Elbow stiffness and choosing effective orthotic bracing
Many surgical and non-surgical treatment options exist for patients with a stiff and typically flexed (contracted) elbow. These include custom made and “off-the-shelf” bracing options.
There are in fact many reasons why an elbow orthosis may be used and therefore many goals for applying an elbow orthosis. Selection of the correct orthosis should be guided by a trained orthotist or other healthcare professional who understands the issues. In this note we are thinking primarily about a situation where a correctable elbow flexion contracture exists.
An elbow orthosis can be made to increase the elbow range of motion by static or so-called dynamic means.
In order to achieve this it is necessary, one way or another to apply a corrective force.
A static brace is one which will need adjustment at intervals as the tissues of the arm relax due to the corrective effect.
A dynamic type of brace should in theory continue to apply a corrective stretch even as the tissues relax and the elbow gradually extends over time.
It is not easy to find objective evidence to support a particular approach although every practitioner will have plenty of anecdotal and “rule of thumb” guidance to bring to the table.
Factors that dictate the “best choice” of approach include -
How the orthosis interfaces with the tissues - can it apply the necessary force and remain comfortable? If it is not tolerable it is likely that the brace will be rejected.
What is the duration of application going to be? Is it a few hours each day or 24 hours a day?
How easy is the elbow orthosis to get on and off? Does the brace design cause discomfort by pinching or impinging on the tissues? Does the brace cause damage to clothing?
Who will need to make adjustments and how often?
The answers to these questions are influenced strongly by the nature of the individual case and it is hard to generalise.
Some orthotists may suggest a custom orthosis as the best choiuce and indeed this should offer a comfortable fit but does not guarantee that.
We have many clinicians who will choose an off-the shelf design to have something which is effective without the delays involved in waiting for a custom brace to be made. Elbow contractures can progress rapidly and can take a long time to deal with. As with many things in health care, prevention is better than cure.
The Anatomical Concepts range of elbow orthoses consist of the three designs that have proved popular in practice.
the 1250 EMO orthosis - offers static progressive stretching and infinite range of motion positioning over a full range of motion
the 1350 E-ROM orthosis - offers bi-directional stretching and infinite range of motion positioning over a full range of motion
the 1300 QUAD orthosis - offers a dynamic, ratchet style stretch and infinite range of motion positioning over a full range of motion
All three designs are exceptional comfortable to use due to the single, dorsal strut and wrap around liner system. The design avoids the tissue impingement often caused by other designs that have a medially placed strut.
Further details of the 1250 EMO, the 1350 E-ROM and the 1300 QUAD can be found in the orthotic section of this site.
Derek Jones PhD MBA