Splint in the Spotlight – Orthoses to Prevent Full Forearm Rotation: The Muenster Orthosis and the Sugar Tong Orthosis

Splint-in-the-Spotlight-700x199

Our Orfit blog shares information and instructions in matching our thermoplastic materials to orthotic designs.
Please check back frequently to gain inspiration and ideas in orthotic fabrication for all of your 
patient’s needs.

Splint Design: Orthoses to Prevent Full Forearm Rotation

Muenster Orthosis

Objectives of these Splints

The Muenster and Sugar Tong Orthosis are two useful orthoses indicated to prevent full forearm pronation and supination. Both help to position the forearm in a neutral position so that healing of injured structures can occur.

Pathology

After trauma and/or surgery of the radius, ulna, Distal Radial-Ulnar joint (DRUJ), proximal radial-ulnar joint and/or TFCC structures, and/or for certain elbow pathologies, it may be important to prevent full active forearm rotation so that the injured tissues and structures can heal without overstretching or shortening of tissue length. Patients with injuries such as TFCC tears, Galeazzi fracture dislocations, DRUJ fractures and dislocations, and ulnar abutment injuries are typically treated with a cast, a Sugar Tong orthosis or the Muenster orthosis to immobilize the forearm.

The Muenster and Sugar Tong orthoses allow for limited active flexion and extension of the elbow, but prevent full forearm rotation, and provide stabilization of the radial-ulnar joint and immobilization of the DRUJ.

The Sugar Tong orthosis is a long thermoplastic rectangle positioned from the dorsal metacarpal heads around the posterior elbow capturing the medial and lateral epicondyles, to the volar palm.

The Sugar Tong orthosis is a long thermoplastic rectangle positioned from the dorsal metacarpal heads around the posterior elbow capturing the medial and lateral epicondyles, to the volar palm.

The Muenster orthosis is a wrist orthosis with long proximal extensions to converge on the medial and lateral epicondyles at the distal humerus.

The Muenster orthosis is a wrist orthosis with long proximal extensions to converge on the medial and lateral epicondyles at the distal humerus.

A study of the degree to which these orthoses actually limit forearm motion indicated that while the Sugar Tong orthosis is more effective at preventing forearm pronation than the Muenster orthosis, neither orthosis completely limits full forearm rotation (Slaughter et al, 2010). Participants in the study received sensory feedback that they were reaching limitations in forearm range of motion, but were still able to rotate through the forearm arc of motion. However, these participants had no forearm pathologies. Patients experiencing painful forearm motion would be instructed to limit full rotation of their forearm: pain, swelling and post- operative bandages would further limit motion.

Product recommendations

  • Muenster Orthosis:  An elastic based coated material is highly recommended for the Muenster Orthosis. Orfit NS, Aquafit NS (Orfit Natural NS) and Orfit Colors NS in 3.2mm (1/8”) all work very well for this design. The non-stick coating of these products allows the fabricator the ability to pinch the thermoplastic material together at the posterior elbow and on the ulnar border, allowing both hands to position the wrist in slight extension and the forearm in the a neutral posture. A more rigid material can also be used: see product recommendations for the Sugar Tong Orthosis.
  • Sugar Tong Orthosis: This orthosis is best made from a long rectangular strip of a more rigid material: OrfibraceOrfit Eco, or Orfit Eco Black NS in 3.2 mm (1/8″) are recommended. The materials that we recommend for the Muenster Orthosis would also work well for the Sugar Tong Orthosis..

The patient should be standing or seated with the elbow flexed to 90° and the forearm positioned in neutral to fabricate these orthoses. You will need full access to the posterior elbow, epicondyles and wrist for best fabrication technique.

Wearing schedule

These orthoses should be worn full time immediately after surgery of the involved structures. The patient would be instructed in gentle elbow range of motion exercises.

Questions?

If you have a question or comment, please post it in the Orfit Splinting & Rehabilitation Group on Facebook, or send an email to welcome@orfit.com.

We've selected some similar articles for you

Splint in the Spotlight – Radial Paralysis: a progressive orthosis

Our Orfit blog shares information and instructions in matching our thermoplastic materials to orthotic designs. Please check back frequently to gain inspiration and ideas in orthotic fabrication for all of your patient’s needs. Radial Paralysis – a progressive orthosis The radial nerve innervates the…
Read more

Splint in the Spotlight – Comfortable and lightweight orthoses with Orfilight materials

When patients are required to wear their orthoses for long duration during day and night, it is always helpful to consider the size of the patient’s extremity, the specifics of the diagnosis and the weight of the selected material for the orthosis. Orfit offers Orfilight, an extremely lightweight material that might be appropriate for many of your patients, regardless of the specific diagnosis.
Read more

Splint in the Spotlight – Dart Thrower’s Motion Orthosis (also known as the Dart Splint)

The Dart Thrower’s Motion Splint allows for guided motion in the plane known as “dart thrower’s motion”, an oblique motion of the wrist that is incorporated during most of our activities of daily living. The motion consists of radial deviation and extension (called radial extension) towards ulnar deviation and flexion (called ulnar flexion).
Read more