

A partial abnormal separation of the articular surfaces of a joint. In more technical terms, a subluxation is "a motion segment, in which alignment, movement integrity, and/or physiological function are altered, although contact between joint surfaces remains intact.

According to nature cause subluxation may happen to any joint

Causes:

Congenital

Trauma

Chronic osteoarthritis

Occupational hazards

Muscular weakness

Incorrect weight lifting

Lack of rest

Sign & symptoms:

Sudden pain in the joint,

Swelling of the joint

Deformity of the joint

The joint may not function or painful

Nerves and blood vessels that pass near the joint may be damaged.

Complications:

Degenerative arthritis

Cosmetic deformity

Fracture acetabulum

Fracture head of femur

Femoral head necrosis

If not treated complication may lead to:

Upper limb

Lower limb

Spine

Medial rotational contracture of shouler joint.

Vaglus deformity of elbow

Swan neck deformity finger

Shortening

Lengthening

Genu Recurvatum

Kyphosis

scoliosis

Orthotic treatment:

Orthotic treatment is depend on nature of injury, severity of injury & location of injury.

FOR HIP

Hip abduction orthoses for child: A hip abduction orthosis is designed to be used for infants from 6-8 months of age. This device provides appropriate anatomical alignment to stabilize the hip, promote tightening of loose ligament structures and promote appropriate bone growth. Application of this device is done by three Velcro straps one at the pelvis or waist and two around the thigh cuff.
Hip Abduction Orthosis for Adult: Hip abduction orthoses are designed to maintain appropriate anatomical alignment of the hip or prosthetic hip replacement. The components include a hip/pelvic girdle, thigh cuff, and hip joint. The joints are usually adjustable and set in some degree of flexion and abduction. This alignment positions the head of the femur in the acetabulum allowing for the ligaments, bone, and surrounding musculature to heal

Hip stabilization orthoses: These orthoses are designed to immobilize and stabilize the hip and surrounding soft tissues following operative management for spasticity, contractures, and hip subluxation and dislocation.They allow for hip joint range of motion to be adjusted according to the physician prescription and rehabilitation requirements.

FOR KNEE

Knee orthosis:

Functional knee orthoses help in the stability of the knee joint secondary to ligamentous injury, post-operative reconstruction, meniscus damage, and for prophylactic protection.

These orthoses is designed to provide maximum stability to the knee joint. Knee orthosis are provided according nature of need

Free Knee: This design is provides medial-lateral stability to knee joint while allowing free motion in flexion and extension.

Drop Lock: This design incorporates a ring that slides down over the knee joint providing for a mechanical lock.

Trigger Lock: A trigger lock design is similar to the bail or French lock. This design often uses cables and a trigger switch allowing patients to unlock the knee joint via a point at the proximal edge of the orthosis. It is commonly used for patients with limited dexterity, balance and for increased safety and stability.

FOR ANKLE

AFOs are provided to support, proper joint alignment to the foot and ankle, assist or substitute for muscle weakness, and protect the foot and lower limb.

Semi-Solid AFO: A semi-solid AFO fabricated from plastic is designed to fit inside of a shoe with little effort. It attaches with a Velcro strap and is stabilized by the use of a well-built shoe. Unlike the dorsi flexion assist AFO this orthosis provides more medial-lateral stability and limitation of motion.

Solid Ankle Foot Orthosis (SAFO): a Solid ankle AFO is designed to provide maximum stability of the foot and ankle. This orthosis limits plantar flexion (pointing toes down) and doors flexion (lifting toes up), medial and lateral motions

Articulated Ankle Foot Orthosis (AAFO):This style of orthosis is designed to provide maximum mediolateral stability while allowing plantar flexion (pointing toes down) and dorsi flexion (lifting toes up).

For Upper limb

Shoulder Stabilizer: It aids in prevention of excessive extension and abduction of the shoulder
Elbow orthosis: This orthosis is designed to provide for variable range of motion at the elbow joint.

Thumb Immobilizer Orthosis: This orthosis is designed to limit the motion that occurs at the wrist and thumb
Static WHFO: Static or stationary wrist hand finger Orthoses are designed to prevent contractures by maintaining proper joint alignment and finger position.
Wrist Hand Orthosis (WHO) with adjustable wrist joint: This WHO is designed with a wrist joint that allows flexion/extension of the wrist where appropriate. This orthosis may be used to position the wrist and/or hand in a desired position or help gain range of motion.

For Spine

Soft Collar: This orthosis is made from soft foam and is used to give support and stability to the cervical spine.
Rigid Collar: Some are fabricated with two pieces of Velcro on each side while others are one piece that wrap around the neck secured with one strap.Rigid collars are effective in reducing motion, providing stability and support to the cervical spine

18.DISLOCATION

It is fully luxation of joint or displaced or misaligned. The most often dislocated joint are the shoulder, patella-femoral and ankle.

Causes:
Congenital

Trauma

Chronic osteoarthritis

Occupational hazards

Muscular weakness

Incorrect weight lifting

Lack of rest

Symptoms:

Sudden pain in the joint,

Swelling of the joint

Deformity of the joint

The joint may not function or painful

Nerves and blood vessels that pass near the joint may be damaged.

Complications:

Degenerative arthritis

Cosmetic deformity

Fracture acetabulum

Fracture head of femur

Femoral head necrosis

Loss of mobility/functions

If not treated complication may lead to:

Upper limb

Lower limb

Spine

Medial rotational contracture of shoulder joint.

Valgus deformity of elbow.

Swan neck deformity finger

Shortening

Lengthening

Genu Recurvatum

Drop foot/Equinus

Kyphosis

scoliosis

Orthotic treatment is same as subluxation

19. CONTRACTURE

A contracture is a shortening of a muscle or tendon in the human body in response to stress exerted on that muscle or tendon. Contractures can occur at any joint of the body.

Causes:

Immobilization of joint

Trauma / injury / disease

Nerve injury- spinal cord damage and stroke

Damage to muscle, tendon, or ligament

Burn

Symptoms:

Significant loss of motion

Pain

Complication:

Dorsiflexion contracture

Planter flexion contracture

Knee flexion contracture

Genu recurvatum

Hip flexion contracture

Elbow flexion contracture

MCP contracture

If not treated complication may lead to:

Pes Equinus

Leg length discrepancy

Scoliosis

Dupuytren's deformity

Orthotic treatment:

Before we give orthotic treatment we must consider the severity of contracture, ROM of the joint. If there is severe contracture, better to have physiotherapy to the patient first.

The contracture patient may need serial type of orthosis according to correction of contracture

For lower limb

AFO

KAFO

HKAFO

For upper limb:

Elbow wrist hand orthosis

Wrist resting hand orthosis

20.LORDOSIS

An exaggeration of the forward curve of the lower part of the spine, sometimes called sway-back.

Causes:

The cause of lordosis is unknown.

Congenital

Poor posture/ Postural

Neuromuscular problems

Hip problem.

Lumber Spondylolysis

DDH

Symptoms:

Poor vertebral posture

The prominence of buttocks

Complications:

Lower Back Pain.

Tight Hamstrings

Bad Technique -not able to squeeze gluteus during Squats. This puts more stress on your lower back & hamstrings, increasing risk of injury.

Lower back pain is the first sign.

Kyphosis develop as secondary curve

If not treated complications may lead to:

Lumber spondylosis

Sciatica

Lower limb paralysis

Orthotic treatment:

Soft orthosis- Lumber corset

21. KYPHOISIS

Deformity in the normal posterior shape of the spine, producing a humpback appearance.

Causes:

Congenital

Postural

Metabolic problems

Neuromuscular conditions

Spina bifida

Tumor

Scheuermann's disease

Symptoms:

Poor posture with a hump appearance of the back or "hunchback,"

Difference in shoulder height

The head bends forward compared to the rest of the body

Difference in shoulder blade height or position

Tight hamstrings muscles

Complications:

Body image problems

Deformity Back pain

Breathing difficulties

Neurological problem

Lordosis develop as secondary curve

If not treated complication may lead to:

Compression fractures due to osteoporosis

Deformity become severe

Affects in function and structural of internal organs

Neurological deficit

Orthotic treatment:

In case of spinal orthosis, for proper orthotic treatment x-ray should be properly studied to know the exact Cobb’s angle for proper pressure point.

Orthosis is used for vertebral wedging greater than 5ºand curves between 45º-65º, in patients with 1 to 2 years of growth remaining.

Milwaukee brace for apex above T9

TLSO for apex below T9 and thoracic lumbar curves

Curve correction and wedging improvement of about 40% can be expected after 6 to 12 months.

The brace may have to be changed every 4-6 months until maximum correction is achieved.

Exercise stressing pelvic tilt, abdominal strengthening, spinal flexibility, and extension of the thoracic spine is an important part of the treatment plan.

22. SCOLOSIS

Scoliosis is a condition that involves complex lateral and rotational curvature and deformity of the spine.

Causes:

Idiopathic

Congenital

Neuro-muscular reason (cerebral palsy, spinal muscular atrophy)

Bio-mechanical reason

Sign & symptom:

A” hump" on one side of their back when they bend forwards (the forward bending)

The lateral curve to their spine

Uneven shoulders height

Uneven pelvic level

Uneven pants legs

Complications:

Development of secondary curve

Affects on functional & internal structural of internal organ

Low back pain

Degenerative changes in the spine.

Narrowing of the spinal canal

Weakness or numbness or pain involving the legs.

Bowel and bladder uncontrolled

Structural deformity

If not treated complication may lead to:

LLD

Paralysis of lower limb

Orthotic treatment:

In case of spinal orthosis, for proper orthotic treatment x-ray should be properly studied to know the exact Cobb’s angle for proper pressure point. Orthosis are not effective for curves greater than 45 degrees.

Milwaukee brace- This orthosis is effective in preventing further progression of spinal curves.

TLSO- This orthosis is now most commonly used because it is effective in preventing a spinal curve from getting worse, and it is easier to use because it can be worn under clothing.

To get best result from orthosis:

Orthosis should wear 23 hours a day.

Orthosis should start early, while the child is still growing.

The spinal curve is between 25 and 40 degrees. Some doctors may advise brace treatment for curves up to 45 degrees.

The orthosis should well fit.

There is family support for the child.

References:

The main references are:

Atlas of orthosis and assistive device-Mosby, 3^rd edition

Outline of orthopedic ,J C Adams,11^th edition

Knee ankle orthosis CSPO intake manual 1999

Manual of spinal orthosis- PIPOS

Manual of upper limb orthosis- PIPOS

Manual of lower limb orthosis- PIPOS

AFO guide –CSPO manual

From internet

http://www.webmd.com/back-pain/brace-orthotic-treatment-for-scoliosis http://www.scoliosisjournal.com/content/3/1/9

www.orthonurse.org/portals/0/kyphosis.pdf

www.springerlink.com/index/CP352Q3502125275.pdf www.srs.org/professionals/bracing_manuals/section12.pdf www.centri.se/dennis_browne.html - 4k

www.grundyorthotics.on.ca/.../details.html

http://www.virtueschildrennepal.org/goalsvcn.html

http://www.footankle.com/back-hip-knee.htm

http://www.cincinnatichildrens.org/health/info/orthopaedics/diagnose/limb-deformity.htm

http://www.fidelityorthopedic.com/orthodicproducts.html

www.spinal-injury.net/tetraplegia.htm - 25k

www.orthotic.com/injury.html - 47k

www.physicaltherapyjournal.com/cgi/reprint/76/2/182.pdf

www.hopehawaii.com/services.html - www.springerlink.com/index/F682166V45975N71.pdf

www.chiroweb.com/archives/24/25/03.html - 46k

www.webmd.com/back-pain/brace-orthotic-treatment-for-scoliosis - www.srs.org/professionals/bracing_manuals/section12.p www.oandp.org/jpo/library/1990_01_068

www.freepatentsonline.com/4981132.html

www.acpoc.org/search/?qu=muscular - 26k

ELBOW WRIST HAND ORTHOSIS ( EWHO)

2009-09-26T20:16:00.000-07:00

This is 8 years old zuhaib.He was born with hydrocephalus.He was treated for hydrocephalus but suffered from rt.sided hemiperisis. Due to hemeperisis his right upper limb and right lower limb were affected. He was under physiotheraphy treatment.He was referred to PRSP for orthotic management.

The patient was mentally not oriented because of hydrocephalus.On assessment of the patient, it was found that upper limb wrist was dropped, elbow joint was contractured
( correctable).Lower limb foot was dropped, ankle joint was stiffed ( correctable) and pes varus.

The Ankle foot orthosis( AFO)for right lower limb

The Elbow wrist hand orthosis ( EWHO) for right upper limb

Elbow wrist hand orthosis ( EWHO) for right upper limb and Solid ankle foot orthosis for right lower limb were prescribed for that patient.

ANKLE FOOT ORTHOSIS

2009-09-26T19:43:00.000-07:00

The Ankle foot orthosis( AFO)for right lower limb

The Elbow wrist hand orthosis ( EWHO) for right upper limb

Elbow wrist hand orthosis ( EWHO) for right upper limb and Solid ankle foot orthosis for right lower limb were prescribed for that patient.

ANKLE FOOT ORTHOSIS

2009-09-25T07:51:00.000-07:00

This is 2 years old child sumia.According to her mother she was normal during delivery.They visited to physician as child became sick. she was diagnosed as post polio paralysis and referred to PRSP for orthotic management.

On assessment patient's right lower limb was weak, walked on drop foot, external rotation of the foot.

It was diagnosed that the patient had Drop foot (Rt) and Ankle Foot orthosis ( ankle in neutral position, maximum correction on casting using three point pressure) was prescribed to her.The Patient's parents were educated about using of orthosis.

Ankle foot orthosis ( Rt)

The patient with Ankle foot orthosis

HIP ABDUCTION ORTHOSIS

2009-09-25T03:07:00.000-07:00

This is 45 days old female baby Seema.The patient mother noticed unequal of lower
both limbs.The patient was came to PRSP for needful management.

According to patient's mother, the baby was delivered normal.On assessment it was found that both lower limb were unequal, Rt. lower limb was hyper extended( knee joint),Telescopic test, ortholani test, and Barlow test were positive.

After assessment, it was diagnosed as Development dysplasia of the Hip (DDH) Right side with knee hyper extended , due to congenital.

Hip abduction orthosis

Hip Abduction orthosis was prescribed ( right hip on 45 degree abduction and right knee on 20 degree flexion) . Palvik harness was ideal prescription for those small baby if there is DDH. But because of knee hyperextended Hip abduction orthosis was selected.

HUMERUS FRACTURE ORTHOSIS

2009-09-25T01:52:00.000-07:00

This is 76 years old Mr.Fateh khan.He was fall down and left upper limb humerus( distal one third) was fractured. The conservative management was done.The patient was referred to PRSP for orthotic management.

The of left humerus fracture ( distal one third)

The assessment was done and it was found that patient has slight swollen just above the left elbow. The left upper limb range of motion were disturbed due to pain. Sensation was intact. Fractured at distal end of the humerus ( radiological review)

Humerus fracture brace with elbow on 90 degree

After assessment the Humerus fracture brace( Bi valved) with elbow on 90 degree was prescribed

The patient with Humerus fracture brace ( side view)

The with Humerus fracture brace ( front view)

The patient and patient attendants were educated about using to appliance. The patient was quite happy and feeling comfortable.

SPINAL ORTHOSIS (BOSTON BRACE )FOR KYPHOSIS

2009-09-24T22:31:00.000-07:00

This is 13 years old Mr. Mohammad.His family noticed him as abnormal body structure
( forward bending of body).So they came to PRSP for orthotic treatment for him.On assessment it came to know that the patient is studying QURAN since age of 5 on same position.

The position which patient use to study for books

According to patient's parent When the patient became age of 9, then abnormal posture of spine was more visible. They consult with physician and physiotherapist still the abnormal posture was visible.

On assessment the patient has kyphosis, cobb's angle was 46 degree at apex of 9th thoracic vertebra, right lower limb shortening by 2 cm. TLSO- Boston overlap brace low profile (Three point pressure system) with posterior opening was prescribed.
Further procedure were proceed.

Prosthetist and orthotist (ICRC) evaluating the TLSO from frontal view

The patient is on sitting position with TLSO

Posterior view of TLSO

The patient with prosthetist and orthotist

The patient and patient's parents were educated regarding appliance TLSO, especially donning and doffing, reviewing etc.

TRANS FEMORAL PROSHTESIS CASE 2

2009-09-22T06:13:00.000-07:00

This is 35 years old Mr. Mohammad usman . He got crushed injury on his both lower limb below knee while he was working on machine. Lt. leg was badly injured and operation was done to save his life from further complication.Lt.Trans femoral amputation was done at level of distal one third level.

Assessment of the patient

He was noticed to the PRSP center for prosthesis. He was already using prosthesis but due to shortening of prosthesis and pain at distal end of stump, he hardly used prosthesis 2 hours a day.
On examination patient stump was swollen, distal end of the stump was light blackish and hip flexion contracture 7 degree.On prosthesis assessment it was found that prostheis height was less by 3 cm and distal end circumference of the socket was less.

After assessment, Lt. transfemoral proshtesis (Otto Bock Modular) was prescribed with laminated quadrilateral socket, suction valve, single axis 3R22 extension assist knee joint , SACH foot and other necessary component.

Teaching about donning and doffing of appliance

The patient was advised to have bandage regularly as well as raising of affected limb during sleeping. Using medium size pillow just below the stump in prone position.It was educated to the patient attendant also.

Trans femoral prosthesis posterior view

Trans femoral prosthesis medial view

Trans femoral prosthesis lateral view

Trans femoral prosthesis frontal view

The appliance was fitted to the patient and trained for gait. After 5 days of gait training the patient walked nicely.

The with modular trans femoral prosthesis

The patient was quite happy with this prosthesis as he felt comfortable and no pain at all compre to previous.

TRANS-TIBIAL PROSTHESIS CASE 2

2009-09-21T22:56:00.000-07:00

This is 25 years old energetic Mr. Mohammad Rauf. He lost his part or leg (below ankle) on the bomb blast while he was on his trip. He was brought to the hospital where the amputation was done at level of middle one third level, to prevent from further complications.After couple of month he came to the PRSP for prosthesis. He was sponsored by ICRC.

Assessment of the stump.

On examination, stump was not well prepared for prosthesis. Wound scar was not properly healed, stump was swollen and 15 degree hip flexion contracture ( correctable) .The patient was advised for pre-prosthetic treatment for month.

The patient noticed after a month. On assessment it was found that stump was well prepared for prosthesis fitting. Polypropylene Endo-skeletal trans tibial prosthesis ( Rt) with PTB SC SP socket design and SC suspension were prescribed to him. Further procedure were proceed accordingly.

The patient made appliance ( Made of polythene pipe)

The patient was already using his own made appliance( made of polythene pipe) which was
bio -mechanically not proper. But it made him easy to use new appliance easily. After 3 days of gait training he walked nicely without any complain, although it was first prosthesis for him.

First fitting of the appliance.

The patient using his own made appliance

The patient is using final trans tibial prosthesis

The patient was comfortable and satisfied with appliance. Gait was nice.

TRANS FEMORAL PROSHTESIS CASE 1

2009-09-21T21:26:00.000-07:00

This is Mr. Dawod Jan, 40 years old. He suffered from bomb blast and badly injured his left lower limb below knee. To save his life Trans femoral amputation was done at level of distal one third.The patient has history of Parkinson disease.

The patient was advised for pre-prosthetic treatment because he has neuroma at distal end of stump, hip flexion contracture 10 degree and swollen stump.

The patient re-noticed for proshtesis as his pre- prosthetic treatment were done. On assessment the patient was fit for prosthesis. The polypropylene trans femoral prosthesis was prescribed to him. It was Quadrilateral socket, modular, sileisan belt suspension, single axis knee joint ( knee joint will be locked initial).The further procedure were proceed after assessment.

Trans femoral prosthesis (Lt)

The patient with Trans femoral prosthesis

The patient with prosthetist

The patient can walk now.He was satisfied and comfortable with appliance. He is quite happy now.

TRANS-TIBIAL PROSTHESIS CASE 1

2009-09-21T20:53:00.000-07:00

This is 60 years old Mr. Mir Nawaz.The patient has the history of diabetic and under diet controlled. He got wound at big toe (Rt lower leg) and slowly spread up to the mid foot.When he visited to the orthopedic doctor, they suggested to have amputation for further prevention of proximal part of leg.The patient under gone for amputation at level of distal one third.

The patient was already using prosthesis. The suspension of the soft liner was loosed and teared also.The patient was complained that there was more pain at medial condylar area and distal end of the stump.

Trans tibial prosthesis( PTB SP SC )

The patient with trans tibial prosthesis ( on first fitting Sitting and standing)

Trans tibial prosthesis

After assessment of the patient and old prosthesis, polypropylene trans tibial prosthesis (Rt) was prescribed with PTB SC SP socket design and SC suspension.

The patient was quite happy with new prosthesis.

contact us

2009-07-24T08:27:00.001-07:00

Gallow's skin traction aids

2009-05-04T05:19:00.000-07:00

Features
Gallow's skin traction aids is special designed for children aged below 2 years. It consist pair of cotton strip which consist whole at center, pair of traction cord and pair of bandaged.It is very economic and easy to use. Fractured limb and sound side limb are bandaged respectively over strip and hanged the limb over the bed stand by the help of traction cord.

Application

Fracture femur

Child must weigh less than 12 kg or below 2 year

Available size
Children size ( up to 2 years)

We provide special extraordinary size according to need.
We provide special service on costume design according to need and prescription.

Special attention
For Gallow's skin traction the orthopedic doctor will instruct for hanging of the affected and sound side limb.Vascular compromise is the biggest danger. Check the circulation twice daily. The buttocks should be just off the bed.

please e-mail on
osteosupportnepal@gmail.com
osteosupport@hotmail.com
Visit: www.osteosupport.kuspito.com

Cervical traction set

2009-05-03T06:43:00.000-07:00

Feature
The Cervical Traction Set is an easy to use cervical traction therapy device. It can be used on over door or it can be fixed on the wall.This Cervical Traction set consist complete with everything you need to start your traction, including head halter, pulleys, traction rope, spreader bar, weight bag up to 10 kg capacity, wooden block with concrete nail.

Cervical traction gently lifts the weight of head from neck and it control the amount of traction.

Application
Relieve neck pain and muscle tension
Shoulders and neck associated with osteoarthritis
Cervical spondylosis,
whiplash, or torticollis.

Capacity of weight- Although 5 to 10 pound (2.5- to 5-kg) weight is most commonly recommended.

Special attention
Before using indoor cervical traction, please consult your orthopedic doctor or neuro-surgeon or physiotherapist or orthotist & prosthetist.

Some Guidelines for indoor cervical traction usere:

Always consult a qualified neuro physician or orthopedic doctor or physiotherapist prior to using neck traction at home.
Follow your physicians recommendations regarding amount of traction, duration and regularity of treatment.
Start with a low amount of weight in the beginning.Gradually increasing as instructed by your doctor.
Keep your head still without motion during the traction session to avoid injury.
Stop traction immediately and consult your physician if you have any symptoms which are unusual, including but not limited to such as dizziness, increased pain, difficulty breathing or lightheadedness.
Never use traction longer than 20 minutes.

If you have any related problem and interesting regarding Cervical spondylosis, whiplash, or torticollis.

Skin traction aids

2009-05-03T05:48:00.000-07:00

FEATURES
Skin traction aids is the set of traction which consist metal hook, crape bandage, hypoallergenic cotton strip, traction cord weight bag.It is very comfortable, easy to use. Set is available with and without weight.The skin can only take about 5kg traction in an adult. If more than this force is required to obtain on maintain a reduction traction must be used.Bandage and strip are washable.

APPLICATIONS
Fracture shaft of femur
Temporary traction - only a few days e.g. Preoperative
Small force required to maintain reduction <5 style="font-weight: bold; color: rgb(255, 0, 0);">AVAILABLE SIZES
Large
Medium
Small

We provide special extraordinary size according to need.
We provide special service on costume design according to need and prescription.

Special attention
For skin traction the orthopedic doctor will instruct for weight( how much weight should be hanged on skin traction ) Traction weight for each individual patient is different. skeletal traction should be given if patient need traction weight ( force) >5kg, need long days traction or skin damage or sepsis.

New pouch arm sling

2009-05-03T05:21:00.000-07:00

Feature
New pouch arm sling is the single piece sling which cover up the forearm and the shoulder. It helps to keep the elbow joint in rest on 90 degree. It is made up of cotton and webbing belt with strong loop and Velcro. It is washable.

Application
Forearm injury / Elbow injury
Post surgical condition of wrist, forearm, elbow and shoulder
Fracture of forearm

Available size
Extra large
large
Medium
Small

We provide special extraordinary size according to need.
We provide special service on costume design according to need and prescription.

Special attention
If you have any related problem and interesting regarding wrist,forearm,elbow shoulder etc. please e-mail on

Post plast sling

2009-05-02T21:21:00.000-07:00

Feature
The post plast sling is the two pieces forearm sling made up of cotton and webbing belt with strong loop and Velcro. It consist comfortable neck support.

Application
Forearm injury
Post surgical condition of wrist and forearm
Fracture of forearm
During forearm cast

Available size
Free size
We provide special extraordinary size according to need.
We provide special service on costume design according to need and prescription.

Special attention
If you have any related problem and interesting regarding wrist,forearm,elbow shoulder etc. please e-mail on

Knee Brace

2009-05-02T20:31:00.000-07:00

Features
The knee brace is made up of strong waterproof synthetic material, skin friendly elastic and spring steels.It covers mid thigh to mid calf.Anatomically contoured back splints & spring steel on the sides ensure rigid immobilization.

Application
Post operative condition of knee
knee injury
Sprain and strain condition of knee
Muscle and ligament injury of the knee

Available size
large
Medium
Small

We provide special extraordinary size according to need.
We provide special service on costume design according to need and prescription.

Special attention
Before using knee brace please consult your orthopedic doctor or neuro-surgeon or physiotherapist or orthotist & prosthetist.
If you have any related problem and interesting regarding knee joint please contact

Levels of amputation

2009-03-26T08:32:00.000-07:00

Patella tendion-bearing ( PTB) design sockets

2009-03-21T19:56:00.000-07:00

Trans tibial suspensions

2009-03-21T19:36:00.000-07:00

Trans femoral suspensions

2009-03-21T19:28:00.000-07:00

Emergency prosthesis / Temporary prosthesis

2009-03-17T09:28:00.000-07:00

Definition:
An unfinished functional replacement for an amputated limb fitted and aligned in accordance with sound biomechanical principles, which is worn for a limited period of time to accelerate the rehabilitation process

Advantage of Early Prosthetic fitting
Early Prosthetic Fitting: A procedure in which a preparatory prosthesis is provided for the amputee immediately after removal of the sutures.

Early prosthetic fitting plays a significant role in a rehabilitation success. The prompt and correct application of compression to the residual limb, together with appropriate therapy have a positive impact on the individual’s rehabilitation process.
2.As a temporary fitting, emergency prosthesis is a useful mean to bridge the period between early and definitive fitting. It is frequently used for several weeks or months until the stump has stabilized before the permanent prosthesis is provided.
3.A trial fitting can serve to objectively determine when and whether the individual will regain the ability to stand upright and walk.

Considerations

Emergency Prosthesis must allow to put upright an amputee as soon as possible after scarring of the stump and to prepare for the definitive prosthesis.
It must allow production of a large number of prosthesis in a short time, such as after natural disaster, in a context of war or post conflicts.
The technique of Emergency Prosthesis makes it possible to manufacture the socket with out a positive casting mould.

1.The prosthesis takes into consideration:
2.Speed and carry out simplicity of fabrication
3.Minimum equipment required
4.Reliability
5.Price
6.Weight

Physiotherapy for Emergency Prosthesis
The preparation of the stump before fitting remains a preliminary and essential stage.
The therapy goals following amputation are:

1. Stump shaping
2. Desensitization
3. Skin mobility
4. Maintaining good range of motion, preventing or reducing contracture

Stump Shaping
What is stump? The stump is the bone and surrounding muscle tissue left after amputation. Another term is residual limb.
The length of the stump is determined by the length of the bone where the cut is made and the quantity of the skin and muscle tissue left to cover and protect the bone.

Elastic wraps work best for stump shaping. Some times a stump “ Shrinker” is used in place of wrapping after the incision is well healed.

What is a stump shrinker? A sturdy elastic cone shaped sock that pulls on over the stump and applies pressure. It replaces the elastic wrapping.

When do we begin wrapping?
Wrapping should begin on day after the surgery or as soon as possible. We must be very careful not to wrap it directly on the wound if it is not healed. This may cause infection. The wound should be protected by a clean bandage. Then the wrapping is done over this. Wrapping may be needed daily for years.

Desensitization
Decreasing or lessening sensitivity.
The stump often is very sensitive following surgery. There are different techniques for desensitization.
• At the beginning you can tell your patient to gently touch their stump with firm pressure just after amputation. Take care that don not put their hands directly on the wound. A bandage or dressing may be placed over the incision before beginning the desensitization techniques.

• Once they can tolerate the gentle touching, you can try brushing with soft cloth. Pressure can increase as the patient can tolerate it.

• When they can tolerate the gentle brushing with soft cloth, you may then begin gentle tapping of the skin. Intensity can increase as the patient can tolerate it.
Caution: Be careful not to interfere with the healing in the acute (early ) phase before stitches are removed and the incision is completely healed. Begin after this phase.

Skin Mobility
• Skin mobility
We are talking about the skin around and over the incision. We also are talking about the skin over the bones of the stump. It is important not to allow this skin to become stuck by scar tissue to the underlying bone. This restricts normal skin movement over this underlying bone. Why is this a problem? This causes abnormal pressure and rubbing of this skin and bone against the inside of the socket of the prosthesis.

• How do you keep the skin mobile?

Over the bone:
Use your thumbs to press down gently but firmly and move the skin in small circles over the underlying bone. Move the skin over the bone. Be certain that you are not just rubbing over the skin!!!

Around an incision:
Use your thumbs, one on each side of the incision, and move the skin side to side, and around in circles, making sure to move the skin over the tissue underneath. Make certain that you are not just rubbing the skin!!!!

Caution: Do not begin before the incision is healed Do not push too hard.
This can be done only when the wound is closed and well closed!! You do not want to open it.!!!! It is usually healed three or four weeks after the surgery. Ask the doctor if your are not sure.

Maintaining Good Range of Motion, Preventing or Reducing Contractures
• What are the causes of contractures?
Contracture happens when tissues around an articulation become stiff. It could be the muscles, joint capsule, tendons, skin, etc.

• Pain may prevent patient from moving and may cause patients to adopt bad postures. A good example is when a patient with an above knee amputation keeps his limb flexed on a pillow to protect it. He can have difficulty to extend his hip later.

• Another cause of contracture is an imbalance in muscles strength. Because some muscles are cut during the amputation, those muscles can become weaker and stronger muscles can then pull harder and keep the limb always in an abnormal and tightened position For example, if the hip adductors are weakened, the hip abductors may pull the leg into a resting position of abduction more easily.
Common contractures in standing

Slide 11

Common contractures in lying position

Common contractures in sitting position

Guide Lines for fabrication of Emergency / Temporary Trans Tibial Prosthesis

Components
Prosthetic foot
Emergency kit
Socket
Suspension belt

Fabrication of Socket
Tools/ Equipment & Raw material Quantity Unit
1 Surgical Gloves 3 pair
2 Cotton cap 3 Pc
3 Plastizote (6mm) 50x30 Cm2
4 Glue 100 Gm
5 Paper cup 1 Pc
6 Glue brush 1 Pc
7 Cellofene 1 Roll
8 Scissor 1 pc
9 Knife 1 pc
10 Indelible pencil 1 pc
11 Powder talc 50 Gm
12 Dynacast roll 5 pc
13 Basin 1 pc
14 Oscillating cutter 1 pc

Fabrication of Socket
Measurements:
1. Take measurements from the amputated side from patella tendon to the distal end of the stump while the patient is seated with knee flexed at 90 degree.
2. Measure the circumference of the stump at the level of patellar apex, distal end of the stump and mid of the stump.
Remarks: This technique of manufacturing does not use the principle of casting, Measurements taken are used to follow the stump up to stabilization.
3. Take the measurements of the healthy leg from patella to ground.
4. Take the size of healthy foot for the choice of prosthetic foot.
5. Measure the heel height of the shoes which will be used by the patient.

Preparation of Stump
• Slip the cotton stockinet on to the stump.
• Mark the wt:sensitive areas i.e.
Fibular head
Tibial crest & tubrosity
Stump end and any other bony prominence
• Cut 6mm plastizote according to the mentioned areas. Chamfered and then glue these patches. On the stump glue 12mm plastizote.
• 12mm plastizote, 10 cm wide and length according to the circumference of the stump at the patella level + 5cm extra, is to be glued on the level of patella and condyles.

Modeling of the socket
• Wrap the dynacast roll on the stump. The application of the dynacast band should be done by exerting a light tension.
• Apply pressure at the wt. bearing areas and give shape to the patella.
• Ensure maximal cohesion between the layers, to smooth the socket with moist gloves.
• Let it dry for 10 min.

Further Procedure
• Release of the cast
• Check socket
• First try on the amputee
• Division of the socket
• Assembling
• Alignment
• Application of belt.
• Fitting of the prosthesis to the patient.
• Gait training

The person with Emergency / Temporary Trans tibial prosthesis

2009-02-27T20:47:00.000-08:00

Clearance test

2009-02-26T09:13:00.000-08:00

The upper limb clearance test

Test:-BACK SCRATCH
Purpose: - To know the ROM, muscle strength and coordination of IP, wrist, elbow and shoulder.
Procedure:-Ask the patient to sit or stand on erect position. Ask the patient to keep hand extended, abducted arm, flex on elbow & place the arm behind the neck and scratch at back. Observe from front and back. If patient can perform means test is negative.
Result: - Positive / Negative

Test: - COORDINATION
Purpose: - To know the mental status.
Procedure: - Ask the patient to sit or stand on erect position. Ask the patient to touch distal end of finger with another distal end of finger of same hand. Ask the patient to do fast with both hands. Observe from front. If patient can perform means test is negative.
Result: - Positive / Negative

The spine clearance test

Test: - FORWARD BENDING & LATERAL BENDING
Purpose: - To know expected ROM of spine.
Procedure: -Ask the patient to stand on erect position. Ask the patient to bend forward & reach to the toes. Slide their hand down each thigh and bend at lateral side. Observe from front and side.
Result: - Positive / Negative

The lower limb clearance test

Test: - LOW SQUAT
Purpose: -To know movements, balance and coordination of the hip, knee and ankle.
Procedure: - Ask the patient to stand on erect position. Ask the patient to keep both upper limb extended forward on shoulder level. Flex the knee and hip at 90 degree. (Just like sitting on chair). Then extend the knee and hip on same position. If the patient can perform means test is negative Observe from front and side.
Result: - Positive /Negative

Test: -STANDING ON TOE
Purpose: - To know ROM, muscle strength and balance of ankle and foot.
Procedure: - Ask the patient to stand on erect position. Ask the patient to raise the toes and stand on toes for while. Observe from front and side.
Result: - Positive / Negative

Note: Ensure that support like walking frame or chair is available during low squat & standing on toe.

The specific test
Test: - THOMAS
Purpose: - To know Hip flexion contracture.
Procedure: - Ask the patient to lie down on supine position on examination table with relax. Examiner stand just near about hip at affected side. Ask the patient to flex both knee and hip and try to touch at chest. Place the one hand just below the lumber region of patient. Examiner should feel lumber region by palm and examination table surface by dorsum of palm. Ask the patient to hold knee on same flexion position and ask to extend the affected limb.
If patient can fully extend the limb & there is no gap between lumber region and palm means that there is no hip flexion contracture. If patient can not fully extend the limb and is stopped in between, it may be due to muscle tightness. So try to give passive force on same limb to keep extend from where it stopped. In this time if there is some gap or curve on lumber spine and difficult to keep on extended position then it can say that pt has hip flexion contracture positive
Result: - Positive /Negative

Test: OBER
Purpose: - To know tightness of ilio tibial band
Procedure: - Ask the patient to lie on examination table by side lying position. (Affected side above).keep the pelvis (ASIS) in level & ask the patient not to move. The examiner stands just back of patient near about thigh.

The examiner hold the affected limb by supporting medial aspect of knee, flex the knee about 90 degree and abduct the hip to end of range (limit).Then release the limb. If limb sudden drop straight, the test is negative. If limb don’t drop sudden and remain abduct means ilio tibial band is tight and test is positive.
Result: - Positive / Negative

Test: - FABER
Purpose: - To know the Flexor, Abductor, External rotators of hip.
To know coordination, flexion & extension of toes.

Procedure: - Ask the patient to sit on the chair with hip and knee joint on 90 degree flex (Possible in lying position also).Ask the patient to raise the sole of foot of affected side and touch opposite knee and slight rub at medial aspect of knee. If patient feel pain and can not perform means test is positive. If patient can perform easily means test is negative
Result: - Positive / Negative

Test: - TRENDELENGBURG SIGN
Purpose: - To know the weak hip abductor
Procedure: - Ask the patient to stand on erect position. Check the ASIS level. Ask the patient to stand on one limb and check pelvic level that whether it is on level or not .If patient is standing on right limb (left limb unsupported) and pelvic drop on unsupported side means right side hip abductor are weak. If pelvic do not drop and on level means right side hip abductor is not weak and it is controlling unsupported side. To compensate unsupported side patient bend his trunk at supported limb. It can be observed from front and back.
Result: - Positive / Negative
Note: Ensure that support like walking frame or chair is available during test.

Test: - KNEE ANTERIOR & POSTERIOR DRAW TEST
Purpose: - To know the anterior and posterior knee stability.
Procedure: - Ask the patient to lie down on the couch (Or sitting on chair).Keep the affected limb on 90 degrees flexed position. The examiner sits just near about flexed knee. Place the both thumb at just side of the patella tendon & fore finger at popliteal area (hamstring tendon) Ask the patient to hold & stablished the leg.
Slowly pull toward examiner and push backward to patient. If forward slide of tibia means anterior cruciate ligament damage and if backward slide of tibia means posterior cruciate ligament damage. The sliding of tibia toward and backward show positive test. If there is no slide means test is negative.

Result: - Positive / Negative

Test: - COLLATERAL LIGAMENT (Medial & lateral)
Purpose: - To know the medial and lateral stability of knee.
Procedure: - Ask the patient to lie on examination table. Flex the knee on 10-20 degree.
For medial collateral ligament
Hold the patient leg at medial aspect of distal end just near about ankle joint. Hold at just above the lateral aspect of knee by another hand. Apply the valgus force on knee. If it is loose or more valgus means medial collateral ligament is weak or not functioning properly. It shows test is positive.

For lateral collateral ligament
Hold the patient’s leg at lateral aspect of distal end just near about ankle joint.
Hold at just above the medial aspect of knee by another hand. Apply the varus force on knee. If it is loose or more varus means lateral collateral ligaments is weak or not functioning. It shows test is positive.

Result: - Positive / Negative

Test: - ANKLE DRAW TEST
Purpose: - To know the ankle joint stability.

Procedure: - Ask the patient to sit on couch. Examiner just sit front of the patient. Ask the patient to keep the foot on slight planter flexion. Keep one hand on the anterior aspect of lower tibia (pushing backwards).By other hand hold just above calcaneus using index finger and thumb at either side of Achilles tendon. Hold calcaneus on palm & pull forward.

If foot draw forward relative to leg or if patient feels pain shows ruptured or weak ligament. It shows that test is positive.
Result: - Positive / Negative

Clinical assessment Clearance test

2009-02-26T08:34:00.000-08:00

Subjective assessment and objective assessment are used for diagnosis purpose. Only subjective assessments don’t give perfect and final diagnosis. It may lead misguidance in diagnosis and treatment plan if objective assessment direct go through the specific area according to patient complain. So, detail objective assessment of whole body should be conducted. For example if patient came with problem at knee. Detail assessment of whole body should be conducted then specific assessment should be conducted at area where patient feel problem. It will show that whether there are any problem in another region or not? Whether cause route is somewhere else. These objective assessments are performed by using DIFFERENT TEST.

Main objective
• To know actual diagnosis of the patient.
• To provide proper appliance to patient according to need.

Clearance test
Clearance test is performed by patient as instruction given by examiner. It is the test which shows that the part or segment is clear or not. During test if patient can’t perform or feel pain, test should perform on that specific part. If patient can perform it is clear that we can proceed further.
During clearing test the examiner should note following points.
• Plain of movement
• Expected range of motion
• Coordination capacity
• Understand the instruction
• Expression

For each test remember for:
• Privacy maintenance
• Explain about procedure
• Make unclothe if necessary
• Demonstration( if patient don’t understand how to do)
• Ensure safety for patient
• If patient can perform result is NEGATIVE
• If patient can not perform result is POSITIVE

PRODUCTS OF OSTEO SUPPORT

2008-12-27T03:46:00.000-08:00

Product detail

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Cervical orthosis casting procedure

2008-12-07T03:56:00.000-08:00

Slide 3Procedure
1.Prepare all the casting requirements.
2.Explained the procedure to the patient.
3.Apply ellofene surrounding the neck.

4.Apply 15 cm pop longate (6 layer) at mid of just below the right ear to left ear-posteriorly.
5.Apply pop longate at proximal up to occipital region at distal up to cervical region, and at lateral up to mid of shoulder.
6.Apply gentle massage to get contour.

4.Apply parting agent both lateral side of pop just below the ear.
5.Apply 15 cm pop longate (6 layer) at mid of just below the right ear to left ear-anteriorly and at lateral up to mid of shoulder.
6.Apply pop longate at proximal up to chin region and at distal up to manubrium region.
7.Apply gentle massage to get contour.

8.Apply small pop longate at overlap area of anterior and posterior longate.
9.Apply gentle massage to get contour.
10.Keep the cervical spine on required extension position.
11.Avoid lateral flexion of neck.
12.Apply gentle massage to get contour throughout the circle of neck.
13.Be sure that chin and occipital bone are in properly rest on the cast.

14.Make mark at lateral side and separate the pop cast from patient's neck.
15.Joint the pop cast again with pop bandage.
16.Clean the patient.
17.Make trim line.

18.Anterior view, posterior view,lateral view, top view or cervical spine cast.

TRANS-TIBIAL DYNAMIC ALIGNMENT

2008-12-02T02:54:00.000-08:00

learn more Trans tibial static alignment

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TRANS-TIBIAL STATIC ALIGNMENT

2008-12-01T06:36:00.000-08:00

TRANS-TIBIAL DYNAMIC ALIGNMENT

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Manual trans-femoral casting procedure

2008-11-30T09:14:00.000-08:00

Material preparation
Stump measurement sheet
15 cm POP bandage 4-6 roll
Measurement tape
Indelible pencil
Stockinet for residual limb and pelvis
parting agent-vaseline
plaster cutting scissor
waterpot

procedure
Cover the stump with vaseline
Place one stockinet over the residual limb/pelvis and one over the stump
( if possible elastic, TUBIGRIP )

Marking
Marks on greater trochanter and along the femur
Marks along the femur for horizontal measurements all 5-7 cm
Take the circular measurements:
most important:
1. Proximal circumference
2. Centre muscle circumference
3. Distal circumference before the stump
endProcedure
Cover the stump with 4 layers of POP Bandage

Use the classic cast grip for
quadrilateral socket design:
1. One hand horizontal under the tuber
2. One hand along the frontal scarpa
triangle
3. Both hands build an angle towards the
medial side
4. The stump is in normal adduction and
flexion
5. Check shape changes under muscle
contraction

Lateral view and frontal viewCut the rope and stockine
Remove the negative cast from patient Modification of the Negative Cast ( Check Socket )
Prepare the proximal trim line of the negative model
Reduce the volume of the negative model along the medial, proximal stump entry part about
2-3 cmThe modified check socket

Reinforced the socket

Check the socket on the patient and correct the volume if necessary
Perfect volume means that the patient can fix the socket with his muscle contraction

Apply lateral and frontal a plumb line on the check socket in normal position

Preparation of the Positive Model
Isolate the check socket with vaseline
Place the check socket in a neutral and functional position in a sand box
Extend the model with a POP-bandage
Place a iron pipe in neutral functional position in the model

Do you want to know more about alignment ?

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CHEST GUARD

2008-11-23T10:34:00.001-08:00

WHAT IS CHEST GUARD?
Chest guard is a type of mini vest.It is fabricated with special foam, air and water proof taffeta, & skin friendly elastic.It was designed and introduced to market(kathmandu, Nepal) by osteo support in 1997, after trying effectiveness of chest guard on motorbike rider.It was modified design of Rib belt.It was first introduced by osteo support on request of motorbike rider.Some motorbike rider used to keep x-ray plate, thick leather, thick plastic etc. on their chest to protect from cold air before chest guard introduced.

WHY CHEST GUARD?
To protect the chest from the cold and its effects.

HOW DOES IT WORK?
CHEST GUARD is made of special foam & air and water proof taffeta.It will protect the chest from direct blow of cold air. It will keep the chest warm and protect the chest from bad effect
of cold air blow.

TO WHOM IT IS EFFECTIVE?
The person who drive motorbike for long distance.
The person who expose on cold air for long time.

SIZE
| X- large | Large | Medium | Small |

FEATURE
Easy for donning and doffing
Adjustable
Posterior opening
Washable

We provide special extraordinary size according to need and design.

If you have any related problem or interesting regarding chest guard
please e-mail on
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Cervical collar

2008-11-22T09:03:00.000-08:00

FEATURES
Made of High density P.U. foam and covered with soft hypoallergenic cotton stockinet for comfort and polythene sheet reinforcement for better immobilization, proper ventilation through eyelet to allow air circulation. Velcro closures are used for easy application removal and adjustment.

Specially designed to support, immobilize or adjust the neck in the flexion extension or hyperextension position.

APPLICATIONS
Cervical Spondylolysis
Cervical Neuralgia
Cervical disc disease
Torticolles (Wryneck)
Whiplash injuries

SIZES
Large
Medium
Small

We provide special extraordinary size according to need.
We provide special service on costume design according to need and prescription.

Special attention

Before using any cervical orthosis consult your orthopedic doctor or neuro-surgeon or physiotherapist or orthotist & prosthetist.

If you have any related problem and interesting regarding cervical spine, neck pain etc. please e-mail on
osteosupportnepal@gmail.com
osteosupport@hotmail.com
Visit: www.osteosupport.kuspito.com

Lumbersacral Belt

2008-11-22T07:47:00.000-08:00

Lumber corset

FEATURES
Lumber sacral Belts are specifically designed and made from durable cotton fabric with skin friendly elastic for better fitness. Its tempered spring steel bars immobilize the lumber and sacral regions more effectively and firmly.
Velcro closures provide close contour fitting around the waist, it can be easily applied, adjusted and removed.

APPLICATIONS
Effective in degenerative disc disease.
Lumbo sacral Spondylolysis.
Post discketomy Care.
Effective for low back ache patient.
Osteoporotic pain of the lumbar spines.

AVAILABLE SIZES
28" to 44"

TYPE
Double lock with four spring steel bars.
Simple with sing spring steel bar
We provide special extraordinary size according to need.
We provide special service on costume design according to need and prescription.

Special attention
Before using lumber sacral belt please consult your orthopedic doctor or neuro-surgeon or physiotherapist or orthotist & prosthetist.
If you have any related problem and interesting regarding lumber sacral, low back pain etc.

Wrist Hand Orthosis Casting procedure

2008-09-28T09:26:00.000-07:00

CASTING PROCEDURE FOR WRIST HAND ORTHOSIS

THE PICTURE WILL EXPLAIN ITSELF

Negative cast for Wrist hand orthosis is ready.

EXERCISES FOR LOW BACK PAIN

2008-09-27T22:05:00.000-07:00

Most people who have back pain naturally feel better by doing certain exercises. Some feel better on sitting (their back and hips are flexed), while others feel better on standing (back and hips are extended). Exercise that moves you toward more comfortable position.

Regular exercises to restore the strength of your back and a gradual return to everyday activities are important for your full recovery. Your orthopedic doctor or physiotherapist may recommend for exercise 10 to 30 minutes a day, 1 to 3 times a day during your early recovery. They may suggest some of the following exercises. This guide can help you better understand your exercise and activity program, which should be supervised by your therapist and orthopedic surgeon.

Stretching and strengthening exercises it include:

Extension exercise

Flexion exercise

Additional exercises

Extension exercises, which stretch tissues of the front of the spine, strengthen the back muscles, and may reduce pain caused by a prolapsed disc. These are generally a good choice for people whose back pain is eased by walking and standing

Press-up back extensions

Procedure

Lie on your stomach with your hands under your shoulders on flat surface.
Push with your hands so your shoulders begin to lift off the floor.
If it's comfortable, put your elbows on the floor directly under your shoulders so you can rest in this position for several seconds.

Alternate arm and leg exercise

Do this exercise slowly. Try to keep your body straight at all times, and don't let one hip drop lower than the other.

Procedure

Start on the flat floor, on your hands and knees.
Tighten your stomach muscles.
Raise one leg off the floor and hold it straight out behind you. Be careful not to let your hip drop down, because that will twist your trunk.
Hold for 3-5 seconds, then lower your leg and change to the other leg.
Repeat 8 to 10 times on each leg.
work up to holding for 10 to 20 seconds each time.
If you feel stable and secure with your leg raised, try raising the opposite arm straight out in front of you at the same time.

Flexion exercises, which strengthen stomach and other muscles, and stretch the muscles and ligaments in the back. These are generally a good choice for people whose back pain is eased by sitting down.

Knee-to-chest exercise

Do not do the knee-to-chest exercise if it increases back or leg pain.

Procedure

Lie on your back with your knees bent and your feet flat on the flat floor.
Bring one knee to your chest, keeping the other foot flat on the floor.Keep your lower back pressed to the floor. Hold for at least 15 to 20 seconds.
Relax and lower the knee to the starting position. Repeat with the other leg.
Repeat 2 to 4 times with each leg.
To get more stretch, put your other leg flat on the floor while pulling your knee to your chest.

Curl-ups

Procedure

Lie on the flat floor on your back with your knees bent at a 90-degree angle. Your feet should be flat on the floor, about 10-12in. from your buttocks.
Cross your arms over your chest.
Slowly contract your abdominal muscles and raise your shoulder blades off the floor.
Keep your head in line with your body.Do not press your chin to your chest.
Hold this position for 1 or 2 seconds, then slowly lower yourself back down to the floor. Repeat 8 to 10 times.

Additional strengthening and stretching exercises.

pelvic tilt exercise

Heel dig bridging

Hip flexor stretch

Wall squats or sit

Heel Raises

Straight leg Raises

Pelvic tilt exercise

Procedure

Lie on your back with your knees bent.
"Brace" your stomach-tighten your muscles by pulling in and imagining your belly button moving toward your spine. You should feel like your back is pressing to the floor and your hips and pelvis are rocking back.
Hold for 10 seconds while breathing smoothly.
Repeat 8 to 12 times.

Heel dig bridging

The heel dig bridging exercise works your hamstrings and the muscles around your hip. Do 8 to 10 repetitions. Do not continue with this exercise if it causes pain.

Procedure

Lie on your back with both knees bent and your ankles bent so that only your heels are digging into the floor. At this point, your knees should be bent about 90 degrees.
From here, push your heels into the floor, squeeze your buttocks, and lift your hips off the floor until your shoulders, hips, and knees are all in a straight line.
Hold briefly, and then slowly lower your hips back down to the floor.

Hip flexor stretch

Procedure

Kneel on the floor with one knee bent and one leg behind you. Position your forward knee over your foot. Keep your other knee touching the floor.
Slowly push your hips forward until you feel the stretch in the upper thigh of your rear leg.
Hold the stretch for at least 10 to 20 seconds. Repeat with your other leg.
Do 2 to 4 times on each side.

Wall Squats or sit
The wall sit exercise strengthens your back, trunk, and thigh muscles, helping you maintain a healthy lower back.

Procedure

Stand with back leaning against wall.

Walk feet 12 inches in front of body.

Keep abdominal muscles tight while slowly bending both knees 45 degrees.

Hold 5 seconds.

Slowly return to upright position.

Repeat 10 times.

Heel Raises

Procedure

Stand with weight even on both feet.

Slowly raise heels up and down.

Repeat 8-10 times.

Straight Leg Raises

Procedure

Lie on your back with one leg straight and one knee bent.
Tighten abdominal muscles to stabilize low back.
Slowly lift leg straight up about 6 to 10 inches and hold 1 to 5 seconds.
Lower leg slowly.
Repeat 8-10 times.

leg length discrepancy (LLD)

2008-09-27T12:53:00.000-07:00

LEG LENGTH DISCREPANCY (LLD)

Introduction
Cause of leg length Discrepancy
Symptoms of LLD
Effects of LLD
Examination of LLD
Type of LLD
Test of LLD
Management of LLD
Summary

Introduction
Leg length discrepancy (LLD) or Lower limb discrepancy is a condition of unequal lengths of the lower limbs. The discrepancy may be in the femur, or tibia, or both. In some conditions, the whole side is affected, including the upper limbs. However, it is the discrepancy of the lower limbs that causes problems with ambulation, and the focus of this discussion will be about lower limb discrepancy.
When evaluating a child with limb length discrepancy, the cause and changing magnitude during growth must be considered. Asymmetry in limb lengths is not considered pathologic. Discrepancies of 1 cm to 1.5 cm are common, generally do not cause any symptoms, and may not require treatment. The greater the discrepancy, the more a child must compensate his or her normal posture and gait (walking pattern) in day to day life, which can lead to a variety of symptoms, such as functional scoliosis, hip, knee and ankle problems.

Causes of leg length Discrepancy

Structural / anatomical LLD
- Congenital defects
- Trauma (eg: motor vehicle accident)
- Burns
- Infection
- Post-surgical shortening
- Tumor
- Hemi atrophy and hemi hypertrophy

Functional LLD
- Pelvic / lumbar anomaly (e.g.: scoliosis)
- Muscle contracture (e.g.: psoas)
- Asymmetrical rear foot pronation

Symptoms of a leg length discrepancy

The symptoms of a leg length discrepancy vary widely and are often related to the underlying problem causing the discrepancy and the alignment problems that result from it. Every patient experiences symptoms of this condition differently. The following are symptoms of a leg length discrepancy:
1. One leg is obviously shorter than the other (although this is not always obvious) problems with posture (i.e. shoulder may tilt toward shorter side) leading to compensatory or functional scoliosis.

2. Gait problems, such as limping, toe-walking, or rotation of the leg, knee that's chronically hyper extended on the short side and flexed on the long side.

3. Pain in the back, hip, knee, and/or ankle

Effects of Leg length Discrepancy

Problems associated with LLD include
Structural scoliosis, lower back pain, degenerative arthrosis of the lumbar and sacroiliac articulations, long leg degenerative hip and patellofemoral arthrosis, equinus contracture of the ankle, foot callosities, cosmetically unappealing shoe lift or prosthesis, cosmetically unappealing gait disturbance, and increased energy consumption during gait

Examination on leg length Disrepancy

a) Clinical Examination
The initial clinical examination is simple. Examination begins with the patient shoeless and standing with both feet flat on the floor. The patient is viewed from both the front and rear sides. From the rear, relative hip, knee, and foot heights are observed. One-cm blocks are inserted under the shorter limb until the iliac crests are level and the trunk is balanced Leveling the pelvis should eliminate scoliosis if it is a result of LLD.

b) Measuring the Discrepancy
To determine the true discrepancy, the patient is placed in a supine position and then measured (using a tape measure) from the prominence of the anterior iliac crest to the lower prominence of the medial malleous. The relative knee heights are measured with the hips and knees flexed. Foot heights and lengths are obtained by direct observation.

c) Analyzing Gait
Adaptations of walking occur as a means of smoothing gait and minimizing energy expenditure. The patient's gait is evaluated for the compensatory mechanisms (adaptations) of pelvic tilting, long knee flexion, and vaulting on the short side. Another form of compensation, used less frequently, is pelvic internal rotation to lengthen stride. Patients with fixed deformities of the spine, pelvis, hip, knee, or ankle may not be able to use the usual compensation mechanisms. For these patients, walking can be difficult.Analysis of oxygen consumption shows little change in patients with mild LLD; however, easy fatigue is a common complaint of these patients

d) Radiologic Assessment
A history and clinical examination may not always allow for an accurate diagnosis. A screening leg length radiograph, known as a scanogram, aids in making a complete diagnosis.

TYPE
1. True Discrepancy in Length.
2. Apparent Discrepancy in Length

1.True Discrepancy in length
True shortening is the actual shortening or bony shortening.True shortening of one lower limb is present where there is a decrease in the distance between the upper surface of the head of the femur and lower surface of the calcaneus, compared with the other limb. This distance can not be measured accurately by clinical means because of the deeply placed position of the relevant bony points .Accurate measurement is possible only by taking a special radiograph on which both lower limbs from the hips to feet are shown alongside a scale.

For clinical purpose, measurements are taken from anterior superior iliac spine (ASIS) to the tibial platue and tibial platue to tip of the medial malleolus.It is accepted that the ASIS lies at the level of proximal and lateral to the upper surface of the head of the femur, and that part of the talus and calcaneus lies distal to the tip of the medial malleous.

2.Apparent Discrepancy in length
Shortening adopted by the patient or shortening which is visible or shortening which is adopted by patient is known as apparent shortening. Apparent shortening is also due to presence of a fixed adduction or abduction deformity at one hip.

In normal standing, the lower limbs are parallel when seen from in front. To bring the lower limbs into a parallel position when a fixed adduction or abduction deformity is present at one hip, the pelvis is tilted and one knee is flexed. In Presence of fixed adduction deformity, the ASIS on the same side is raised above the horizontal causing apparent shortening of ipsilateral limb. When fixed abduction deformity is present the ASIS is on the opposite side is raised above the horizontal causing apparent shortening of the contra lateral limb (apparent lengthening of the ipsilateral limb)

Test for Leg length Discrepancy

1. True leg length Discrepancy
To determine true leg length discrepancy, place the patient’s legs in precisely comparable position and measure the distance from the ASIS to the medial malleoli of the ankles.ASIS to Tibial platue and Tibial platue to medial malleoli also can measure.

True shortening measure on supine position:
a) Lie down the patient on supine position.
b) Stand on right hand side of the patient.
c) Identify ASIS.
d) Place the measuring tape on ASIS to the medial malleolus and note the total length. Note reading measurement of both lower limbs. (From one fixed bony point to another)
e) Any difference between the two measurements indicates the amount of true shortening present.

True shortening measure on standing position
a) Let stand the patient on erect position with both knees fully extended.
b) Identify both ASIS. ASIS on side of shorter limb will lie at a lower level.
c) Place flat wooden blocks of varying thickness under the foot of shorter limb until the ASIS lie at a horizontal plane.
d) The total height of the wooden blocks used equals the difference in limb length.

To determine in short order where the discrepancy lies (whether in the tibia or in the femur),ask the patient to lie supine , with knees flexed to 90 degree and feet flat on the table .If one knee appears higher than the other , the tibia of the extremity is longer .If one knee projects further anteriorly than other , the femur of the extremity is longer

2. Apparent leg length Discrepancy
Established that there is no true leg length discrepancy before testing for an apparent discrepancy in which there is no true bony inequality. Apparent shortening may stem from pelvic obliquity or from adduction or flexion deformity in the hip joint. During inspection pelvic obliquity manifest itself as uneven anterior or posterior superior iliac spines while the patient is standing.

The apparent lengths of the lower limbs are measured from a fixed point such as xiphisternum or umbilicus to the tip of the malleolus of both legs respectively.
a) Lie the patient on supine position with legs in neutral position as possible.
b) Measure the distance from xiphisternum or umbilicus to medial malleoli of the ankle respectively.
c) Difference between the measurements for each lower limb indicates the presence of a fixed adduction or abduction deformity at one hip, but only if true shortening or lengthening is absent.

Management of LLD

1. Non-surgical management
a) Compensation

2. Surgical management
a) Epiphysiodesis
b) Shortening
c) Lengthening

1. Non-surgical management
A lift is indicated when the inequality affects the gait pattern, shoe wear, function, or causes pain. A 1-cm lift can fit comfortably inside of the shoe; however, larger inserts can render the foot unstable in the shoe. Lifts placed on the sole of the shoe function well up to approximately 3 cm.Beyond this, the shoe becomes heavy and awkward. Compliance depends on the patient and family.

a) Compensation
Leg length inequality of 2 cm or less is usually not a functional problem. Often, leg length can be equalized with a shoe lift, which usually corrects about two thirds of the leg length inequality. Up to 1 cm can be inserted in the shoe. For larger leg length inequalities, the shoe must be built up. This need to be done for every shoe worn, thus limiting the type of shoe that the patient can wear. Leg length inequalities beyond 5 cm are difficult to treat with a shoe lift. The shoe looks unsightly, and often the patient complains of instability with such a large lift. A foot-in-foot prosthesis can be used for larger leg length inequalities. This is often done as a temporizing measure for young children with significant leg length inequalities. The prosthesis is bulky, and a fixed equinus contracture may result.

2. Surgical management
a) Epiphysiodesis
b) Shortening
c) Lengthening

a) Epiphysiodesis

Epiphysiodesis is a reliable procedure that inhibits growth with few complications. This obviously cannot be done on skeletally mature patients, and the final leg length inequality and the degree of growth inhibition need to be predicted and are subject to errors.Because the procedure effectively shortens the longer leg and is usually done on the uninvolved side. It may be unappealing to the patient and family.

b) Shortening

Shortening techniques can be used after skeletal maturity to achieve leg length equality. Shortening can be done in the proximal femur using a blade plate or hip screw, in the mid-diaphysis of the femur using a closed intramedullary (IM) technique or in the tibia. Shortening is an accurate technique and involves a much shorter convalescence than lengthening techniques.

c) Lengthening
Lengthening is usually done by corticotomy and gradual distraction. This technique can result in lengthenings of 25% or more, but typically lengthening of 15%, or about 6 cm, is recommended The limits of lengthening depend on patient tolerance, bony consolidation, maintenance of range of motion, and stability of the joints above and below the lengthened limb

Summary
Leg length discrepancy is a condition of unequal lengths of the lower limbs. The discrepancy may be in the femur, or tibia, or both. When evaluating a child with limb length discrepancy, the cause and changing magnitude during growth must be considered. LLD is associated with burn, infection, trauma, muscle contracture, congenital defect etc. LLD results lower back pain, scoliosis, ugly gait, more energy consumption etc. Discrepancies of 1 cm to 1.5 cm are common, generally do not cause any symptoms, and may not require treatment. LLD are categories on true discrepancy and apparent discrepancy. True discrepancy is bony or structure discrepancy, apparent discrepancy is adopted or functional discrepancy.Multi-disciplinary approach is necessary for effective management of LLD.Which include orthopedic doctor, orthotist & prosthetist, physiotherapist etc.

Contact Us

2008-07-24T08:11:00.000-07:00

Contact us

2007-03-15T09:42:00.000-07:00

For prefabricated orthopaedic products.
For custom made prosthetic and orthotic service.
For Pre-prosthetic treatment.
For physiotherapy service.
For free orthotic , prosthetic, pre-prosthetic treatment consultancy.
For free consultancy by e-mail, phone call for orthotic ,prosthetic, and pre-prosthetic treatment.

Service address:

Kushibu,Nayabazar-16
kathmandu,Nepal
Tel. +977-01-4 381469
Mobile. 9841 275627

E-mail :
osteosupport@hotmail.com
osteosupportnepal@gmail.com

Visit: www.osteosupport.kuspito.com

About us

2007-03-15T08:36:00.000-07:00

Osteosupport is orthotic and prosthetic based business firm.It was established in Kathmandu Nepal in 1996, but legally registered in 1997. It was the collective ideas of orthopaedic surgeon, physiotherapist and orthotist and prosthetist.Since the day of our establishment, we have been providing different orthopedic needs and requirement of client from different parts of the Kingdom of Nepal.