The effect of prefabricated wrist-hand orthoses on flexion control of the wrist

This research raises questions regarding the design of a variety of prefabricated wrist-hand orthoses (WHO) which has essentially remained unchanged for several decades. Variations in the efficacy between the orthoses tested in reducing wrist motion suggest there is potential to develop enhanced WHO designs to facilitate motion restriction.

Prefabricated wrist-hand orthoses (WHOs) with a volar bar are commonly prescribed to manage the functional deficit of the wrist as a result of rheumatoid changes in addition to other conditions resulting in dysfunction of the wrist.
RA causes inflammation of the synovial joints at the wrist. During flexion the articular surfaces of the wrist bones become closer in proximity, increasing pain. A WHO is used to maintain the wrist in a position of extension, alleviating pain and increasing functionality of the RA hand. 10° to -20° (extension) has been described as the optimal position for those users presenting with synovitis and a position of extension optimises efficiency of the flexor muscles.
Studies have previously investigated the efficacy of WHOs, with a number of these authors reporting that the wrist was positioned in extension by the WHO during the testing protocol. However the literature does not report on whether this wrist position was maintained by the orthosis during the testing protocol. Therefore assessing the performance of current WHO designs at maintaining wrist position is a key aspect of the results. It is the aim of the present work to investigate and underpin the shortcomings of several different WHO designs.