Study guide
10.2 Spinal & Upper Extremity Orthoses
ABPMR Physical Medicine and Rehabilitation Board Exam Study Guide Exam
Track your progress as you read
Finished sections get a check mark.
1 Chapter 1: Introduction & Exam Overview
1.1 ABPMR Part I Exam Overview & Format 1.2 Board Review Strategy & Content Blueprint Breakdown
2 Chapter 2: Musculoskeletal Medicine
2.1 Shoulder & Upper Extremity Diagnostics 2.2 Knee, Hip & Lower Extremity Conditions 2.3 Spine Pathology, Radiculopathy & Myelopathy 2.4 Inflammatory Arthritis, Tendinopathies & Concussion 2.5 Bone Health, Osteoporosis & Metabolic Bone Disease 2.6 Thoracic Outlet Syndrome & Peripheral Nerve Entrapment 2.7 Fracture Rehabilitation & Immobilization Complications 2.8 Overuse Tendinopathies & Regenerative Medicine 2.9 Gait Analysis & Abnormal Gait Patterns
3 Chapter 3: Spinal Cord Injury Rehabilitation
3.1 ASIA Examination & Impairment Scale 3.2 Spinal Cord Injury Syndromes 3.3 Autonomic Dysreflexia & Acute Complications 3.4 Neurogenic Bladder, Bowel & Secondary Complications
4 Chapter 4: Stroke & Neuromuscular Rehabilitation
4.1 Stroke Vascular Syndromes & Acute Assessment 4.2 Stroke Motor Recovery & Hemiplegic Complications 4.3 Spasticity Assessment & Multimodal Management 4.4 ALS, GBS, CIDP & Neuromuscular Disease Rehab 4.5 Multiple Sclerosis & Demyelinating Disease Rehabilitation 4.6 Parkinsonism, Movement Disorders & Functional Neurologic Disorder
5 Chapter 5: Electrodiagnostics (EMG/NCS)
5.1 Nerve Conduction Studies Principles & Physics 5.2 Needle Electromyography & MUAP Analysis 5.3 Mononeuropathies & Radiculopathy Patterns 5.4 Neuromuscular Junction Disorders & Myopathies
6 Chapter 6: Traumatic Brain Injury
6.1 TBI Severity Classification, Glasgow Coma Scale, and Pathophysiology 6.2 Rancho Los Amigos Levels of Cognitive Functioning and Disability Rating Scale 6.3 Neurobehavioral Sequelae and Agitation Management 6.4 Concussion Evaluation, Vestibular-Ocular Dysfunction, and Return-to-Play/Work Protocols
7 Chapter 7: Chronic Pain & Interventional Spine
7.1 Fluoroscopic Spine Interventions 7.2 Opioid Stewardship & Controlled Substance Compliance 7.3 Complex Regional Pain Syndrome, Fibromyalgia & Myofascial Pain 7.4 Spinal Cord Stimulation & Intrathecal Therapy
8 Chapter 8: Amputee Rehabilitation & Prosthetics
8.1 Amputation Surgical Levels & Medicare K-Levels 8.2 Socket Designs & Suspension Systems 8.3 Prosthetic Feet & Microprocessor Knee Mechanisms 8.4 Post-Amputation Care, Residual Limb & Phantom Pain
9 Chapter 9: Pediatric Rehabilitation
9.1 Cerebral Palsy Classification & GMFCS 9.2 Spina Bifida & Myelomeningocele Management 9.3 Muscular Dystrophies & Neuromuscular Disease in Children 9.4 Pediatric Brachial Plexopathy & Congenital Disorders
10 Chapter 10: Prosthetics, Orthotics & Assistive Technology
10.1 Lower Limb Orthoses — AFOs & KAFOs 10.2 Spinal & Upper Extremity Orthoses 10.3 Upper Limb Prosthetics — Body-Powered vs Myoelectric 10.4 Wheelchairs, Seating Systems & Pressure Mapping
11 Chapter 11: Medical Rehabilitation & Outcomes
11.1 Dysphagia Assessment & Management 11.2 Neurogenic Bladder & Bowel Management 11.3 Pressure Injuries & Wound Management 11.4 Outcome Measures & Medical Complications 11.5 Cancer Rehabilitation & Oncologic Rehabilitation 11.6 Burns, Endocrine/Metabolic & Medical Complications Rehabilitation
12 Chapter 12: Cardiopulmonary Rehabilitation
12.1 Cardiac Rehabilitation Phases & Metabolic Equivalents 12.2 Pulmonary Rehabilitation & COPD Management
13 Chapter 13: Foundational Rehabilitation Concepts
13.1 Kinesiology, Biomechanics & Functional Anatomy 13.2 Rehabilitation Pharmacology & Medication Management 13.3 Research Methodology, Biostatistics & Evidence-Based Practice 13.4 Nutrition, Metabolism & Energy Expenditure in Rehabilitation 13.5 Diagnostic Procedures: Imaging, MSK Ultrasound, Urodynamics & Neuropsych Assessment
10.2 Spinal & Upper Extremity Orthoses
Key Takeaways Explain This Topic AI
Boston TLSO is indicated for scoliosis curves with an apex at or below T7, whereas Milwaukee CTLSO with a neck ring is required for apex above T7.
Jewett and CASH hyperextension TLSOs utilize a three-point bending system to restrict sagittal flexion in uncomplicated anterior column compression fractures (T10-L2).
Halo vest orthoses provide gold-standard maximal cervical immobilization (~90-95%), whereas SOMI orthoses excel at controlling upper cervical flexion (C1-C3) in supine patients.
Resting hand splints position the upper extremity in the functional intrinsic-plus alignment, while radial nerve splints provide dynamic MCP extension assist for wrist drop.
Last updated: July 2026
Spinal & Upper Extremity Orthoses
Spinal orthoses and upper extremity splints are designed to restrict undesirable motion, offload traumatized axial or appendicular structures, stabilize musculoskeletal alignment, and enhance functional capacity. In physical medicine and rehabilitation, prescribing these orthoses requires balancing rigid motion restriction against the physiological risks of muscle atrophy, joint contracture, pressure skin breakdown, and patient non-compliance.
Spinal Orthoses: Scoliosis and Thoracolumbar Trauma
Spinal orthoses are designated according to the anatomical regions they encompass: Cervical (CO), Cervicothoracic (CTO), Thoracolumbosacral (TLSO), and Cervicothoracolumbosacral (CTLSO) orthoses. Their primary biomechanical mechanisms include three-point bending forces, fluid compression of abdominal tissues to offload axial spinal loads, and kinetic motion restriction.
Scoliosis Orthoses
Orthotic management of Adolescent Idiopathic Scoliosis (AIS) aims to halt curve progression during periods of rapid skeletal growth. Orthoses are indicated for progressive scoliotic curves between 25° and 40° Cobb angle in skeletally immature patients (Risser stage 0 to 2).
Boston TLSO : A custom-molded, rigid thermoplastic thoracolumbosacral orthosis featuring internal corrective pads that exert three-point pressure forces combined with relief voids opposite the curve apex.
Indication : Scoliotic curves with an apex at or below the seventh thoracic vertebra (T7).
Wear Protocol : Prescribed for 18 to 23 hours per day until skeletal maturity is reached (Risser stage 4-5 or post-menarche).
Milwaukee CTLSO : Incorporates a molded pelvic girdle connected by vertical metal uprights to a neck ring with occipital and throat pads.
Indication : High thoracic scoliotic curves with an apex above T7, or kyphotic deformities (Scheuermann's kyphosis). The neck ring provides the superior three-point bending force necessary to control high thoracic curves that a standard TLSO cannot reach.
Charleston Night Bender & Providence Orthosis : Hypercorrective nocturnal orthoses designed to be worn exclusively while supine (8 to 10 hours overnight).
Indication : Single thoracolumbar or flexible lumbar scoliotic curves. The Charleston brace applies aggressive lateral bending forces that overcorrect the spinal curve past neutral, which is tolerated only because the patient is unweighted in the supine position.
Thoracolumbar Spinal Trauma & Compression Fractures
Post-traumatic orthotic management of the thoracolumbar spine depends on fracture stability and the anatomical column involvement (Denis three-column classification).
Jewett & CASH (Cruciform Anterior Spinal Hyperextension) TLSO : Lightweight, open-frame orthoses utilizing a three-point pressure system comprising two anterior pads (one sternal pad, one pubic pad) exerting posterior force, and one posterior pad (thoracolumbar pad) exerting anterior force.
Biomechanical Function : Restricts anterior spinal flexion while maintaining the thoracolumbar spine in hyperextension.
Clinical Indication : Uncomplicated anterior column compression fractures of the thoracolumbar junction (T10 to L2) without posterior element or middle column disruption.
Contraindication : Unstable burst fractures, three-column injuries, or pedicle/facet fractures, as hyperextension forces can worsen posterior displacement.
Rigid Custom-Molded TLSO (Bivalve / Total Contact Jacket) : Solid plastic shell fabricated from custom body scans or cast impressions.
Biomechanical Function : Provides total circumferential contact, compressing abdominal contents to decrease axial spinal loading by ~30%, while strictly immobilizing motion across sagittal, frontal, and transverse planes.
Clinical Indication : Unstable thoracolumbar fractures, burst fractures, post-operative spinal fusion stabilization, and multi-level traumatic spinal injuries.
- Orthosis Type Anatomical Region Planes Controlled Primary Clinical Indication Special Considerations
- Boston TLSO Thoracolumbar (below T7) Sagittal & Frontal Scoliosis curve apex T7 or lower Worn 18-23 hours/day
Milwaukee CTLSO Cervicothoracolumbar Sagittal, Frontal, Rotational Scoliosis apex above T7, Scheuermann Features neck ring with throat pad
Jewett / CASH Thoracolumbar Sagittal Flexion Anterior compression fx (T10-L2) Contraindicated in burst fractures
Custom TLSO Jacket Thoracolumbar Sagittal, Frontal, Transverse Burst fractures, post-op fusion High skin breakdown monitoring
- Cervical Orthoses & Upper Extremity Splints
- Cervical Spine Orthoses
The cervical spine is the most mobile spinal segment, requiring progressive structural rigidity based on clinical instability.
Halo Vest : Gold standard for maximal cervical spine immobilization. Consists of a rigid metal cranial ring fastened to the outer table of the skull via four threaded pins (two anterior pins placed 1 cm superior to the lateral third of the eyebrows; two posterior pins placed 180° opposite), attached via four upright bars to a padded fiberglass body vest.
Motion Restriction : Restricts ~90-95% of cervical spine flexion, extension, lateral bending, and rotation.
Indications : Unstable upper cervical spine fractures (C1 ring fractures, unstable C2 hangman's fractures, type II/III odontoid fractures) and post-traumatic cervical dislocations.
SOMI (Sterno-Occipito-Mandibular Immobilizer) : Rigid orthosis featuring a chest plate extending upwards to occipital and mandibular supports.
Biomechanical Strength : Superior to all other non-invasive orthoses in restricting cervical flexion in the upper cervical spine (C1-C3) .
Special Advantage : Can be easily donned and doffed while the patient remains supine, making it ideal for bedridden trauma patients.
Philadelphia & Aspen Collars : Semi-rigid foam collars with plastic anterior and posterior reinforcement shells.
Motion Restriction : Limits ~40-50% of flexion-extension; provides minimal control over cervical rotation or lateral bending.
Indications : Post-operative soft tissue healing, stable cervical strain, and step-down immobilization.
Upper Extremity Splints
Upper extremity orthoses are classified as static (immobilizing) or dynamic (applying force to permit/assist motion).
Resting Hand Splint (Functional Hand Splint) : A static splint that positions the upper extremity in the "intrinsic-plus" or functional position:
Joint Positioning : Wrist in 20-30° extension, metacarpophalangeal (MCP) joints in 60-70° flexion, proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in 0-15° extension (slight flexion), and thumb in palmar abduction/opposition.
Indications : Preventing flexion contractures in spastic upper limb stroke/TBI, resting acute hand trauma, and managing active rheumatoid arthritis flares.
Radial Nerve Splint (Dynamic Extension Splint / Cock-Up Extension Splint) :
Biomechanical Design : Holds the wrist in ~30° extension while incorporating rubber bands or dynamic outriggers that passively pull the MCP joints into extension while permitting active finger flexion.
Indication : Acute radial nerve palsy ("wrist drop"), allowing functional object grasp and release while preventing extensor tendon overstretching.