gms | German Medical Science

Clinical issue/s: A complication of work or sports injuries of the elbow is joint stiffness with subsequent limited active and passive range of motion (ROM). The elbow joint is a critical link between the upper arm and the forearm and contributes to the positioning of the hand for activities of daily living. Even minimal limitations in active and/ or passive range of elbow motion can impact a patient's ability to function.

Clinical reasoning: Mobilization orthoses are used by therapists in conjunction with other interventions to help patients regain motion in stiff joints. These orthoses apply force to the stiff joint via elastic or non-elastic components. The force holds the stiff joint at its end-range position to allow for new cell formation and improved tissue length, thus allowing increased motion. The client is instructed to increase the force as the joint and/ or tissue accommodates to a new end-range position over time. In this manner, mobilization orthoses permit progressive changes in tissue length.

Innovative, analytical or new approach: This literature review examines the current levels of evidence supporting the use of dynamic and/ or static progressive orthoses for clients with limitations in elbow ROM. It also offers relevant information on the benefits of these orthoses, types of diagnoses to be treated, wearing schedules, the outcomes affected and the recommended duration of orthotic use.

Contribution to advancing HT practice: It is suggested that clinicians utilize evidence-based therapeutic interventions supported by the most up-to-date published research. This requires clinicians to seek out the highest level of studies to support their clinical decisions, and also to incorporate their clinical expertise and their patient's values and judgement into the process. While reviewing the evidence presented, it is critical to consider how each individual patient might match the subjects detailed in the specific study, and whether the client will agree to the suggested schedule of orthotic wear that is described.