Author(s): Michael Isaiah Morgan, Khushboo Gupta, Megan Clark, MD
Originally published: December 21, 2022 Last updated: November 20, 2025
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Overview and Description

Terminology: An orthosis is an externally applied device used to modify structural and functional characteristics of the neuromuscular skeletal system, as defined by the International Standards Organization of the International Society for Prosthetics and Orthotics.1 The term orthotics refers to the science and practice of patient assessment, fabrication, fit, and adjustment of an orthosis.

An orthosis or orthotic device is applied to the body to modify or control skeletal structure or function. A basic principle for limb orthoses is the use of three points of pressure to perform at least one of the following functions: 1) stabilize or immobilize a body part; 2) improve alignment; 3) prevent deformities; 4) protect against injury; 5) assist with motion; 6) offload a joint or body part; or 7) improve function. Orthoses are named for the joints/segments they act upon, according to the International Organization for Standardization (ISO) and are classified based on action (e.g., static versus dynamic).

Other useful terminology to consider includes understanding the differences between custom versus off-the-shelf orthoses as well as dynamic versus static orthoses. “Off-the-shelf” orthoses are prefabricated, mass-manufactured orthotic devices that are available in various designs, sizes, and materials and require minimal adjustments. Custom-fabricated orthoses refer to those made specifically for individual patients. Meanwhile, custom-fitted orthoses include devices that are already fabricated and are adjusted by a therapist to fit a patient by trimming, molding, or bending the orthosis.

A static orthosis allows no motion at the involved joint or segment. A dynamic or articulated orthosis permits motion across the joint, and often incorporates strings, springs, pulleys, or other mechanical additions to promote function. A tone-reducing orthosis inhibits reflexes and provide prolonged stretch to decrease tone.2 A static progressive orthosis is a type of adjustable tone-reducing orthosis that applies force to a joint and holds it in its end range position to improve passive joint range of motion.3 In acute injury, orthoses are used to maintain range of motion, prevent contractures, manage pain, protect damaged or weakened soft tissue, or provide immobilization. Chronic orthosis use aims to prevent or control unwanted motion, enhance desired motion, decrease abnormal tone, alleviate pain, or maximize function. These interventions apply to all phases of a rehabilitation plan and depend on the patient’s level of impairment.

Some medical conditions that may warrant the use of upper limb orthoses may include trauma, stroke, brain injury, spinal cord injury, multiple sclerosis, cerebral palsy, peripheral nerve injury, peripheral neuropathy, arthritic conditions, burns, hypotonia, hypermobility, neuromuscular disorders, and contracture management in both pediatric and adult populations.

Common complications that can be seen with orthotic management include pressure injuries or skin breakdown, infection, and pain. Thus, it is essential that special attention is given to examine the skin, neurological function, vascular status, and musculoskeletal system in patients who will be using an orthosis, and that orthoses are regularly adjusted to maintain optimal fit and function. It is essential to educate patients and their family members about these potential issues and how to recognize early signs to prevent progression.

Relevance to Clinical Practice

Upper limb orthoses

Upper limb orthoses differ in scope and purpose from lower extremity orthoses due to the functional difference between fine motor control in the upper extremity and gross motor control and weight-bearing in the lower extremity.3 Along the same lines, the upper extremity has less soft tissue, decreased force requirements, increased sensory requirements, and more precision of movement compared to the lower extremity.1 Upper limb orthoses often focus on achieving a functional range of motion rather than a normal range of motion. While the examples listed here represent commonly utilized orthoses, this list is not exhaustive. Recent innovations such as 3D-printed custom devices, soft robotic gloves and sensor-integrated orthoses are expanding options.

Thumb, Finger, and Hand Orthoses

  • Thumb and finger orthoses are often utilized to stabilize bony and soft tissue structures as well as prevent contracture.
  • Hand orthoses are commonly used for intrinsic hand musculature weakness or paralysis with intact wrist extensors.3
Type of OrthosisActionGoals/Indications
Static finger orthosisInhibit motion at the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of a fingerPromote healing (e.g., phalanx fracture) and prevent flexion contracture (e.g., burns)
Proximal interphalangeal orthosisDecrease exaggerated displacement of PIP jointPrevent contracture formation (e.g., blocking excessive PIP flexion in Boutonniere deformity or obstructing PIP hyperextension in swan neck deformity)
Metacarpophalangeal extension stop orthosisStop metacarpophalangeal (MCP) joint hyperextension with lumbrical bar while allowing MCP flexionSupport transverse arch weakness, prevent claw hand deformity, maintain functional hand position
Thumb interphalangeal (IP) orthosisMaintain neutral position of thumb IP jointSupport weak extensor pollicis longus
Short opponens orthosisImmobilize the first MCP and reduce movement of the carpometacarpal (CMC) joint while allowing wrist movementProtect and promote healing (e.g., ulnar collateral ligament injury) as well as decrease pain and provide thumb stability
Long opponens orthosis (e.g., thumb spica)Immobilize the first MCP and CMC joints and often crosses the wrist joint to restrict wrist and thumb movementProvide stability, promote healing, decrease pain (e.g. arthritis of the wrist and thumb, De Quervain’s tenosynovitis)

Wrist-Hand Orthoses (WHOs)

  • Static resting WHOs preserve wrist and hand architecture generally by positioning the wrist and hand in functional alignment, including wrist in neutral to slight extension, MCPs partially flexed, and thumb abducted.
  • A frequent functional focus for WHOs involves facilitating prehension, or the ability to hold or grasp. An example of this concept includes dynamic WHOs that protect and assist weak wrist extensors by transferring power from active wrist extension into finger flexion through tenodesis.
  • Dynamic dorsal WHOs for radial nerve injuries position the hand with wrist in extension.3
Type of OrthosisActionGoals/Indications
Thenar web space stabilizer orthosis (e.g., C-bar orthosis)Maintains the thumb web space and functional position of the handPrevent web space contractures and increase the ability to perform functional tasks with thumb in abducted position
Wrist cock up orthosisStabilizes functional position of the wrist and hand while allowing MCP flexionDecrease pain, provide stability and function, protect structures from excessive movement to promote healing (e.g., carpal tunnel syndrome, arthritis, radial neuropathy)
Wrist-driven prehension orthosisFacilitate finger flexion through active wrist extensionPromote prehension through tenodesis action (e.g., cervical spinal cord injury, commonly C6 or C7)3

Elbow Orthoses (EOs)

  • EOs, including elbow immobilizers, can address functional limitations caused by soft tissue contractures at the elbow.
  • EOs are used after surgery or trauma for limb stabilization instead of casting. These can be static or dynamic.
  • Functionally, dynamic EOs are commonly used for assistance with elbow flexion in patients with weak elbow flexors. They can also assist in elbow extension.3
  • Static elbow-wrist-hand orthoses (EWHOs) are used for fractures such as those involving the radius/olecranon and distal humerus.

Shoulder-Elbow Orthoses (SEO)

  • SEOs support the shoulder to reduce pain and/or provide position due to muscle weakness, e.g., brachial plexus injuries or shoulder subluxation after stroke.
  • A mobile arm support SEO (MAS-SEO) is used in severe arm paralysis to improve limb function through assisting shoulder and elbow motion by supporting the weight of the arm and reducing the effects of gravity. These devices are commonly used in a seated position (often in a wheelchair).3

Shoulder-Elbow-Wrist Orthoses (SEWO)

  • SEWOs are used post-operatively in rotator cuff and anterior-posterior capsular repairs to relieve tension on the deltoid and rotator cuff. SEWOs externally rotate the glenohumeral joint and stretch the shoulder internal rotators while protecting soft tissue and preventing contractures.3

Other Upper Limb Orthoses

  • Typically, tone reduction orthoses are used to reduce flexor tone in patients with significant spasticity. One example is a Bobath finger spreader orthosis that uses digit abduction to decrease finger flexor tone
  • A balanced forearm orthosis (BFO) is a type of shoulder-elbow-wrist-hand orthosis (SEWHO) that supports the weight of the arm, allowing for gravity-eliminated movement of the arm in a transverse plane. This type of orthosis is often utilized for self-feeding, for example, by facilitating horizontal arm movement like elbow flexion and extension in a patient with high cervical spinal cord injury.  
  • A dynamic movement orthosis (DMO) glove provides compression and enhanced sensory input to allow guided movement, which can be useful for orthotic management of dystonia.
  • A universal cuff serves to hold task-specific items, such as a razor or utensil. Similarly, upper limb orthoses can incorporate a variety of task-specific attachments to aid in directed activities, such as writing, grooming, or any number of other functional tasks.3

Cutting Edge/Unique Concepts/Emerging Issues

Functional electric stimulation (FES) devices are used as an alternative or adjunct to traditional orthoses. These devices generate an electrical current that stimulates a muscle, causing muscle contraction in a predictable movement pattern to create physiological bracing. This concept has been applied for the upper limb to improve wrist extension as well as to prevent shoulder subluxation.4 Recent systematic reviews and meta-analyses have reported an improvement in upper limb motor function, grip strength, and functional task performance after stroke with the use of FES. These can further be reinforced with supporting methods like occupation therapy. Moreover, studies report BCI-FES combined therapy produces the best clinical outcomes.5,6

Advances in materials, 3D printing, and robotic exoskeletons are providing new options for patients in a variety of applications. 3D-printed orthotics can enhance gait parameters, functional performance, fit, comfort, and effectiveness, compared to conventional methods7. Smart orthotic devices with wearable sensors have been around, but recent advances in sensor miniaturization, real-time monitoring of joint and muscle activity, and AI-personalization have drastically improved patient engagement drastically.8 Exoskeleton-assisted upper limb rehabilitation after stroke has shown significant benefit in improving function and quality of life 9. Robotic therapy is also being evaluated in other applications, such as post-SCI. However, limitations such as small sample sizes, lack of standardized assessment methods, and durability concerns still exist. Thus, the application of these modern advancements has been limited to date, and their future study is warranted. The incorporation of sensors that provide real-time information has enabled the increased efficacy of active orthoses for tremor suppression.10 Step counters, accelerometers, pressure sensors, and temperature sensors can all be used to provide objective data to supplement user reports in evaluating effectiveness and compliance for a variety of applications.

Gaps in Knowledge/Evidence Base

The use of static progressive orthoses for the treatment of upper limb joint stiffness or contractures due to an orthopedic cause shows benefits in increased active range of motion, increased grip strength, and reduced need for pain medications during orthotic intervention.11

Despite controversies, orthoses that allow patients to use their paretic limb for functional tasks and a broader range of rehabilitative interventions generally result in improved limb function and improved quality of life. Patients rely on orthotic intervention as a cost-effective and less invasive means to manage common medical conditions, such as wrist bracing for carpal tunnel syndrome.

The cost of orthotic devices varies based on complexity, materials used, and fabrication process. To optimize both patient care and utilization of health care resources, it is paramount to have an in-depth knowledge of the patient’s deficits, as well as an understanding of the environmental and personal factors that will influence a patient’s orthoses use. Typical barriers to device utilization include its appearance, weight, and ability to don and doff the orthoses.1 Incorrectly prescribed orthoses may lead to functional impairment and biomechanical derangement, which cause medical complications. To limit these obstacles, a team including orthotists, therapists, and physicians must work in concert to maximize patient benefit.

Currently, there is no single, standardized classification system for upper limb orthotics. A review identified twelve separate classification systems with different aims; however, the expert panel found none of these systems helpful in informing clinician decisions about the appropriate choices of orthosis for their patients 12. Existing classification systems do not properly account for all varieties of orthotics currently available and must therefore be updated and revised. Historically, orthotics have been described and classified using eponyms, acronyms, anatomical sites, purpose, material, and sometimes in combination. The standardization of a single, universally accepted classification system, along with consistent terminology regarding upper limb orthotics, can help guide future studies and inform selection guidelines.

References

  1. Cifu DX. Upper Limb Orthotic Devices. In: Braddom’s Physical Medicine and Rehabilitation. 6th ed. Elsevier; 2020. Accessed August 30, 2022. https://www.sciencedirect.com/book/9780323625395/braddoms-physical-medicine-and-rehabilitation
  2. Cuccurullo S. Prosthetics and Orthotics. In: Physical Medicine and Rehabilitation Board Review. 4th ed. DemosMedical; 2020. Accessed August 30, 2022. https://connect.springerpub.com/content/book/978-0-8261-3457-8/
  3. Webster JB, Murphy DP. Atlas of Orthoses and Assistive Devices. 5th ed. Elsevier; 2019. Accessed August 30, 2022. https://www.sciencedirect.com/book/9780323483230/atlas-of-orthoses-and-assistive-devices
  4. Vafadar AK, Côté JN, Archambault PS. Effectiveness of functional electrical stimulation in improving clinical outcomes in the upper arm following stroke: a systematic review and meta-analysis. Biomed Res Int. 2015;2015:729768. doi:10.1155/2015/729768
  5. Zhang X, Zhang Y, Zhang L, et al. A systematic review on functional electrical stimulation-based rehabilitation systems for upper limb stroke recovery. Front Neurol. 2023;14:1272992. doi:10.3389/fneur.2023.1272992
  6. Zhang Y, Gao Y, Zhou J, Zhang Z, Feng M, Liu Y. Advances in brain-computer interface controlled functional electrical stimulation for upper limb recovery after stroke. Brain Research Bulletin. 2025;226:111354. Accessed September 23, 2025. https://www.sciencedirect.com/science/article/pii/S0361923025001662
  7. Atallah H, Qufabz T, Bakhsh HR, Ferriero G. The current state of 3D-printed orthoses clinical outcomes: a systematic review. BMC Musculoskelet Disord. 2025;26(1):822. doi:10.1186/s12891-025-09070-4
  8. Moroni RC, Majewska K. Innovations in Orthotic Devices: Additive Manufacturing, Auxetic Materials and Smart Sensors for Enhanced Rehabilitation. Appl. Sci. 2025;15(18):10167. doi:10.3390/app151810167
  9. Akgün İ, Demirbüken İ, Timurtaş E, et al. Exoskeleton-assisted upper limb rehabilitation after stroke: a randomized controlled trial. Neurol Res. 2024;46(11):1074-1082. doi:10.1080/01616412.2024.2381385
  10. Nguyen HS, Luu TP. Tremor-Suppression Orthoses for the Upper Limb: Current Developments and Future Challenges. Front Hum Neurosci. 2021;15:622535. doi:10.3389/fnhum.2021.622535
  11. Costa CR, McElroy MJ, Johnson AJ, Lamm BM, Mont MA. Use of a static progressive stretch orthosis to treat post-traumatic ankle stiffness. BMC Res Notes. 2012;5:348. doi:10.1186/1756-0500-5-348
  12. Do current upper limb orthotic classification systems help clinicians choose and design effective orthoses? A scoping review with expert interviews – Journal of Hand Therapy. Accessed September 22, 2025. https://www.jhandtherapy.org/article/S0894-1130(23)00071-6/abstract

Original Version of the Topic

Marlis Gonzalez-Fernandez, MD, PhD, David Taftian, MD, Mark Hopkins, PT, CPO. Upper and lower limb orthoses and therapeutic footwear. 9/20/2014

Previous Revision(s) of the Topic

Mi Ran Shin, MD, Olga Morozova, MD, Jeffery Rubin, DO. Upper and lower limb orthoses and therapeutic footwear. 2/26/2019

Mi Ran Shin, MD, MPH, Annie Abraham, MD, Olga Morozova, MD. Upper Limb Orthotics. 12/21/2022

Author Disclosure

Michael Isaiah Morgan
Nothing to Disclose

Khushboo Gupta
Nothing to Disclose

Megan Clark, MD
Nothing to Disclose