1. Upper Limb Orthoses
Orthoses of the upper limb range from shoulder including slings and rigid orthoses to wrist and elbow orthoses
The orthoses which are used for a relatively short period of time are known as splints
They are classified w.r.t primary function as assistive, substitutive ,protective and corrective orthoses
Assistive or substitutive orthoses are used for the patients with paralysis, the device augments residual motor power or substitutes mechanical joint motion and is also used for stabilization for absent anatomical function

2. Upper Limb Orthoses
Protective orthoses shield the affected joint from the likelihood of developing contractures as in the case of or reduce painful motion as in the case of arthritis
Corrective orthoses are used to increase joint range of motion in the case of dermal or capsular contracture

3. Assistive orthoses
Of all assistive orthoses the basic opponens orthoses earlier called as the short opponens splint is the simplest
It has a thumb pad attached to the palmar surfaces between the index and the middle fingers assisting the patient to use residual motor power to achieve palmar prehension

4. Assistive orthoses
The forearm bar may be attached to the basic opponens orthosis to create basic opponens orthosis with wrist control also know as long opponens splint
The forearm bar may be attached to the dorsal, palmar ,ulnar or radial aspect of wrist and forearm.
It maintains the wrist in a fixed position preventing the hand from dropping into palmar flexion

5. Assistive orthoses
Another addition to basic opponens orthosis is metacarpophanlangeal extension stop
This is sometimes called as the lumbrical bar is secured to the palmar bar and applies palmward force to proximal phalanges to resist metacarpophanlangeal hyperextension
This type of device protects the hand from forming claw hand deformity also aids prehension
Claw hand deformity-(an abnormal condition of the hand characterized by extreme flexion of the middle and distal phalanges and hyperextension of the metacarpophalangeal joints. It is caused by atrophy of the interosseous muscles.)

6. Assistive orthoses
Another assistive orthosis is the wrist flexion orthosis often called as the cook-up splint
It consist of a palmar hand bar and a palmar forearm bar with straps to secure the orthosis to the limb
This orthosis prevents the wrist from dropping into palmar flexion seen in radial neuropathy
It is also used to protect wrist from repetitive motion strain as experienced by the keyboard operators

7. Substitutive Orthoses
Prehension orthoses are an e.g. of substitutive orthoses
These are generally useful for patients with tetraplegia
They enable the user to grasp, hold or release objects voluntarily

8. Substitutive Orthoses
The wrist driven WHO has a hinged linkage between the forearm and the finger stabilizers
When the patient extends the wrist the linkage causes the finger stabilizers to approach the thumb thus enabling the grasp
The user must maintain active extension in order to retain the held object
Release of the object occurs when the user allows the wrist extensors to relax ,allowing the wrist to flex passively

9. Substitutive Orthoses
Most of the wrist driven orthoses have a mechanism that help the user to adjust the grasp according to the size of the object
For lifting a paper the wearer would adjust the mechanism so that a small arc of wrist motion achieved finger closure ,for lifting a thicker object the mechanism is adjusted so that the same arc of motion achieved wider closure

10. Substitutive Orthoses
Utensil Holder: It will consist of a clip or a elastic webbing along the circumference of the palm
The palmar side has a slim leather pocket ,in which one may place a pen, spoon or any other object of appropriate size
It is also called as a universal cuff
The orthoses may have a forearm bar to prevent unwanted wrist motion and keep the wrist in a stable functional position
For grasping the object must be inserted in the pocket by the patient either by holding the object in his teeth and placing it in the pocket or an attendant can place the object in the pocket

11. Protective Orthoses
The wrist-hand stabilizer orthosis also termed a resting splint, is a sheet of semi-rigid plastic placed on palmar surface of the hand and forearm.
The sheet extends from the distal tips of the fingers to the middle third of the forearm and is curved to support the palmar arch and cradle the forearm.
Straps secure the plastic to the hand and forearm. Some stabilizers include a thumb component to prevent motion of that digit.
The stabilizer is widely used by patients with exacerbation of rheumatoid arthritis and those with burns who are vulnerable to flexion contractures.

12. Protective Orthoses
A thumb stabilizer prevents movement of the first interphalangeal joint.
The orthosis consists of a longitudinal bar along the length of the thumb with stabilizing straps or a sleeve on the thumb and a strap around the hand.

13. Protective Orthoses
A finger stabilizer is used for the patient with boutonniere deformity, which is persistent flexion of the proximal interphalangeal joint.
Two bands that apply dorsally directed forces to the proximal and middle phalanges oppose the force.

14. Corrective orthosis
Corrective orthosis: apply a low, constant force with approximate counter forces to reduce contracture.
Such appliances are usually factory-made but can also be custom made. The patient who has a flat hand with extension contractures of the metacarpophalangeal joints may be fitted with a finger flexion HO
It has dorsally located plate over the metacarpals and another plate over the proximal phalanges linked to a palmar rod
Springs or rubber bands apply tensile force to the orthosis

15. Corrective orthosis
The finger extension orthosis also called reverse knuckle bender, has an opposite force system, namely a palmary located bar linked to two dorsal bars. Rubber bands or strings exert tension.
Versions of these corrective orthoses are available to correct extension and flexion deformities of the interphalangeal joints.
Neuromuscular electrical stimulation to forearm musculature ,combined with a corrective WHO, reduces spasticity in children with cerebral palsy.

16. Elbow orthoses
The elbow orthoses used for reducing soft tissue contractures must be custom made or custom fabricated with structural plastic bands and total contact plastic cuffs and straps
These are used to reduce elbow extension and flexion contractures
The need to reduce extension and flexion of the elbow joint can result due to trauma or disease or for immobilization after a surgery

17. Shoulder elbow orthoses
Used for support of painful shoulder or traumatized brachial plexus injury
For short term use a conventional arm sling is provided ,for long term use a sling offers very little function
A gunslinger orthosis is used in which the patients arm is strapped to a forearm trough which is mechanically coupled to a plastic hemi-girdle anchored to the patients pelvis
The coupling helps to prevent external, internal rotation as well as flexion & extension of the elbow joint

18. Shoulder elbow wrist orthoses
These orthoses are used to protect the soft tissues or to protect contractures of soft tissue. Sometimes they are used to correct a existing deformity
The sewo’s which are used to promote healing or relieve pain are used custom made with selected structural and biomechanical components. the hardware is adjustable so that a few sizes will fit all
This device helps in transferring the weight of the upper limb to the pelvis. The device is stabilized with the help of trunk straps

19. Shoulder Abduction Orthosis
Shoulder Abduction Orthosis (Harvey Airplane Splint)
Description: Frame design with thoracic and arm sections attached to adjustable shoulder joint; Also has adjustable elbow joint
Function: Limit shoulder flexion/extension; Horizontal flexion/extension; Abduction; Usually set to allow free elbow range of motion
Indication: Primarily for post-operative use (i.e. rotator cuff reconstruction)