RS-AOP 220
Week 11: Concepts and Upper Extremity Orthotics
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Section:
TOTAL: 30 POINTS
CASE 1 (15 POINTS)
P. O., a 40 y/o female patient, was referred to physical therapy with complaints
of numbness and tingling on her right lateral hand, particularly on the anterior
thumb, index, and middle fingers. The patient reported that her symptoms
increase during prolonged typing on the keyboard when she is at work as well
as when she grips her steering wheel when driving long distances. Upon
assessment, you also noticed that there is slight atrophy of her thenar muscles
and decreased grip strength.
1. Based on the information given, what is most likely the condition of this
patient and why (include its usual signs and symptoms and mechanism of
injury that justify your diagnosis)? Cite your references.
Based on the information provided, the patient, P.O., a 40-year-old female,
likely has Carpal Tunnel Syndrome (CTS), a common condition caused by
compression of the median nerve within the carpal tunnel at the wrist. The
symptoms—numbness and tingling in the thumb, index, and middle fingers,
worsening with typing and gripping a steering wheel—are classic signs of CTS,
which is aggravated by repetitive wrist movements that increase pressure within
the carpal tunnel (Frontera et al., 2018).
Physical signs like slight atrophy of the thenar muscles and reduced grip
strength suggest a more advanced stage of CTS, where prolonged compression
affects the motor branch of the median nerve. As noted in course materials, CTS
causes pain, numbness, and tingling in the radial three and a half digits, often
worse at night or with repetitive use, and may lead to muscle wasting and
weakness over time (UE Orthotics Notes, 2024, p. 17).
The likely mechanism of injury here is repetitive strain from typing and
driving, both known risk factors. These activities decrease space in the carpal
tunnel, exerting pressure on the nerve and impairing both sensory and motor
function. Without intervention, this can lead to permanent nerve damage and long-
term functional limitations (DeLaune et al., 2010).
2. What orthosis can you prescribe this patient and why? Write down its
name, function/goal, instructions for wearing, and insert a photo. Cite
your references.
For a patient with Carpal Tunnel Syndrome, the appropriate orthosis is a
Wrist-Hand Orthosis (WHO), specifically a Neutral Position Wrist Splint. It
holds the wrist in 0–15° extension to reduce median nerve compression in
the carpal tunnel (UE Orthotics Notes, 2024, p. 17). This helps relieve pain,
prevent further irritation, and protect the wrist during repetitive activities or
sleep.
The splint’s main function is to immobilize the wrist while allowing finger
movement, which is essential for daily tasks. Keeping the wrist neutral
increases space in the carpal tunnel, easing pressure on the nerve (Frontera
et al., 2018). It is especially helpful at night to prevent wrist flexion that
worsens symptoms.
Instructions for Wearing:
o The orthosis should be worn especially at
night to prevent wrist flexion during
sleep, which is a common aggravating
factor in CTS.
o During the day, it may be worn while
performing repetitive tasks, such as
typing or driving, but should not be worn
continuously for long periods to prevent
joint stiffness and promote active muscle
use.
o The patient should remove the orthosis
during exercises, bathing, and activities
that do not provoke symptoms.
The neutral wrist splint for CTS should be
lightweight, low-profile, and allow for full
PhysioWorks Clinic. (n.d.). Custom finger movement. It should also position the
Hand and Wrist Orthosis [Image]. wrist to relieve pressure on the median
PhysioWorks Clinic.
https://physioworks.clinic/physical
-therapy-clinic-treatments/custom
-hand-and-wrist-orthosis/
nerve (UE Orthotics Notes, 2024, p. 17). Prefabricated or custom-made
versions are available depending on the severity and duration of symptoms.
CASE 2 (15 POINTS)
B. B. M. is a 50 y/o male patient who was referred to rehab with complaints of
insidious aching pain on his right lateral elbow and forearm after his weekly
game of tennis. Upon assessment, you noted that tenderness can be elicited
with palpation of the lateral epicondyle. Gripping activities as well as extension
of the wrist with the elbow extended and forearm pronated also aggravate the
pain. Additionally, there is observable weakness of the patient’s grip.
1. Based on the information given, what is most likely the condition of this
patient and why (include its usual signs and symptoms and mechanism of
injury that justify your diagnosis)? Cite your references.
The patient, B. B. M., a 50-year-old male, is most likely experiencing Lateral
Epicondylitis, also known as Tennis Elbow. This condition is a repetitive overuse
injury affecting the tendinous origin of the forearm extensor muscles, especially
the extensor carpi radialis brevis (ECRB). Pain typically develops at the lateral
epicondyle of the humerus, where these tendons attach.
Common signs and symptoms include localized tenderness at the lateral
epicondyle, pain during gripping, wrist extension with the elbow extended and
forearm pronated, and reduced grip strength—all of which match the clinical
presentation of this patient. Lateral epicondylitis is characterized by pain elicited
on resisted wrist extension and palpation of the lateral elbow, along with functional
impairment if untreated (University of the East, 2024, pp. 14–15).
The mechanism of injury is typically due to repetitive wrist extension or
forceful gripping, such as what occurs in racquet sports like tennis. The repeated
stress leads to microtearing and degeneration of the tendon—referred to as
tendinosis, not just inflammation—resulting in pain and dysfunction (Magee, 2014).
If unmanaged, it can become chronic and limit both occupational and recreational
activities.
2. What orthosis can you prescribe this patient and why? Write down its
name, function/goal, instructions for wearing, and insert a photo. Cite
your references.
The most appropriate orthosis for the patient is a Tennis Elbow Strap, also
known as a Counterforce Forearm Brace. This orthosis is specifically indicated
for Lateral Epicondylitis, which involves microtrauma and overuse of the
common wrist extensor tendons—particularly the extensor carpi radialis brevis
(ECRB)—resulting in pain at the lateral epicondyle. As described in the UE
Orthotics notes, this type of orthosis is designed to relieve tension at the site of
tendon origin by altering the point of force transmission (UE Orthotics Notes,
2024, p. 11).
The goal of the tennis elbow strap is to reduce strain on the lateral
epicondyle by absorbing and redistributing stress from the wrist extensors,
particularly during resisted wrist extension and gripping tasks. By applying
compression to the proximal forearm musculature, the orthosis acts as a
“counterforce” that limits muscle expansion and tendon pull, thus helping to
alleviate pain, prevent further irritation, and promote functional use of the arm
during daily and recreational activities (Magee, 2013; Frontera et al., 2018).
Counterforce straps are helpful in the subacute and chronic stages of
lateral epicondylitis. The orthosis should not be worn during complete rest, as
functional loading is important for tendon recovery when pain allows (UE
Orthotics Notes, 2024, p. 11).
Instructions for Wearing:
o Position the strap approximately
2 cm (1–2 fingerbreadths)
below the lateral epicondyle
over the muscle belly of the
forearm extensors.
o Adjust the strap to provide firm
but comfortable compression.
It should not restrict circulation or
cause numbness.
o Wear the orthosis during painful
or repetitive activities like
racquet sports, lifting, typing, or
other gripping tasks.
o Remove the brace when at rest
or sleeping to avoid unnecessary
compression or skin irritation.
Larson Sports Ortho. (n.d.). Counterforce
Strap [Image]. Larson Sports Ortho. o Ensure proper skin hygiene and
https://larsonsportsortho.com/product/
counterforce-strap/
check for pressure marks, especially with prolonged use.
REFERENCES
American Academy of Orthopaedic Surgeons. (2024, April). Tennis elbow
(lateral epicondylitis). OrthoInfo. Retrieved from
https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-
epicondylitis/
DeLaune, S. C., & Ladner, P. K. (2010). Fundamentals of nursing: Standards and
practice, fourth edition.
https://repository.poltekkes-kaltim.ac.id/606/1/Fundamentals%20of%20Nursing_
%20Standards%20and%20Practice%20(%20PDFDrive.com%20).pdf
Frontera, W. R., Silver, J. K., & Rizzo, T. D. (2018). Essentials of Physical
Medicine and Rehabilitation (4th ed.). Elsevier.
https://shop.elsevier.com/books/essentials-of-physical-medicine-and-
rehabilitation/frontera/978-0-323-54947-9
Magee, D. J. (2013). Orthopedic physical assessment (6th ed.). Elsevier.
UE Orthotics Notes. (2024). Orthotic management of upper extremity conditions
[Class lecture handout]. Department of Physical Therapy
