Ann Marie is a 36 year old working mother of 2 daughters. She
is also an accomplished guitarist and loved to play guitar every
Sunday at her church.
On February 16, 1997, while ice skating with her daughters,
Ann’s life was about to have a minor setback. She had fallen
backwards while exiting the ice rink and suffered a left distal
radius and ulnar fracture. She had ORIF surgery requiring
3 pins and had her arm in a full cast to immobilize the fracture.
On March 25th, 1997 (approximately 5 weeks later) the cast
was removed and Ann began occupational therapy with a static
splint 3 times a week, working on ROM at wrist and elbow extension/flexion,
supination and pronation. The surgical pins were removed in
April and more aggressive occupational therapy began. Elbow
AROM was restored to almost 170° extension, but supination
was still lacking ROM, which meant she couldn’t play her beloved
guitar! In June, 1997, Ann was referred to Frank Caruso by
a Philadelphia area Novacare outpatient Rehab. The occupational
therapist wanted to increase Ann’s supination and requested
an evaluation for an Ultraflex® system, which he had seen
demonstrated at an inservice at his facility. He was concerned
that Ann’s functional goals had not been met and that her
therapy time was ending, due to insurance constraints.
Frank Caruso’s evaluation took place in June, and between
that, the doctor’s X-rays (that determined no bony block)
and the OT’s input, it was determined that Ann’s loss of ROM
was due to adverse soft tissue healing caused from surgery
and immobilization, which also lead to secondary muscle weakness.
Ann was then casted for a custom molded Ultraflex EWHO to
increase supination ROM, using Ultraflex’s supination traction/resistance
Initial evaluation showed Ann’s PROM at 28° and AROM
at 20° of supination/pronation. The orthosis was fitted
on July 2, 1997 and measurements showed that PROM was 28°
and AROM was 18°.
Ann was discharged from occupational therapy and was put on
a self-therapy protocol using the Ultraflex® EWHO. She
was started on a 10 ratchet resistance setting towards supination
and placed on the following schedule to establish compliance:
First 3 days...1-2 hours
Second 3 days...3-4 hours
Third 3 days 5-6 hours
Fourth 3 days....7-1O hours
Ann was then re-evaluated in 2 weeks to check on wearing
tolerance, motion increase/decrease, and any problems with
the fit of the orthosis. She was tolerating the orthosis well,
with no fitting or skin pressure problems. She was not wearing
the orthosis at night. However, she was wearing it during
the day at work. Because she was right-handed, Ann was able
to file, write, answer phones and perform various other office
duties, while her left hand received continuous Ultraflex
therapy. Her boss was very supportive and Ann felt she could
be more productive and at the same time do her therapy! She
was re-evaluated on July 16, 1997 and her supination PROM
was 35°, an increase of 7° and AROM was 35°, an
increase of 17°.
Frank decided to keep wearing time the same, but increase
tension to a 15 ratchet setting. Ann was very encouraged and
was happy with her initial gain.
She was next seen on July 30, 1997. Ann was delighted! PROM
and AROM showed 90° full motion symmetry! She was able
to play the guitar again, since supination is a necessary
function for playing. Even though the OT helped bring back
most ot her everyday function, it was important for Ann to
gain back the necessary supination/pronation to be able to
do the things most important to her life goals!