American Society for Peripheral Nerve

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Stollery External Rotation Abduction Thermoplastic Shoulder Orthosis
Tania C Buchanan, BScOT, MHS1; Jaret L. Olson, MD2; Kathleen O'Grady, BScOT3
1Stollery Children's Hospital, Edmonton, AB, Canada, 2Division of Plastic Surgery, University of Alberta, Edmonton, AB, Canada, 3Occupational Therapy, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada

Introduction:The most common obstetrical brachial plexus injury pattern is the upper trunk, which can result in significant shoulder and elbow dysfunction.After primary nerve surgery involving nerve grafting, and/or nerve transfers, infants are typically placed in a sling and swath with the shoulder internally rotated and adducted.This position reinforces muscle imbalance of strong internal rotators and weak external rotators.However, positioning the shoulder in external rotation and abduction allows for secondary releases and soft tissue lengthening for infants with fixed contractures at the time of their primary nerve surgery, while not placing any additional stress on the grafted or transferred nerves.This paper outlines the fabrication of the External Rotation Abduction Thermoplastic Shoulder Orthosis (SERATSO), which ideally positions the arm for primary nerve transfers and grafts surgeries and secondary procedures.
Method: The SERATSO is easily modified for the two different applications by changing the position of the infant/child in sitting/standing, the position of the arm in molding, and the attachment of the arm/body piece to the body component.Orthosis wearing schedule for primary nerve repairs is continuously for 3 weeks and for secondary procedures continuously for 6 weeks, followed by 6 weeks at night.Material costs range from $150 to $180 and requires 2 hours for therapist and 3 hours for the assistant for fabrication, intra-operative fitting, and post-operative check.
Results:From 2008 to 2015, the SERATSO design has been used in 28 secondary procedures such as Hofer, L’episcopo and/or pectoralis releases. The children have ranged from 3.5 to 8 years of age with two outliers at 14 and 15 years of age.Since 2013, this design was also used 12 times for primary nerve transfers and grafts for infants ranging from 9 to 11 months in age.Splint compliance has been 100 percent.There have been no orthosis failures.Prefabricating the orthosis decreases the time an infant or child is anaesthetized and in a surgical suite.The SERATSO design requires minimal dressing, allows for visual inspection, and better accommodates an infant or child’s abdomen while sitting or standing.Prefabrication ensures desired post-op positioning of arm.For secondary procedures, the orthosis can be removed for skin inspection, hygiene, exercises, and weaned from use.
Conclusion:This robust orthosis design has withstood many children participating in functional activities and play.Parents appreciate the durable design, the ability to remove orthosis for skin care, and the customized aesthetic decorations.


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