Basic Structure & Function of Human Joints -A joint: the junction or pivot point between two or more bones. Also transfer & disperse forces produced by gravity & muscle activity -Arthrology: the study o the classification, structure, and function of joint. -Structure & ultimate joint function affect by: 1-Aging, 2- Long-term immobilization, 3- Trauma, 4- Disease -These Factors also significantly influence the quality and quantity of human movement.

-Most effective rehabilitation specific Anatomy & detailed Function of the individual joints throughout the body must been well known. -This is a prerequisite or understanding: --Impairments -Most effective rehabilitation

Classification of joints based on motion: Synarthroses: Synarthrosis: junction between bones allows slight to essentially no movement. Classified as: 1- fibrous 2-cartilaginous. 1-Fibrous joints are stabilized by specialized dense connective tissues, usually with a high concentration of collagen.

2-Cartilaginous joints, in contrast, stabilized by varying forms of flexible of: fibrocartilage or hyaline cartilage, often mixed with collagen. -generally exist in the midline of the body, such as the symphysis pubis, the interbody joints of the spine -The function strongly bind and transfer forces between bones. -well supported by periarticular connective tissues -Allow very little movement.

Acute trauma : - detectable pathology. -A torn or severely stretched tissue causes an acute inflammatory reaction, which involves a predictable inflammatory mediators(cytokines) Cytokines have important implications in both joint pain and exercise. current research suggests that components of exercise prescription intensity, duration, & mode are influential cytokine levels than the exercise-induced muscle damage (and resultant inflammation) itself.

Brief overview of joint pathology 1- A single overwhelming event (acute trauma) 2- Response to an accumulation of lesser injuries over an extended period (chronic trauma).

Acute trauma : - Greater understanding of anti-inflammatory cytokines may prove useful in optimizing exercise prescription, especially in post-operative phases of rehabilitation. -Careful reduction or realignment of the fractured fragments helps to restore congruity to the joint and thereby facilitate smooth, low- friction sliding functions of articular surfaces -This critical to maximal recovery of function.

Chronic trauma : classified (overuse syndrome) & accumulation of unrepaired, relatively minor damage. -Chronically damaged tissu lose restraining functions, although the instability of the joint masked by a muscular restraint substitute. -cause abnormal loading conditions on tissues, which lead to their mechanical failure. Two disease states that commonly cause joint dysfunction are osteoarthritis (OA) and rheumatoid arthritis (RA).

Orthosis : -Orthosis: A force system designed to control, corrects, or compensates bone deformity, deforming forces or forces absent from body. -An orthotic device: an external device applied on the body to limit motion, correct deformity, reduce axial loading, or improve function in a certain segment of the body. -A Splint: orthopedic device use to immobilize & support the body part. -A Brace: device fitted to the body part which is weak & injured to give support. Knee brace.

Characteristics of an orthotic device : 1- Weight of the orthosis 2-Adjustability 3- Functional use 4-Cosmetic 5- Cost 6-Durability 7- Material 8-Ability to fit various sizes of patients 9- Ease of putting on (donning) and taking off (doffing) 10-Access to tracheostomy site & other drains 11-Access to surgical sites for wound care 12-Aeration to avoid skin maceration from moisture

Indications orthotic devices 1- Pain relief 2- Mechanical unloading 3- Management 4- Immobilization after surgery 5- Immobilization after traumatic injury 6- Compression fracture management 7- Kinesthetic reminder to avoid certain movements

Duration of orthotic : - In situations where bone instability is not an issue, until the patient can tolerate discomfort without the brace. -When used for stabilization after surgery or acute fractures, allow 6-12 weeks to permit ligaments and bones to heal.

Drawbacks of an orthotic: 1- Discomfort 2- Local pain 3- Osteopenia 4-Skin breakdown 5- Nerve compression 6-Ingrown facial hair for men 7-Muscle atrophy with prolonged use 8-Decreased pulmonary capacity 9-Increased energy expenditure with ambulation 10- Difficulty donning and doffing orthosis 11- Difficulty with transfers 12-Psychological and physical dependency

Drawbacks of an orthotic: 13- Increased segmental motion at ends of the orthosis 14-Unsightly appearance 15-Poor patient compliance

Orthosis success leading to : 1- Decreased pain 2- Increased strength 3- Improved function 4- Increased proprioception 5- Improved posture 6- Correction of spinal curve deformity 7- Protection against spinal instability 8- Minimized complications 9- Healing of ligaments and bones

Maintenance of orthosis : Orthosis should be simple &durable as possible. Patient should be taught for: Cleaning the leather. Oiling the joints. Wash the orthosis if possible

BIOMECHANICAL PRINCIPLES : 1) Three Point Pressure 2) Mechanical Advantage 3) Torque 4) Degree and Duration of Stress 5) Repetitive stress 6) Control Normal force across the joint 7) Control Axial Force across the joint 8) Control line of action of Ground reaction force

Orthosis design: : 1-Static Splint 2-Serial Static Splint 3-Drop out Splint 4-Dynamic Splint 5-Static Progressive Splint

Static Splint : For stabilization and protection joint in particular position.

2- Serial Static Splint This type of orthosis helps in regaining movement reducing pain with not over stressing the tissue.

3- Drop out Splint This type of splint blocks one movement and enhance other

4-Dynamic splint: For mobility and enchasing function.

5- Static Progressive Splints Stress and tension adjustment and movement enchasing splint. Used nowadays to avoid splint complication.

LL orthosis Spinal orthosis UL orthosis Ankle-foot orthosis Knee-ankle foot orthosis Hip-Knee-ankle foot orthosis Reciprocal Gait orthosis AFO KAFO HKAFO RGO Foot orthosis Knee orthosis Hip orthosis LL orthosis FO KO HO Cervical-Thoracic orthosis Cervical-Thoracolumbosacral orthosis Thoracolumbosacral orthosis Lumbosacral orthosis CTO CTLSO TLSO LSO Cervical orthosis Thoracic orthosis Sacral orthosis Sacroiliac orthosis Spinal orthosis CO TO SO SIO Wrist-Hand orthosis Elbow-Wrist-Hand orthosis Shoulder-Elbow orthosis Shoulder-Elbow-Wrist-Hand orthosis WHO EWHO SEO SEWHO Hand orthosis Wrist orthosis Elbow orthosis Shoulder orthosis UL orthosis HdO WO EO

I-Shoulder 1- FIGURE OF EIGHT AXILLA WRAP -common name: Axilla Wraps, clavicle strap brace Objectives: -To retract the scapulae -To apply pressure to the axilla to prevent or correct hypertrophic scar. -To maintain and restore shoulder mobility -To stretch contracted tissue around anterior chest -To prevent and correct Kyphotic Posture.

I-Shoulder 1- FIGURE OF EIGHT AXILLA WRAP Indication: 1.) Axilla Burns or skin grafting 2.) Shoulder Adduction Contracture 3.) Kyphotic Posture 4.) Clavicle Fracture

2.) Lateral Trunk Based Static Shoulder- Elbow-Wrist Orthosis Common Name: Shoulder/Gunslinger Splint Objectives: 1) To fully immobilize the shoulder and sometimes Elbow to promote healing 2) The elbow and wrist are immobilize to maintain full control on shoulder. Indications: 1) In Posterior Glenohumeral Instability. 2) Partial Brachial Plexus injury and brachial neuritis 3) Rotator cuff repair

3- AIRPLANE SPLINT Common Name: Axilla/ Airplane splint/Conformer Objectives: 1) To elevate hand and prevent edema 2) To prevent and reduce an axilla contracture 3) To maintain and restore Shoulder Mobility 4) To immobilize upper extremity after skin grafting 5) To apply pressure to prevent or reduce hypertrophic scaring Indication: 1) Brachial plexus injury 2) Shoulder Adduction Contractures 3) Complete supraspinatus tear 4) Axilla burns or skin grafting

4) Static Shoulder Elbow Wrist Sling Common Name: Hemi arm sling Objectives: 1) To immobilize Shoulder and Elbow 2) To support the weight of the upper extremity across the contralateral shoulder, without stress on neck and back 3) To prevent Brachial Plexus Traction 4) To prevent pain and shoulder subluxation Indication: 1) Shoulder subluxation caused by flaccid hemiplegia 2) Brachial plexus injury 3) Rotator Cuff injury 4) Upper Extremity Trauma 5) Shoulder surgery

5) Circumferential Nonarticular Humerus- Stabilizing Orthosis Common Name: Humeral Fracture/ Function Brace/ Sarmiento Brace Objectives: To stabilize Fracture to promote healing without immobilizing any joint Indications: Humeral Shaft Fracture