2025 Orthotics Q&A Summary
A patient presents with separated connective tissue at the pubis symphysis. What orthosis do
you recommend and what hormone is responsible for the increased elasticity of the pubis
symphysis during pregnancy?
Relaxin hormone - is released in pregnant women which increases the elasticity of
connective tissue to assist and ease birth.
SI belt - used when pubis symphysis becomes too elastic causing pain and instability
Describe the flexion synergy pattern in the upper extremity and lower extremity.
UE: shoulder abduction, external rotation, elbow flexion, forearm supination, wrist
flexion
LE: hip flexion, abduction, external rotation, knee flexion, ankle dorsiflexion, inversion
Describe the extensor synergy pattern in the upper extremity and lower extremity.
UE: Shoulder adduction, internal rotation, elbow extension, forearm pronation, wrist
flexion
LE: hip extension, adduction, internal rotation, knee extension, ankle plantarflexion,
inversion
During normal heel strike, the forward hip is how flexed?
25 deg flexed
Gait cycle is described by the activity between
Heel strike on one side and the follow heel strike on the same side
Describe Legg-Calve-Perthes disease (osteochondrosis).
Males>females, average age onset 6 years old, psoatic limp due to psoas major
weakness, lower extremity moves into external rotation, flexion and adduction, MRI will
show collapse of subchondral bone at femoral neck
Describe slipped capital femoral epiphysis.
Males>females, age onset 13 years, AROM restricted in abduction, flexion, and
internal rotation, vague pain at hip, knee, and thigh
Describe avascular necrosis
Etiologies resulting in lack of blood supply to the femoral head, AROM is decreased
in hip flexion, internal rotation, and abduction, pain at groin, thigh, and tenderness at hip
Describe adhesive capsulitis
Characterized by restriction in shoulder motion in external rotation, abduction, and
flexion, inflammation and fibrosis at shoulder
How would you align a patient with lumbar DJD in the sagittal plane?
Decrease lumbar lordosis which moves pressure off the affected posterior portion of
the vertebrae onto the vertebral body and away from the arthritic joints.
How would you align a patient with L5, S1 spondylolisthesis in the sagittal plane?
, Decrease lumbar lordosis which is the most appropriate position to prevent
progression and allow for healing of the pathology
It is early in the recovery phase of a patient with a L3 complete spinal cord injury.
The expect outcome would most likely be?
Some recovery of function since damage is to the peripheral nerve roots. Spinal cord
ends at L1 at the conus medularis; a spastic bladder is expected with an upper motor neuron
injury
With regard to spondylolithesis, what are the radiographic signs that contraindicate orthotic
intervention and indicate a surgical candidate?
Superior vertebrae angulation of 50 degrees relative to inferior vertebrae
Anterior translation of the superior vertebrae over the inferior vertebrae
Patient presents with an L1 burst fracture from a snowmobiling accident; which orthosis is
most appropriate?
Custom polymer TLSO - to have coverage spaning several levels above and below the
pathological site. Burst fractures are most unstable in the transverse plane. Custom TLSO is
most efective at rotational control and has proper coverage
With a traction injury to the anterior division of the brachial plexus you would expect:
weakness of the elbow flexors, wrist flexors, and forearm pronators. What other muscle
weakness would you expect?
Thumb abductors - Anterior nerve root gives rise to C6 nerve root, median nerve,
which abducts the thumb
Patient presents with a T11 anterior compression fracture. Patient is neurologically intact and
the fracture is stable. Which orthoses would be appropriate?
CASH TLSO and Jewett TLSO - both effective for anterior compression FX near the
thoracolumbar junction. By placing the thoracic spine in extension, pressure is removed from
anterior portion of the vertebral body allowing natural bone remodeling to occur
When taking an impression for a patient with a L5/S1 spondylolihesis, how would you
position the patient if they were allowed to stand for the procedure?
Ask the patient to flex their hips and knees slightly to reduce lumbar lordosis for
optimal alignment for spondylolisthesis
You have a patient for an evaluation post stroke. You notice a forward flexed posture. What
positive muscle length test do you expect with this?
Thomas test - test for iliopsoas (hip flexion) tightness
What are some of the biomechanical principles behind a LSO corset?
Kinesthetic reminder - to use proper posture and to discourage certain motions
Increase intradominal pressure - solidifies soft tissie hydrostatically whereby providing
support to the lumbar spine
Multiple three-point pressure systems - work to hold proper alignment and resist/stop certain
motions
A patient presents with separated connective tissue at the pubis symphysis. What orthosis do
you recommend and what hormone is responsible for the increased elasticity of the pubis
symphysis during pregnancy?
Relaxin hormone - is released in pregnant women which increases the elasticity of
connective tissue to assist and ease birth.
SI belt - used when pubis symphysis becomes too elastic causing pain and instability
Describe the flexion synergy pattern in the upper extremity and lower extremity.
UE: shoulder abduction, external rotation, elbow flexion, forearm supination, wrist
flexion
LE: hip flexion, abduction, external rotation, knee flexion, ankle dorsiflexion, inversion
Describe the extensor synergy pattern in the upper extremity and lower extremity.
UE: Shoulder adduction, internal rotation, elbow extension, forearm pronation, wrist
flexion
LE: hip extension, adduction, internal rotation, knee extension, ankle plantarflexion,
inversion
During normal heel strike, the forward hip is how flexed?
25 deg flexed
Gait cycle is described by the activity between
Heel strike on one side and the follow heel strike on the same side
Describe Legg-Calve-Perthes disease (osteochondrosis).
Males>females, average age onset 6 years old, psoatic limp due to psoas major
weakness, lower extremity moves into external rotation, flexion and adduction, MRI will
show collapse of subchondral bone at femoral neck
Describe slipped capital femoral epiphysis.
Males>females, age onset 13 years, AROM restricted in abduction, flexion, and
internal rotation, vague pain at hip, knee, and thigh
Describe avascular necrosis
Etiologies resulting in lack of blood supply to the femoral head, AROM is decreased
in hip flexion, internal rotation, and abduction, pain at groin, thigh, and tenderness at hip
Describe adhesive capsulitis
Characterized by restriction in shoulder motion in external rotation, abduction, and
flexion, inflammation and fibrosis at shoulder
How would you align a patient with lumbar DJD in the sagittal plane?
Decrease lumbar lordosis which moves pressure off the affected posterior portion of
the vertebrae onto the vertebral body and away from the arthritic joints.
How would you align a patient with L5, S1 spondylolisthesis in the sagittal plane?
, Decrease lumbar lordosis which is the most appropriate position to prevent
progression and allow for healing of the pathology
It is early in the recovery phase of a patient with a L3 complete spinal cord injury.
The expect outcome would most likely be?
Some recovery of function since damage is to the peripheral nerve roots. Spinal cord
ends at L1 at the conus medularis; a spastic bladder is expected with an upper motor neuron
injury
With regard to spondylolithesis, what are the radiographic signs that contraindicate orthotic
intervention and indicate a surgical candidate?
Superior vertebrae angulation of 50 degrees relative to inferior vertebrae
Anterior translation of the superior vertebrae over the inferior vertebrae
Patient presents with an L1 burst fracture from a snowmobiling accident; which orthosis is
most appropriate?
Custom polymer TLSO - to have coverage spaning several levels above and below the
pathological site. Burst fractures are most unstable in the transverse plane. Custom TLSO is
most efective at rotational control and has proper coverage
With a traction injury to the anterior division of the brachial plexus you would expect:
weakness of the elbow flexors, wrist flexors, and forearm pronators. What other muscle
weakness would you expect?
Thumb abductors - Anterior nerve root gives rise to C6 nerve root, median nerve,
which abducts the thumb
Patient presents with a T11 anterior compression fracture. Patient is neurologically intact and
the fracture is stable. Which orthoses would be appropriate?
CASH TLSO and Jewett TLSO - both effective for anterior compression FX near the
thoracolumbar junction. By placing the thoracic spine in extension, pressure is removed from
anterior portion of the vertebral body allowing natural bone remodeling to occur
When taking an impression for a patient with a L5/S1 spondylolihesis, how would you
position the patient if they were allowed to stand for the procedure?
Ask the patient to flex their hips and knees slightly to reduce lumbar lordosis for
optimal alignment for spondylolisthesis
You have a patient for an evaluation post stroke. You notice a forward flexed posture. What
positive muscle length test do you expect with this?
Thomas test - test for iliopsoas (hip flexion) tightness
What are some of the biomechanical principles behind a LSO corset?
Kinesthetic reminder - to use proper posture and to discourage certain motions
Increase intradominal pressure - solidifies soft tissie hydrostatically whereby providing
support to the lumbar spine
Multiple three-point pressure systems - work to hold proper alignment and resist/stop certain
motions
