Optimizing Elbow Rehabilitation: A Guide to Selecting and Using the Right Braces

Summary of Elbow Rehabilitation and Bracing

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Abstract

• The elbow joint, critical for hand movement relative to the body, has a complex structure prone to stiffness, especially when immobilized after trauma. Early mobilization is essential in post-traumatic scenarios, with a focus on protecting ligamentous structures during movement. Rehabilitation includes using elbow braces, which are selected based on the clinical situation and intended rehabilitation goals. These braces vary in type, offering different levels of protection, movement restriction, and dynamic or static movement. However, the success of using braces in rehabilitation largely depends on patient compliance.

Keywords: brace, elbow, rehabilitation, stiffness, trauma

Introduction

• The elbow facilitates various hand movements due to its complex interaction of muscles, soft tissues, and neuromotor control. It enables flexion-extension (adjusting limb length) and pronation-supination (rotating the palm). Immobilization post-injury or surgery can adversely affect these tissues and functions, necessitating early rehabilitation. This process should align with the healing phases, focusing on pain and swelling control, range of motion recovery, and regaining muscle flexibility and neuromuscular control.

Classification of Elbow Braces

Since elbow braces are used for different clinical situations and objectives, there exist several different types.

According to Jacobs , braces can have fixed protection or locked articulation, allow an adjustable ROM to restrict flexion-extension and pronation-supination, or allow dynamic and static progressive movement .

Furthermore, braces can be customized or ready-made. In the past the most commonly used materials for customized braces were metal alloys.

Currently, thermoplastic materials (polyethylene or polypropylene) are the ones mainly used, in thicknesses ranging from 2 to 5 mm according to the required stiffness and strength.

Braces manufactured with this type of material can be combined with straps or with unhinged, locked or progressively adjustable mechanical joints.

Splint tuners are mostly made of metal and serve to lock elbow flexion-extension at a set level.

The simplest ready-made braces are splints made of cardboard or cork which are fixed in place with elastic bands.

Cork braces, because of the flexibility of this material, allow small movements of the elbow and are therefore preferable in order to avoid excessive immobilization.

Ready-made braces mostly consist of an aluminum frame, which can be combined with a joint, padding and straps.

The joint may be the unrestrained or “ROM-type”, i.e. with a knob or Allen key for manual adjustment of the ROM.

The most commonly used paddings are silicone or neoprene; they help to avoid sores which would occur with direct contact between the limb and metal frame.

Conclusion

• Elbow braces are crucial in the rehabilitation process following acute injury or surgical intervention. They aid in reducing venous stasis and regional pain syndrome, allowing safe movement within a ROM. The effective use of braces in conservative treatment and post-surgical rehabilitation is vital, though challenges include cost, physician involvement in patient education, and patient adherence to the treatment protocol.

In conclusion, the rehabilitation of the elbow joint is a multifaceted process that integrates early mobilization, protection of ligaments, and the use of specially designed braces. The type and effectiveness of braces depend on the individual's condition and their commitment to the rehabilitation program.