Evidence for orthotic treatment of the upper limb

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Shoulder orthoses

Meta-Analyses

Dong, W., Goost, H., Lin, X.B., Burger, C., Paul, C., Wang, Z.L., Zhang, T.Y., Jiang, Z.C., Welle, K. and Kabir, K., 2015. Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis.
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Ghai, S., Driller, M. and Ghai, I., 2017. Effects of joint stabilizers on proprioception and stability: A systematic review and meta-analysis.
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Gutiérrez-Espinoza, H., Araya-Quintanilla, F., Cereceda-Muriel, C., Álvarez-Bueno, C., Martínez-Vizcaíno, V. and Cavero-Redondo, I., 2019. Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: A systematic review and meta-analysis. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine, 41, p.34.
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Systematic Reviews

da Silva, J.L.G.F., Gonçalves, S.M.B., da Silva, H.H.P. and da Silva, M.P.T., 2024. Three-dimensional printed exoskeletons and orthoses for the upper limb—a systematic review. Prosthetics and Orthotics International, 48(5), pp.590-602.
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Healy, A., Farmer, S., Pandyan, A. and Chockalingam, N., 2018. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PloS one, 13(3), p.e0192094.
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Higo, A., Palmer, S., Liaghat, B., Tallis, J., Silvester, L. and Pearce, G., 2024. The effectiveness of conservative interventions on pain, function, and quality of life in adults with hypermobile Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorders and shoulder symptoms: A systematic review. Archives of Rehabilitation Research and Clinical Translation, p.100360.
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Jordan, R.W., Saithna, A., Old, J. and MacDonald, P., 2015. Does external rotation bracing for anterior shoulder dislocation actually result in reduction of the labrum? A systematic review. The American journal of sports medicine, 43(9), p.2328.
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Peters, J.A., Zwerver, J., Diercks, R.L., Elferink-Gemser, M.T. and van den Akker-Scheek, I., 2016. Preventive interventions for tendinopathy: A systematic review. Journal of science and medicine in sport, 19(3), p.205.
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Interventional Studies

Chan, S.K., Bentick, K.R., Kuiper, J.H. and Kelly, C.P., 2018. External rotation bracing for first-time anterior dislocation of the shoulder: A discontinued randomised controlled trial comparing external rotation bracing with conventional sling. Shoulder & Elbow, p.1758573218768521.
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Haarman, C.J., Hekman, E.E., van der Kooij, H. and Rietman, J.S., 2024. Evaluating the clinical effects of a dynamic shoulder orthosis. Prosthetics and orthotics international, 48(4), pp.455-465.
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Observational Studies

Baker, H.P., Tjong, V.K., Dunne, K.F., Lindley, T.R. and Terry, M.A., 2016. Evaluation of shoulder-stabilizing braces: Can we prevent shoulder labrum injury in collegiate offensive linemen?. Orthopaedic Journal of Sports Medicine, 4(12).
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Elbow orthoses

Systematic Reviews

Barati, H., Rezaie, M.R., Shariaty, S., Sadra, S. and Rahimi, Z., 2019. The Effect of Orthoses on Treatment of Lateral Epicondylitis: a Systematic review. Journal of Rehabilitation Sciences & Research, 6(2), pp.51-59.
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da Silva, J.L.G.F., Gonçalves, S.M.B., da Silva, H.H.P. and da Silva, M.P.T., 2024. Three-dimensional printed exoskeletons and orthoses for the upper limb—a systematic review. Prosthetics and Orthotics International, 48(5), pp.590-602.
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Healy, A., Farmer, S., Pandyan, A. and Chockalingam, N., 2018. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PloS one, 13(3), p.e0192094.
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Peters, J.A., Zwerver, J., Diercks, R.L., Elferink-Gemser, M.T. and van den Akker-Scheek, I., 2016. Preventive interventions for tendinopathy: A systematic review. Journal of science and medicine in sport, 19(3), p.205.
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Sutton, D., Gross, D.P., Côté, P., Randhawa, K., Yu, H., Wong, J.J., Stern, P., Varatharajan, S., Southerst, D., Shearer, H.M. and Stupar, M., 2016. Multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Chiropractic & manual therapies, 24(1), p.8.
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Veltman, E.S., Doornberg, J.N., Eygendaal, D. and van den Bekerom, M.P., 2015. Static progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients. Archives of orthopaedic and trauma surgery, 135(5), p.613.
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Interventional Studies

Barati, H., Zarezadeh, A., MacDermid, J.C. and Sadeghi-Demneh, E., 2019. The immediate sensorimotor effects of elbow orthoses in patients with lateral elbow tendinopathy: a prospective crossover study. Journal of shoulder and elbow surgery, 28(1), pp.e10-e17.
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Kroslak, M., Pirapakaran, K. and Murrell, G.A., 2019. Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. Journal of shoulder and elbow surgery, 28(2), pp.288-295.
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Nowotny, J., El-Zayat, B., Goronzy, J., Biewener, A., Bausenhart, F., Greiner, S. and Kasten, P., 2018. Prospective randomized controlled trial in the treatment of lateral epicondylitis with a new dynamic wrist orthosis. European journal of medical research, 23(1), p.43.
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Observational Studies

Manocha, R., Johnson, J. and King, G., 2019. The Effectiveness of a Hinged Elbow Orthosis in Medial Collateral Ligament Injuries: An In Vitro Biomechanical Study. The American Journal of Sports Medicine, 47(12), pp.2827-2835.
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Saremi, H., Chamani, V. and Vahab-Kashani, R., 2016. A newly designed tennis elbow orthosis with a traditional tennis elbow strap in patients with lateral epicondylitis. Trauma monthly, 21(3).
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Wrist hand orthoses / Wrist orthoses

Meta-Analyses

Cavaleri, R., Schabrun, S.M., Te, M. and Chipchase, L.S., 2016. Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: A systematic review and meta-analysis.
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Systematic Reviews

Cantero-Téllez, R., Naughton, N., Algar, L. and Valdes, K., 2018. Linking hand therapy outcome measures used after carpal tunnel release to the International Classification of Functioning, Disability and Health: A systematic review. Journal of hand therapy: official journal of the American Society of Hand Therapists.
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Healy, A., Farmer, S., Pandyan, A. and Chockalingam, N., 2018. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PloS one, 13(3), p.e0192094.
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Lue, S., Koppikar, S., Shaikh, K., Mahendira, D. and Towheed, T.E., 2017. Systematic review of non-surgical therapies for osteoarthritis of the hand: an update. Osteoarthritis and cartilage, 25(9), p.1379.
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Roll, S.C. and Hardison, M.E., 2017. Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand: A Systematic Review. The American Journal of Occupational Therapy, 71(1), p.7101180010p1.
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Samargandi, O.A., Alyouha, S., Larouche, P., Corkum, J.P., Kemler, M.A. and Tang, D.T., 2017. Night orthosis after surgical correction of dupuytren contractures: a systematic review. The Journal of hand surgery, 42(10), pp.839-e1.
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Sutton, D., Gross, D.P., Côté, P., Randhawa, K., Yu, H., Wong, J.J., Stern, P., Varatharajan, S., Southerst, D., Shearer, H.M. and Stupar, M., 2016. Multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Chiropractic & manual therapies, 24(1), p.8.
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Valdes, K., Boyd, J.D., Povlak, S.B. and Szelwach, M.A., 2018. Efficacy of orthotic devices for increased active proximal interphalangeal extension joint range of motion: A systematic review. Journal of hand therapy: official journal of the American Society of Hand Therapists.
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Wong, A.L., Wilson, M., Girnary, S., Nojoomi, M., Acharya, S. and Paul, S.M., 2017. The optimal orthosis and motion protocol for extensor tendon injury in zones IV–VIII: A systematic review. Journal of hand therapy: official journal of the American Society of Hand Therapists, 30(4), p.447.
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Interventional Studies

AKKAN, H., ARIK, M.I., KORKMAZ, M., KABAY, S.C. and GÖKPINAR, H.H., 2024. The Effects of Orthosis and Exercise on The Median Nerve Morphology and Functional Status of Patients with Carpal Tunnel Syndrome: A Randomized Pilot Study.
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de Carvalho Silva, F., da Silva, R.V.T., Meireles, S.M., Fernandes, A.D.R.C. and Natour, J., 2024. Daytime Functional Usage Versus Night-Time Wearing: Identifying the Optimal Wearing Regimen for a Custom-Made Orthosis in the Treatment of Trapeziometacarpal Osteoarthritis. Archives of Physical Medicine and Rehabilitation, 105(10), pp.1837-1845.
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de Carvalho Silva, F., da Silva, R.V.T., Meireles, S.M., Fernandes, A.D.R.C. and Natour, J., 2024. Daytime Functional Usage Versus Night-Time Wearing: Identifying the Optimal Wearing Regimen for a Custom-Made Orthosis in the Treatment of Trapeziometacarpal Osteoarthritis. Archives of Physical Medicine and Rehabilitation, 105(10), pp.1837-1845.
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de Moraes, V.Y., Queiroz Jr, J., Raduan-Neto, J., Fernandes, M., Okamura, A. and Belloti, J.C., 2021. Nonsurgical treatment for symptomatic carpal tunnel syndrome: a randomized clinical trial comparing local corticosteroid injection versus night orthosis. The Journal of Hand Surgery, 46(4), pp.295-300.
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Kaufman-Cohen, Y., Levanon, Y., Friedman, J., Yaniv, Y. and Portnoy, S., 2021. Home exercise in the dart-throwing motion plane after distal radius fractures: A pilot randomized controlled trial.
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Nowotny, J., El-Zayat, B., Goronzy, J., Biewener, A., Bausenhart, F., Greiner, S. and Kasten, P., 2018. Prospective randomized controlled trial in the treatment of lateral epicondylitis with a new dynamic wrist orthosis. European Journal of Medical Research, 23.
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Pisano, K., Wolfe, T., Lubahn, J. and Cooney, T., 2023. Effect of a stabilization exercise program versus standard treatment for thumb carpometacarpal osteoarthritis: A randomized trial. Journal of Hand Therapy, 36(3), pp.546-559.
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Susanne, L. and Lisbeth, C., 2024. Wrist Stabilising Exercise Versus Hand Orthotic Intervention for Persons with Hypermobility–A Randomised Clinical Trial. Clinical Rehabilitation, p.02692155241293265.
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Observational Studies

Valdes, K., Naughton, N. and Szelwach, M.A., 2021. Patient satisfaction with the CMC controller: A cohort study. Journal of Hand Therapy, 34(1), pp.53-57.
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Case Series / Case Studies

Johnson, C., Swanson, M. and Manolopoulos, K., 2021. Treatment of a zone III extensor tendon injury using a single relative motion with dorsal hood orthosis and a modified short arc motion protocol—A case report. Journal of Hand Therapy, 34(1), pp.135-141.
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Finger orthoses

Systematic Reviews

Healy, A., Farmer, S., Pandyan, A. and Chockalingam, N., 2018. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PloS one, 13(3), p.e0192094.
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Lunsford, D., Valdes, K. and Hengy, S., 2017. Conservative management of trigger finger: A systematic review. Journal of hand therapy: official journal of the American Society of Hand Therapists.
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Pompeu, Y., Aristega Almeida, B., Kunze, K., Altman, E. and Fufa, D., 2021. Current Concepts in the Management of Advanced Trigger Finger. JBJS Reviews, 9(9).
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Soreide, E., Murad, M.H., Denbeigh, J.M., Lewallen, E.A., Dudakovic, A., Nordsletten, L., van Wijnen, A.J. and Kakar, S., 2018. Treatment of Dupuytren's contracture. The bone & joint journal, 100(9), p.1138.
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Valdes, K., Boyd, J.D., Povlak, S.B. and Szelwach, M.A., 2018. Efficacy of orthotic devices for increased active proximal interphalangeal extension joint range of motion: A systematic review. Journal of hand therapy: official journal of the American Society of Hand Therapists.
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Valdes, K., Naughton, N. and Algar, L., 2015. Conservative treatment of mallet finger: A systematic review. Journal of hand therapy: official journal of the American Society of Hand Therapists, 28(3), p.237.
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Valdes, K., Naughton, N. and Algar, L., 2016. ICF components of outcome measures for mallet finger: A systematic review. Journal of hand therapy: official journal of the American Society of Hand Therapists, 29(4), p.388.
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Young, N., Terrington, N., Francis, D. and Robinson, L.S., 2018. Orthotic management of fixed flexion deformity of the proximal interphalangeal joint following traumatic injury: A systematic review. Hong Kong journal of Occupational Therapy: HKJOT, 31(1), p.3.
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Interventional Studies

Algar, L., Backe, H., Richer, R., Andruskiwec, S., Zalenski, P., Lengyel, A. and Svogun, C., 2023. Prospective Randomized Clinical Trial Comparing 3-Point Prefabricated Orthosis and Elastic Tape Versus Cast Immobilization for the Nonsurgical Management of Mallet Finger. The Journal of Hand Surgery, 48(9), pp.951-e1.
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Avery, J.C. and Richards, L.G., 2021. Comparison of Trigger Finger Orthotic Wearing Schedules: A Feasibility Study. Physical & Occupational Therapy In Geriatrics, 39(2), pp.182-205.
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Grange, M., Carra, K., Barrett, S. and McKinstry, C., 2024. Management of stable proximal interphalangeal joint volar plate injuries with figure-of-8 orthoses: A parallel-group randomized controlled trial. Journal of Hand Therapy.
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Grange, M., Carra, K., Barrett, S. and McKinstry, C., 2024. Management of stable proximal interphalangeal joint volar plate injuries with figure-of-8 orthoses: A parallel-group randomized controlled trial. Journal of Hand Therapy.
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Hirth, M.J., Hunt, I., Briody, K., Milner, Z., Sleep, K., Chu, A., Donovan, E. and O'Brien, L., 2023. Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: a randomized equivalence trial. Journal of Hand Therapy, 36(2), pp.347-362.
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Teo, S.H., Ng, D.C.L. and Wong, Y.K.Y., 2018. Effectiveness of proximal interphalangeal joint-blocking orthosis vs metacarpophalangeal joint-blocking orthosis in trigger digit management: A randomized clinical trial. Journal of hand therapy: official journal of the American Society of Hand Therapists.
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Yendi, B., Atilgan, E., Namaldi, S. and Kuru, C.A., 2024. Treatment of trigger finger with metacarpophalangeal joint blocking orthosis vs relative motion extension orthosis: A randomized clinical trial. Journal of Hand Therapy.
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Observational Studies

Arslan, Ö.B., Şahin, Y., Sığırtmaç, İ.C., Yildiz, B., Ayhan, E. and Öksüz, Ç., 2023. Use of relative motion orthoses from the perspective of hand-injured patients: A qualitative study. Journal of Hand Therapy, 36(2), pp.425-432.
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Merritt, W., 2023. The relative motion concept in acute and chronic boutonniere deformity: Invited commentary. Journal of Hand Therapy, 36(2), pp.258-268.
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Papatolicas, K.A., Clingin, J.E. and Nicks, R.J., 2024. Dorsal blocking orthoses for proximal interphalangeal joint volar plate injuries: A retrospective cohort study investigating the impact of joint angle on patient outcomes. Journal of Hand Therapy.
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Saito, K. and Kihara, H., 2020. A Trial of the Effect of 2-Step Orthosis Treatment for Mallet Finger Fractures. Journal of Sport Rehabilitation, 30(2), pp.315-319.
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Narrative Literature Reviews

Currie, K.B., Tadisina, K.K. and Mackinnon, S.E., 2022. Common hand conditions: a review. Jama, 327(24), pp.2434-2445.
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Thumb orthoses

Meta-Analyses

Ahern, M., Skyllas, J., Wajon, A. and Hush, J., 2018. The effectiveness of physical therapies for patients with base of thumb osteoarthritis: Systematic review and meta-analysis.
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Baradaran, A., Baradaran, A., Ebrahimzadeh, M.H., Kachooei, A.R., Rivlin, M. and Beredjiklian, P., 2018. Comparison of Custom-made Versus Prefabricated Thumb Splinting for Carpometacarpal Arthrosis: A Systematic Review and Meta-analysis. The archives of bone and joint surgery, 6(6), p.478.
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Buhler, M., Chapple, C.M., Stebbings, S., Sangelaji, B. and David, B.G., 2018. Effectiveness of splinting for pain and function in people with thumb carpometacarpal osteoarthritis: a systematic review with meta-analysis. Osteoarthritis and cartilage.
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Marotta, N., Demeco, A., Marinaro, C., Moggio, L., Pino, I., Barletta, M., Petraroli, A. and Ammendolia, A., 2021. Comparative effectiveness of orthoses for thumb osteoarthritis: a systematic review and network meta-analysis. Archives of Physical Medicine and Rehabilitation, 102(3), pp.502-509.
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Systematic Reviews

Healy, A., Farmer, S., Pandyan, A. and Chockalingam, N., 2018. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PloS one, 13(3), p.e0192094.
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Meireles, S.M., Jones, A. and Natour, J., 2018, July. Orthosis for rhizarthrosis: A systematic review and meta-analysis. In Seminars in arthritis and rheumatism.
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Spaans, A.J., Van Minnen, L.P., Kon, M., Schuurman, A.H., Schreuders, A.T. and Vermeulen, G.M., 2015. Conservative treatment of thumb base osteoarthritis: a systematic review. The Journal of hand surgery, 40(1), pp.16-21.
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Observational Studies

Gabriel, C., Barbier, O., David, M., Manon, J., Detrembleur, C. and Libouton, X., 2022. Effect of splint on pain, function and quality of life in trapeziometacarpal osteoarthritis patients. Acta Orthopaedica Belgica, 88(1), pp.179-85.
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Hoogendam, L., van der Oest, M.J., Wouters, R.M., Andrinopoulou, E.R., Vermeulen, G.M., Slijper, H.P., Porsius, J.T., Selles, R.W. and Hand-Wrist Study Group, 2021. Patients with higher treatment outcome expectations are more satisfied with the results of nonoperative treatment for thumb base osteoarthritis: a cohort study. Archives of Physical Medicine and Rehabilitation, 102(8), pp.1533-1540.
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Tsehaie, J., Spekreijse, K.R., Wouters, R.M., Feitz, R., Hovius, S.E.R., Slijper, H.P., Selles, R.W. and Hand-Wrist Study Group, 2019. Predicting Outcome After Hand Orthosis and Hand Therapy for Thumb Carpometacarpal Osteoarthritis: A Prospective Study. Archives of physical medicine and rehabilitation, 100(5), p.844.
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Narrative Literature Reviews

Currie, K.B., Tadisina, K.K. and Mackinnon, S.E., 2022. Common hand conditions: a review. Jama, 327(24), pp.2434-2445.
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Editorial Information

Last reviewed: 01/12/2024

Next review date: 01/12/2025

Approved By: British Association of Prosthetists and Orthotists (BAPO)

Reviewer name(s): Laura Barr, British Association of Prosthetists and Orthotists (BAPO) Professional Affairs Committee.