4.

4
 Orthosis & Prothesis
V. Hip-Knee-Ankle-Foot-Orthosis (HKAFO)
• When Is a Hip-Knee-Ankle-Foot Orthosis Indicated?
There is much less evidence available in the
clinical research literature to guide prescription
and selection of HKAFOs than for selecting AFOS
and KAFOS.
Because HKAFOS encompass the hip, pelvis, and
sometimes the trunk, they tend to be much more
cumbersome to use, more challenging to don and
doff, more expensive to fabricate, and require
more maintenance than AFOs and KAFOS.
HKAFOS only partially restore functional mobility,
often with high energy cost.
The additional control of joint motion achieved by
moving proximally with a hip joint and pelvic band
or an attached lumbosacral orthosis must be balanced against the practical
challenges that the wearer will face when using the device.
Persons who use HKAFOS for standing and for the limited mobility that they
provide typically have much more neuromotor system impairment that those who
use AFOs and KAFOS. These orthoses are most often prescribed for children with
neurologic involvement and individuals with SCI but may also be appropriate for
those with progressive neuromuscular disorders
Hip-Knee-Ankle-foot orthosis ‫ال‬ 
‫هي كدا بتضم ايه‬
‫ بس احنا اتفقنا قبل كدا ان كل ما‬Trunk ‫ وال‬Pelvis ‫ وال‬Hip ‫ال‬ -
‫ يغطي مناطق اكتر كل اما يكون أغلى عشان هيحتاج‬orthosis ‫ال‬
‫ اكتر وفي تفاصيل اكتر‬material
‫ هتكون‬Energy Expenditure ‫وكمان هيكون اتقل وبالتالي ال‬ -
Mobility ‫أعلى وكل اما يثبت أكتر كل أما يأثر على ال‬
‫ الزيادة دا يكون جايب‬proximal stabilization ‫ف مهم جدا ال‬ -
‫ اللي بتحصل‬limitation ‫فايدة مكان ال‬
orthosis ‫الن اصال لبسه هيبقى صعب مش زي يعني اسهل نوع‬ -
‫ بس‬foot ‫اللي هو ال‬
‫ اكتر يبقى اصعب‬joints ‫وكل اما يبدأ يغطي‬ -
trunk ‫دا اصعب واحد النه اصال احيانا بيوصل لل‬HKAFO ‫ وال‬-
‫وكمان هيحتاج محافظة اكتر من البييشنت واغلى‬ -
‫ متوفرة‬indications ‫ف الزم تبقى كل ال‬ -
Ankle.foot orthosis ‫مش زي مثال ال‬ -
‫محتاجة حوارات‬ ‫الن دي استخدامها اكتر بكتير واسهل بكتير مش‬ -
2
Orthosis & Prothesis
• Hip-Knee-Ankle-Foot Orthosis Design Options
As in the case of AFOs and HKAFOs can be fabricated with many different
materials (e.g., metals, thermoplastics, carbon composites and with orthotic ankle,
knee, and hip components.
neuromotor ‫ دا بيكون عنده ال‬HKAFO ‫خلي بالك ان العيان اللي هتستعمله ال‬ -
‫ او ال‬KAFO ‫ اوحش بكتير او حالته سيئة اكتر من اللي استخدمتله‬dysfunction
AFO
neurological dysfunction ‫وبيكون اكتر استخدام ليه هو االطفال اللي عندهم‬ -
‫ بس يكون في ليڤل عالي‬spinal cord injury ‫او الناس اللي عندهم‬ -
HKAFO ‫ بتاعة ال‬Designs ‫ ال‬
KAFO ‫شبه بتاعة ال‬ -
carbon ‫ وفي برضو‬thermoplastic ‫ وال‬metal ‫يعني في كذا ماتريال زي ال‬ -
composite

A. Conventional HKAFO
Historically, during the years immediately following the po epidemic until the mid to
late 1980s, orthotists fabricated HKAFO adding a hip joint and pelvic band to
conventional KAFOS Fig illustrates the configuration of conventional HKAFOS.
These devices are designed to hold both lower extremities in a stable extended
position for upright standing, persons wearing this orthosis use either a hop-to gait
with walkers or a swing-through gait with a pair of crutches for ambulation.
Typically, HKAFOS require an assistive device to use upper extremity and trunk
compensatory mechanisms to advance the orthosis. On rare occasions, a single
HKAFO might be used for persons with neuromuscular or musculoskeletal
impairment affecting one lower extremity. Even after the incorporation of
lightweight thermoplastic or carbon composite materials, the energy cost of
ambulation with conventional HKAFOS is significant and often functionally
prohibitive.
Conventional ‫ ال‬
‫ كمان‬trunk ‫ وممكن لو هو واخد ال‬pelvic belt ‫ وال‬hip ‫ بالظبط بس زودنا عليه جزء ال‬KAFO ‫زي اللي في ال‬ -
lumbosacral orthosis ‫ زي ال‬lumbosacral part ‫يبقى فيه‬
‫ بتاعة االورثوسيز‬components ‫زي الصورة دي كدا اللي شوفناها واحنا بنشوف ال‬ -
Conventional hip knee ankle foot ‫ وبنسميه‬double part hip knee ankle foot orthosis ‫دا اسمه‬ -
"‫ "اللي صورته فوق‬orthosis
Energy expenditure ‫دا طبعا تقيل جدا عشان كم الحديد اللي فيه ودا هيأثر على ال‬ -
‫شايف هيبقى غالي وتقيل ولبسه وقلعه هيكون صعب‬ ‫ف الزم يستفيد منه اكبر افادة الن زي ما انت‬ -
3
 Orthosis & Prothesis
‫ زي دا‬single bar ‫واحد ممكن يبقى‬limb ‫ في‬neuromuscular problem ‫لو حد عنده‬ -
‫ برضو‬thermoplastic material ‫ ويبدلوه ب‬metal ‫ ويقللو ال‬Conventional ‫لما بدأو يطورو شوية في ال‬ -
AFO ‫ او ال‬KAFO ‫كان تقيل مقارنة بال‬
‫ بسرعة برضو‬fatigue ‫ بتاعته عالية ف حصل‬Energy expenditure ‫ف برضو ال‬ -
‫ اللي موجودة‬drawbacks ‫ تغطي ال‬benifits ‫عشان كدا برضو الزم ال‬ -

B. Reciprocating HKAFO
One of the most common HKAFOS uses a mechanical linkage to couple flexion of
one hip with extension of the other, which permits a reciprocal step-over-step gait.
Colloquially referred to as reciprocating gait orthoses, these HKAFOs are used for
a variety of pathologies that result in paraplegia, including spinal cord injury.
The costs and benefits need to be carefully weighed when considering whether an
orthosis that would facilitate therapeutic reciprocal
Reciprocating HKAFO ‫ ال‬
‫ لما الشخص يجي يتحرك بيه بيكون‬thermoplastic ‫ او ال‬Conventional ‫ال‬ -
walking aid ‫الزم يستعمل‬
swing through ‫ او‬swing to ‫ مع بعض سواء‬Two limbs ‫والزم يحرك ال‬ -
extension ‫ و وطرف في‬flexion ‫مينفعش يكون طرف في‬ -
‫ بيكون اغلى وكمان بيحتاج ان اللي بيستعمله يكون ال‬Reciprocating ‫ال‬ -
‫ بتاعته متطورة‬functions
‫ اللي هي الحتة اللي فوق دي‬mechanical limb ‫وبيكون فيه‬ -
extension ‫ ورجل في‬flexion ‫بتسمح للبيشنت انه يخلي رجل في‬ -

Walking would be appropriate for an individual with paralysis The individual and/or
the caregivers must clearly understand that these devices cannot fully restore the
ability to walk at what would be considered community level. They must explore and
embrace the goals of therapeutic walking enhancement of bone health,
cardiovascular conditioning, and digestive and urinary health, among others
For many individuals, gaining the motor skills necessary for safe use of the device
may require substantial time and effort, training times reported in the literature
range from 45 to 80 hours over a period of weeks to months. They must be ready
to adhere to stretching protocols to ensure sufficient range of motion at the hip,
knee, and ankle so that the device will both fit and operate optimally. They must be
prepared to work to improve muscle performance and postural control of trunk and
upper extremities so that they can use the orthosis most effectively. They must be
willing to maintain a stable weight so that the orthosis will fit over many
4
Orthosis & Prothesis
months or years. They must have the postural control necessary to (eventually) don
and doff the orthosis without substantial assistance. They must understand the
design of the orthosis and the function of its components enough to recognize
when maintenance, adjustment, or repair is necessary.
٨٠ ‫ ل‬٤٥ ‫ ويقعد‬spinal cord injury ‫ طويل زي مثال لو عنده‬training ‫وطبعا عشان الشخص يستخدمه محتاج‬ -
ROM ‫ عشان يظبط ال‬flexibility exercises ‫ساعة تدريب على مدار اسابيع او شهور وكمان التمارين دي تكون‬
spasticity ‫الن بيكون عنده‬
‫ ومحتاج يكون عنده‬Crutches ‫ تكون كويسة عشان هو هيتحرك ب‬upper limb ‫ بتاعة ال‬strength ‫وكمان الزم ال‬ -
‫ ويكون كويس‬trunk ‫ في ال‬proximal control
‫ اللي هو رجل قدام ورجل ورا‬step over step ‫ومهم جدا ان العيان عشان يقدر يتحرك يكون بيعرف يعمل‬ -
lock ‫ او‬joint ‫ لو عمل تثبيت لل‬swing to or through ‫ دا ممكن عادي يبقى‬orthotic ‫ال‬ -
‫الزم تعرف العيان انه غالي واسباب انه محتاجه وهيستفاد ايه من التمرين الطويل دا‬ -
urinary system, digestive system, cardiovascular system ‫زي انه مفيد لل‬ -
‫وتقوله ان هو مش هيتحرك طبيعي برضو زي اي حد بس هو التكلفة الزيادة عشان األهداف اللي قولناها‬ -
‫وممكن تقعد البيشنت مع ناس استعملت نفس نوع االورثوتك دا عشان يعرفو مميزاته وعيوبه‬ -
‫ ودا محتاج مجهود كبير‬trunk ‫ لشخص بيستعمل النوع دا وبيعتمد في حركته على ال‬٨ ‫الفيديو اللي في الدقيقة‬ -
‫ محترمة‬rehab ‫ عندع عالية ف محتاج‬spasticity ‫ بيكون ال‬spinal cord injury ‫ او‬paraplegia ‫اللي عندع‬ -
‫خد بالك من حركة الرجلين‬ -
‫ ف‬KAFO ‫ عند الراجل دا اصال اوحش من اللي محتاج‬function‫ لو خدت بالك هتالقيها مقفولة عشان ال‬knee ‫ وال‬-
‫ ف بتقفلهاله‬knee ‫عشان كدا مش هيعرف يتحكم في ال‬

This is quite a bit to commit to; it is often wise to have the person interested in
pursuing use of such an orthosis interact with someone else who has successfully
used one to get a clear sense of what is required and what the potential outcomes
are.
X.B: A review of the use of KAFOs and HKAFOs for ambulation found very limited
scientific evidence to guide clinical decision-making about these devices.
VI- HIP ORTHOSES
Hip orthoses (HOs) (figure 24) provide support and
control for individuals with hip disorders and after hip
surgeries. HOs can control hip
abduction-adduction, flexion-extension, and rotation
either unilaterally or bilaterally as needed.
HOs are either prefabricated or custom made to a
patient's measurements. HOs are commonly used to

5
 Orthosis & Prothesis
position the femoral head in the acetabulum to allow for healing or to prevent
further damage to the joint
Hip orthosis ‫ ال‬
acetabulum ‫ في ال‬head of femur ‫مهمتها انها بتثبت ال‬ -
hip dislocation or replacement ‫وممكن تستعملها للناس بعد ال‬ -
‫ ف الهيد ممكن تطلع‬shallow ‫ بقت‬acetabulum ‫ يعني ال‬hip dysplasia ‫او اللي عندهم‬ -
• Indications for a Hip Orthosis
1. Hip replacement (arthroplasty)
2. Hip dislocation
3. Hip dysplasia

Upper limb orthoses

Anatomy-Related Principles
Therapists treating the upper extremity must have a thorough understanding of the
complex anatomic features of the hand and upper extremity in order to effectively
manage patients with dysfunction Disturbance of the delicate relationship between
the bones, muscles, nerves, and other soft tissue structures, either by disease or
Trauma, can result in a marked interruption of normal function. Knowledge of
normal anatomic features and how pathologic conditions affect them is in
important factor in aiding therapists as they make appropriate clinical decisions
regarding treatment interventions.
Upper limb orthosis ‫ ال‬
‫ الزم يكون عارف شوية اناتومي كدا‬upper limb Orthosis ‫اي حد بيعمل‬ -
‫ اللي تحت دول‬٣ ‫ وعددهم‬creases ‫يعرف ان عندنا‬ -
‫ مش بيكون‬fixed ‫ ودا بيكون‬distal carpal row ‫ ودا اللي بيكونه ال‬proximal transvers arch ‫ في ال‬-
mobile
mobile ‫ ودا بيكون‬head of metacarpal ‫ اللي بيكون عند ال‬distal transverse arch ‫ وفي ال‬-
distal phalanges ‫لحد ال‬shaft of metacarpal ‫ ودا من اول ال‬longitudinal ‫ وفي ال‬-
‫ دي‬arches ‫ايه فايدة ال‬ -
‫ ومش هتقدر تمسك حاجة بايدك‬flat ‫ لو مش موجودة ايدك هتبقى‬fist ‫انك تقدر تعمل‬ -
‫والحاجة متزحلقش ايدك‬ -

6
Orthosis & Prothesis
➢ ARCHES OF THE HAND
The configuration of the bones in the
hand, along with the tension of the
muscles and ligaments in this region,
contributes to the creation of an arch
system composed of the proximal
transverse, distal transverse, and
longitudinal arches (Fig. 1).
This arch system is vital to positioning
the hand in a manner that allows for
normal function related to grasp and
prehension. Incorporation of these
arches within an orthosis is an
essential tactic that promotes
maximal function and allows for
optimal comfort
Additionally, preservation of the arches helps to prevent undesired migration of
the orthosis during use of the upper extremity. The fixed proximal transverse arch
is created by the configuration of the distal row of the carpal bones and the volar
carpal ligament
The mobile distal transverse arch is located at the level of the metacarpal heads.
The longitudinal arch spans the length from the metacarpal to the distal phalanx
➢ PALMAR CREASES
The typical arrangement of creases is easily visible on the volar surface of the
hand (Fig. 2). Those individuals who fabricate orthoses need to familiarize
themselves with the location of these creases and how each one correlates with
the underlying anatomy, these creases are commonly used as anatomic guides
when an orthosis pattern is being created. For example, when a wrist
immobilization orthosis is being fabricated,
the distal and proximal palmar creases must
be left uninhibited by the distal end of the
orthosis in order to allow for unrestricted
ROM at the MP joints. However, care must be
taken not to leave too much anatomy
unsupported because the mechanical
advantage of the orthosis can then be altered
adversely.
hand ‫ بتاعة ال‬creases ‫والزم برضو تعرف ال‬ 
wrist crease ‫ال‬ -
proximal palmer crease ‫وفي ال‬ -
distal palmer crease ‫ال‬ -

7
 Orthosis & Prothesis
thenar crease ‫ال‬ -
proximal thumb crease ‫ال‬ -
distal thumb crease ‫ وال‬-
distal ‫ وال‬middle ‫ وال‬proximal digital ‫ وفي ال‬-
‫ مهم تعرفها ليه‬
proximal ‫ دا مش المفروض انه يعدي ال‬orthosis ‫ ال‬wrist demobilization orthosis ‫النك لو هتعمل‬ -
‫ بسس‬wrist ‫ ال‬immobilize ‫ النك بت‬crease
‫ دا‬crease ‫النك مش هتقدر ساعتها تحرك صوابعك لو عدا ال‬ -

➢ METACARPAL LENGTH AND MOBILITY

Dual obliquity is a concept relating to the anatomy of the metacarpals Because
of the differing lengths of the metacarpals (radial side of hand longer than ulnar),
an oblique angle is formed compared with the distal ends of the radius and ulna
when an object is held in the hand. In addition, the object is angled in accordance
with the distal transverse arch and the increasing mobility of the ulnar
metacarpals . This dual obliquity should be incorporated into an orthosis so that
it provides a comfortable and functional structure that effectively resists
migration.

‫ ال‬

dual obliquity
‫ اكبر من‬ulna ‫ او ال‬index ‫ مش كلها قد بعض يعني اللي ناحية ال‬metacarpal ‫ لو خدت بالك هتالقي ان ال‬-
radial ‫ او ال‬ring finger ‫ وال‬little ‫اللي ناحية ال‬
oblique angle ‫ عاملة‬metacarpal ‫ بتاعة ال‬head‫ف انت لما تيجي تمسك حاجة هتالقي ال‬ -
‫ ودا شئ يساعد ف انك متوقعش حاجة‬mobile ‫ هتالقيهم‬4th, 5th metacarpal ‫وكمان لو بصيت عند ال‬ -
‫ مش هتقدر تمسك حاجة وهتقع من ايدك‬fixed ‫انت ماسكها النهم لو بقو‬
fixed ‫ اللي بيكونو‬2nd, 3rd metacarpal ‫على عكس ال‬ -

8
Orthosis & Prothesis
➢ POSITIONING THE HAND
When the fabricator is deciding how to position the hand within an orthosis, many
factors must be considered, including the patient's diagnosis, and goals of
intervention. In addition to facilitating the healing of any affected tissues, being
mindful of proper positioning within an orthosis can help to prevent future joint and
soft tissue contractures.

The two most common positions described in the literature include the position of
function and the position of rest (known as antideformity position or safe position).
See Fig. 4 for the general joint angles described for each position.
The antideformity position, commonly referred to as safe position in the clinical
setting, considers the unique anatomic characteristics of the MP and PIP joints. The
length of the collateral ligaments at the MP joint varies according to the position of
the MP joint (Fig. 5). The collateral ligaments are slack with joint extension, whereas
in the collateral ligaments increases with greater amounts of MP joint flexion.
Placing these joints in flexion within an orthosis helps to prevent MP joint extension
contractures (resulting in limited flexion post-immobilization). If the joints are
placed in extension with resulting MP contractures, it can g impair the patient's
grasping ability.
Similarly, at the PIP joint level, the volar plate is placed e with PIP joint extension,
whereas flexion at the PIP joint places the val plate at risk for shortening (see Fig.
5A and B). Shortening of the vola plate can result in debilitating PIP joint flexion
contractures, which c significantly affect the ability not only to grasp but also
release objec Therefore, careful positioning of the PIP joint in extension (as long as
is not contraindicated) is crucial to maintain the length of the volar pla tissue. on te

Figure 4: (A). The functional position of the hand places the wrist in 20 to 30
degrees of extension, the metacarpophalangeal (MP) joints in 35 to 45 degrees of
flexion, the proximal interphalangeal (PIP) joints in 45 degrees of flesion, the distal
interphalangeal joints in a relaxed flesed position, and the thumb in palmar
abduction. (B), The antideformity position of the hand places the wrist in 30 to 40
degrees of extension, the MP joints in 60 to 90 degrees of flexion, the PIP and distal
interphalangeal joints in extension, and the thumb in palmar abduction.
Figure 5: Soft tissue length changes associated with joint positioning A, Placing the
metacarpophalangeal (MP) jelat in extension will cause the MP collateral ligaments
and the proximal interphalangeal (PIP) voler plate to become "lack" and at risk of
becoming shortened. B, Placing the MP joint is flexien elongates both the MP
collateral ligaments and the volar plate of the PIP joint to minimize risk of shortening
(contractures) of these structures.

9
 ‫‪Orthosis & Prothesis‬‬

‫‪ ‬لما تيجي تستخدم ‪ orthotic‬لل ‪ hand‬هتحتاج االيد تكون في اي ‪position‬‬

‫انت عندك ‪positions 2‬‬

‫ال ‪Functional‬‬ ‫‪-‬‬

‫ال ‪ antideformity‬او ‪resting position‬‬ ‫‪-‬‬

‫بتختار طبعا كل نوع منهم على حسب الحالة والعالج‬

‫‪ .1‬ال ‪ antideformity‬بتختاره لو عيان عنده ‪ burn‬عشان انت مش عايز بحصله ‪contracture‬‬

‫ف بتحطه في وضع ال ‪ resting‬بحيث يكون مرتاح‬ ‫‪-‬‬
‫وبيكون ال ‪ wrist‬عامل ‪ flexion‬من حوالي ‪ ٣٠:٤٠‬درجة‬ ‫‪-‬‬
‫درجة‬ ‫‪ -‬وال ‪ metacarpal‬عاملين ‪ flexion‬من ‪6٠:9٠‬‬
‫‪10‬‬
Orthosis & Prothesis
extended ‫ بيكونو‬proximal, distal interphalangeal joint ‫ وال‬-
palmer abduction ‫ بيكون عامل‬thumb ‫ وال‬-
‫دا بيظهر اول ما تحط ايدك على ترابيزة وتوصفه‬ -
antideformity position ‫• ليه اسمه‬
‫ في الصورة اللي تحت‬-
collateral ligament ‫ في حاجة اسمها‬proximal metacarpal joint ‫ في عند ال‬-
burn ‫ ف انت لو مثبت ايدك في الوضع دا خصوصا لو حد عنده‬extension position ‫بيكون مرتخي في ال‬ -
extension contracture ‫هيحصله‬
6٠:9٠ ‫ في‬metacarpal ‫ يعني مشدود ف بنحط ال‬taught ‫ بيكون‬ligament ‫ في الصورة اللي على اليمين ال‬-
degree flexion
‫ بتكون مرتخية في ال‬Volar plate ‫ في حاجة اسمها‬proximal interphalangeal joint ‫طب لو بصينا عن ال‬ -
contracture ‫ ف برضو لو ثبتنا عندها هتعمل‬flexion
taught ‫ بيبقى‬extension ‫ف لما يكون في وضع ال‬ -
grasp ‫ دا كانك ماسك حاجة او عامل‬Functional position ‫ ال‬-2
2٠:٣٠ ‫ من‬extension ‫ بيكون في‬wrist ‫ال‬ -
٣٥:٤٥ flexion ‫ بتكون عاملة‬metacarpal ‫ال‬ -
flexion ‫ بيكون عامل‬PIP j ‫ال‬ -
‫ برضو‬flexion ‫ بيكون في‬DIP j ‫ وال‬-
palmer abduction ‫ بيكونوفي‬thumb ‫ال‬ -
Classification of upper limb orthoses
Upper limb orthoses can be categorized in several ways, for example upper arm
Orthoses may be divided into clavicular and shoulder Orthoses, elbow Orthoses,
wrist Orthoses and hand, finger Orthoses or it can be categorized according to
function as static, dynamic, and functional orthoses
➢ According to function
1. Static Orthoses
They serve as a rigid support for patients with fractures, inflammatory
conditions of tendons and soft tissue, or nerve injuries
2. Dynamic Orthoses
- They are used primarily to assist movement of weak muscles.
- Have articulations with rubber or elastic resistance to strengthen muscles or
to provide passive stretching
- Not used for ADL
3. Functional Orthoses to actively use upper limb in ADI. Examples of per limb
orthos
upper limb Orthosis ‫ال‬ 
stabilization ‫ هنقسمعا على حسب الحاجة اللي بتعملها‬-
11
 Orthosis & Prothesis
Dynamic function ‫ و‬static ‫ يا اما نقسمها على حسب‬-
fracture ‫ تماما زي ال حاالت ال‬motion ‫ دي يعني بتمنع لنا ال‬static ‫ وال‬-
weak ‫ بتاعة ال‬function ‫ قد كدا بس بيساعد في انه يحسن ال‬activity ‫ مش بيساعد في‬dynamic ‫ ال‬-
‫ لو بنقوي عضالت معينة‬rubber band ‫ بنستخدمه مع ال‬Rehab .‫ او وقت ال‬muscles
‫ وهكذا‬static ‫ ودا‬dynamic ‫ هنقعد نصنف بقى دا‬upper limb Orthosis ‫ لما نيجي نتكلم على ال‬-

I- Shoulder and clavicular orthoses

1. Shoulder sling
Used to restrict shoulder motion as in dislocated or subla shoulder by
providing humeral cuff and chest straps to keep the we
head in the glenoid cavity.
shoulder sling ‫دا ال‬ 
chest strap ‫ وال‬humeral part ‫ بيكون في‬-
glenoid ‫ جوا ال‬head ‫ وبنستعمله عشان نحافظ على ال‬-
glenoid ‫ جوا ال‬head ‫ ال‬immobilize ‫ واحنا عايزين ن‬dislocation ‫ لو عيان عنده‬-
static ‫ ودا طبعا‬-
2. Standard arm sling and hemi-sling
An arm sling (commonly called shoulder sling) is the most readily available
and well-known device used to support the arm. Unfortunately, a simple sling
often is uncomfortable. The easily available alternative to the simple sling is
the hemi-sling. Both standard sling and hemi-sling are being used for
shoulder immobilization as in humeral and scapular fractures or dislocated or
subluxated shoulder.
shoulder sling ‫ بس االسم الشائع بتاعه هو ال‬arm sling ‫ دا اسمه‬
‫ ودا ممكن‬indirectly ‫ بس‬shoulder ‫ لل‬extension ‫ كلها وبيعمل‬forearm ‫ودا ممكن يكون مغطي ال‬ -
‫ ودي الصورة اللي على اليمين‬subluxation ‫ او‬dislocation ‫ او‬humeral fracture ‫نستعمله لو عيان عندع‬
‫ ودا مريح اكتر ودي الصورة اللي على الشمال‬hand ‫وممكن يغطي ال‬ -

12