Full Length Article| Volume 36, ISSUE 1, P166-178, January 2023

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Utilization of 3D printed orthoses for musculoskeletal conditions of the upper extremity: A systematic review

Published:November 21, 2021DOI:


      • A systematic review was performed on studies utilizing 3D printed orthoses for musculoskeletal conditions of the elbow, wrist, hand and digits in clinical settings.
      • The 10 studies included in this systematic review report on actual patient use of 3D printed orthoses.
      • The 3D printing process of orthoses for the upper extremity remains complex and under-utilized.
      • There is a need for more clinical trials to study the benefits of 3D printed orthoses compared with custom made low temperature thermoplastic orthoses for patients in the hand therapy setting.


      Study Design

      Systematic Review


      3D printed orthoses are emerging as a possible option in the field of hand therapy to fabricate conventional casts and orthoses. It is unknown how this technology is currently being used to treat upper extremity musculoskeletal conditions, and if 3D orthoses are comparable to custom- made low temperature thermoplastic orthoses fabricated by hand therapists.

      Purpose of the Study

      The primary aim of this review was to investigate the utilization, effectiveness and feasibility of 3D printed technology to manufacture custom orthoses for musculoskeletal conditions of the upper extremity.


      Studies describing 3D printed orthoses or casts used in treatment with patients were included following a comprehensive literature search using CINAHL, PubMed, Medline, ProQuest, and EBSCO databases. The selected studies had to address musculoskeletal conditions of the elbow, wrist, hand and/or digits that would typically be immobilized with a cast or brace or orthotic or orthosis.


      Ten studies met the inclusion criteria. Study designs included case studies, case series, and 1 randomized clinical trial. 3D printed orthoses/casts appear to be comfortable, provide adequate immobilization, and have pleasing aesthetics. However, expensive equipment, lack of appropriate software and scanning tools and lack of highly skilled clinicians are all factors preventing the implementation of 3D printed orthoses into current clinical practice.


      3D printed orthoses appear to be effective at immobilization of a limb, aesthetically pleasing, and utilize lightweight and well -ventilated materials. However, the feasibility of implementing 3D printing technology in hand therapy settings remains challenging in part due to the resources required.


      While 3D printing shows promise, the high cost of equipment, lack of training and skill of clinicians and the long time required for production are all factors that need to be improved to make 3D printing a viable option in the hand therapy setting.


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      1. American Society of Hand Therapists. Practice management: orthosis versus splint. Available at: Accessed June 14, 2021.

        • Keller JL
        • Henderson JP
        • Landrieu KW
        • Dimick MP
        • Walsh JM
        The 2019 practice analysis of hand therapy and the use of orthoses by certified hand therapists.
        J Hand Ther. 2021;
      2. American Society of Hand Therapists. Practice management: coding. Available at: Accessed June 14, 2021.

        • Choo YJ
        • Boudoir-Revere M
        • Chang MC
        3D printing technology applied to orthosis manufacturing: narrative review.
        Ann Palliat Med. 2020; 9: 4262-4270
        • Patterson RM
        • Salatin B
        • Janson R
        • Salinas SP
        • Mullins MJS
        A current snapshot of the state of 3D printing in hand rehabilitation.
        J Hand Ther. 2020; 33: 156-163
        • Blaya F
        • San Pedro Silva JL
        • D'Amato R
        • Heras ES
        • Juanes JA
        Design of an orthopedic product by using additive manufacturing technology: the arm splint.
        J Med Syst. 2018; 42: 1-15
        • Katt B
        • Imbergamo C
        • Seigerman D
        • Rivlin M
        • Beredjiklian PK.
        The use of 3D printed customized casts in children with upper extremity fractures: a report of two cases.
        Arc Bone Joint Surg. 2021; 9: 126-130
        • Popescu D
        • Zapciu A
        • Tarba C
        • Laptoiu D.
        Fast production of customized three-dimensional-printed hand splints.
        Rap Prototyp J. 2020; 26/1: 134-144
        • Cazon A
        • Kelly S
        • Paterson AM
        • Bibb R J
        • Campbell RI.
        Analysis and comparison of wrist splint designs using the finite element method: multi-material three-dimensional printing compared to typical existing practice with thermoplastics. Proceedings of the Institution of Mechanical Engineers, Part H.
        J Eng Med. 2017; 231: 881-897
        • Graham J
        • Wang M
        • Frizzell K
        • Watkins C
        • Beredjiklian P
        • Rivlin M.
        Conventional vs 3-dimensional printed cast wear comfort.
        Hand. 2020; 15: 388-392
        • Portnoy S
        • Barmin N
        • Elimelech M
        • et al.
        Automated 3D-printed finger orthosis versus manual orthosis preparation by occupational therapy students: preparation time, product weight, and user satisfaction.
        J Hand Ther. 2020; 33: 174-179
        • Chi C-H
        • Wang I-J
        • Chien-Hsiou J-RS
        Customized designs of short thumb orthoses using 3D hand parametric models.
        Assist Tech. 2020;
        • Chae DS
        • Kim DH
        • Kang KY
        • et al.
        The functional effect of 3D-printing individualized orthosis for patients with peripheral nerve injuries: three case reports.
        Medicine. 2020; 99: 1-6
        • Baronio G
        • Harran S
        • Signoroni A.
        A critical analysis of a hand orthosis reverse engineering and 3D printing process.
        Appl Bionics Biomech. 2016;
        • Chen YJ
        • Lin H
        • Zhang X
        • Huang W
        • Shi L
        • Wang D.
        Application of 3D–printed and patient-specific cast for the treatment of distal radius fractures: initial experience.
        3D Print Med. 2017; 3: 1-9
        • Oud T
        • Kerkum Y
        • De Groot
        • Gijabers H
        • Nollet F
        • Brehm MA.
        Production time and user satisfaction of 3-dimensional printed orthoses for chronic hand conditions compared with conventional orthoses: a prospective case series.
        J Rehab Med. 2021; 4: jrmcc00049
        • Lunsford C
        • Grindle G
        • Salatin B
        • Dicianno BE.
        Innovations with 3-dimensional printing in physical medicine and rehabilitation: a review of the literature.
        PM R. 2016; 8: 1201-1212
        • Chen L
        • Xiong Y
        • Mi B
        • et al.
        A Novel instant 3-dimensional printing system for postoperative fracture patients: a comparative cohort study. Medical Science Monitor.
        Int Med J Exp Clin Res. 2021; 27: e928240-e928241
        • Guida P
        • Casaburi A
        • Busiello T
        • et al.
        An alternative to plaster cast treatment in a pediatric trauma center using the CAD/CAM technology to manufacture customized three-dimensional-printed orthoses in a totally hospital context: a feasibility study.
        J Ped Orth B. 2019; 28: 248-255
        • Chen Y
        • Lin H.
        • Yu Q
        • et al.
        Application of 3D-printed orthopedic cast for the treatment of forearm fractures: finite element analysis and comparative clinical assessment.
        BioMed Res Intl. 2020;
        • Sarkis-Onofre R
        • Catalá-López F.
        • Aromataris E
        • et al.
        How to properly use the PRISMA Statement.
        Syst Rev. 2021; 10: 117
        • Slim K
        • Nini E
        • Forestier D
        • Kwiatkowski F
        • Panis Y
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
      3. Oxford centre for evidence-based medicine 2011 levels of evidence. Available at:, Accessed 29 oct 2021.

        • Quintal I
        • Carrier A
        • Packham T
        • Bourbonnais D
        • Dyer JO.
        Tactile stimulation programs in patients with hand dysesthesia after a peripheral nerve injury: A systematic review.
        J Hand Ther. 2021; 34: 3-17
      4. Higgins JP Thomas J Chandler J Cumpston M Li T Page MJ Welch VA. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons, 2019
        • Nam HS
        • Seo CH
        • Joo SY
        • Kim DH
        • Park DS
        The application of three-dimensional printed finger splints for post hand burn patients: a case series investigation.
        Ann Rehab Med. 2018; 42: 634-638
        • Marinho FD
        • Santos PMD
        • Nardi SMT
        • Sime MM
        • Coutinho GC
        Use of 3D printed orthesis and occupational therapeutic treatment in rhizarthrosis.
        Brazil Notebooks of Occ Ther. 2020; (Ahead of Print)
        • Kim SJ
        • Kim SJ
        • Cha YH
        • Lee KH
        • Kwon JY
        Effect of personalized wrist orthosis for wrist pain with three-dimensional scanning and printing technique: a preliminary, randomized, controlled, open-label study.
        Prosth Orth Int. 2018; 42: 636-643
        • Miclaus R
        • Repanovici A
        • Roman N.
        Biomaterials: polylactic acid and 3D printing processes for orthosis and prosthesis.
        Materiale plastice. 2017; 54: 98-102
        • Joseph M
        • Constant R
        • Rickloff M
        • Mezzio A
        • Valdes K.
        A survey of client experiences with orthotics using the QUEST 2.0.
        J Hand Ther. 2018; 31: 538-543
        • Heinemann AW
        • Bode RK
        • O'Reilly C
        Development and measurement properties of the Orthotics and Prosthetics Users’ Survey (OPUS): a comprehensive set of clinical outcome instruments.
        Prosth Orth Int. 2003; 27: 191-206
        • Mehta P
        • MacDermid JC
        • Richardson J
        • MacIntyre NJ
        • Grewal R
        A systematic review of the measurement properties of the patient-rated wrist evaluation.
        J Orth Sports Phys Ther. 2015; 45: 289-298
        • MacDermid JC.
        The Patient-Rated Wrist Evaluation (PRWE)© User Manual.
        McMaster University, Hamilton2007
      5. Demers. L, Weiss-Lambrou, R, Ska, B. The Quebec user evaluation of satisfaction with assistive technology (QUEST 2.0): an overview and progress. Tech Disability, 14, 101-105.

        • Sears ED
        • Chung KC.
        Validity and responsiveness of the jebsen–taylor hand function test.
        J Hand Surg. 2010; 35: 30-37
        • Stern EB.
        Stability of the Jebsen-Taylor hand function test across three test sessions.
        Am J Occu Ther. 1992; 46: 647-649
        • Kwok IH
        • Leung F
        • Yuen G.
        Assessing results after distal radius fracture treatment: a comparison of objective and subjective tools.
        Ger Ortho Surg Rehab. 2011; 2: 155-160
        • Choi H
        • Seo A
        • Lee J.
        Mallet finger lattice casts using 3D printing.
        J Healthc Eng. 2019;
        • Fernandez-Vicente M
        • Chust AE
        • Conejero A.
        Low- cost digital fabrication approach for thumb orthoses.
        Rap Prot J. 2017; 23/6: 1020-1031
        • Li J
        • Tanaka H.
        Rapid customization system for 3D-printed splint using programmable modeling technique–a practical approach.
        3D Print Med. 2018; 4: 1-21
        • Visscher DO
        • Te Slaa S
        • Jaspers ME
        • et al.
        3D printing of patient-specific neck splints for the treatment of post-burn neck contractures.
        Burns Traum. 2018; 6: 1-3
        • Farhan M
        • Wang JZ
        • Bray P
        • Burns J
        • Cheng TL
        Comparison of 3D scanning versus traditional methods of capturing foot and ankle morphology for the fabrication of orthoses: a systematic review.
        J Foot Ank Res. 2021; 14: 1-11
        • Wojciechowski E
        • Chang AY
        • Balassone D
        • et al.
        Feasibility of designing, manufacturing and delivering 3D printed ankle-foot orthoses: a systematic review.
        J Foot Ank Res. 2019; 12: 1-12
        • Keller M.
        • Guebeli A.
        • Thieringer F.
        • Honigmann P.
        Overview of in-hospital 3D printing and practical applications in hand surgery.
        BioMed Res Int. 2021; 2021
        • Keller M.
        • Guebeli A.
        • Thieringer F.
        • Honigmann P.
        In-hospital professional production of patient-specific 3D-printed devices for hand and wrist rehabilitation.
        Hand Surg Rehab. 2021; 40: 126-133

      JHT Read for Credit

      Quiz: # 912

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The study design is
        • a.
        • b.
          case series
        • c.
          systematic review
        • d.
          prospective cohort
      • # 2.
        The 3D printed orthotics were an alternative for casts whose purpose was
        • a.
        • b.
          restoration of ROM
        • c.
        • d.
      • # 3.
        The study investigates the ___________ of 3D printed orthotics in hand therapy
        • a.
        • b.
        • c.
        • d.
          all of the above
      • # 4.
        How many articles were found that were RCTs
        • a.
        • b.
        • c.
        • d.
      • # 5.
        There are significant hurdles that will need to be crossed before 3D printed orthotics become standard in hand therapy practices
        • a.
          not true
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.