16 - Orthotic Treatment Considerations for Arthritis and Overuse Syndromes in the Upper Limb

Abstract

The chapter reviews the basic pathophysiology, pathomechanics, and orthotic treatment considerations of persons with arthritis and overuse syndromes involving the upper limb. The most common forms of arthritis (rheumatoid arthritis and osteoarthritis) and most common forms of overuse syndromes (lateral epicondylitis, cubital tunnel syndrome, carpal tunnel syndrome, de Quervain tenosynovitis, trigger finger [stenosing tenosynovitis]) are reviewed. Each of the pathologic conditions and diagnoses are reviewed by anatomical level (elbow, wrist, hand, thumb, fingers) and magnitude of deformity (mild, moderate, and severe). Using this framework, the orthotic treatment considerations are then presented in a practical and clinically relevant manner to guide the busy practitioner in making evidence-based decisions. Topics covered include orthosis design considerations (i.e., force systems, biomechanical motion controls, limb alignment, limb–orthosis interface dynamics and fitting principles) that are critical to enabling the patient with highly disabling conditions to achieve desired functional goals.