Common Options for Custom Upper Extremity Garments

Zippers
On a sleeve which is open at the wrist, zippers are generally placed to open at the wrist. This allows the patient to get the hand through the smallest part of the sleeve. A sleeve which would be attached to a glove or gauntlet would open at the top of the sleeve. Many patients do not require a zipper on a sleeve. A patient with good hand and finger strength on the opposite side usually does not need a zipper unless the extremity presents too much pain and difficulty. We strongly recommend against a zipper for a sleeve to be used in lymphedema management of the upper extremity. Most lymphedema patients will be more comfortable with an expansion panel.

It is best to avoid placing a zipper over the front (radial) or back (ulnar) of the elbow, although there may be occasions where this may be unavoidable. Specify a “dorsal zipper” for most patients. A dorsal sleeve zipper would run dorsally from the wrist, mid-way between the ulnus and the radius, to laterally between the antecubital fossa and the elbow and then to the lateral upper arm opposite the axilla.

Inserts
For some patients, bunching of fabric in the antecubital fossa (the front of the elbow) can be uncomfortable. An “anterior (radial) elbow insert” made with our stretchy soft Insert Material will help prevent that. Inserts over the back of the elbow (ulnar) are sometimes requested for patients with skin breakdown. See below for the procedure for incorporating a ‘contracture dart’ into an elbow insert.

Expansion Panels
An expansion panel is made of the same soft and stretchy fabric we use to make the inserts described above. A panel of this fabric along the ulnar side of the arm (the back of the elbow) allows for minor fluctuations in patient measurements and growth in small children. The expansion panel is designed into the garment in such a way as to ensure that the required pressure is not compromised.

Linings
It is possible to line an entire garment with our Lining Material, but for many patients this would be uncomfortably bulky. When considering a lining on any garment always keep in mind that the lining means two layers of material and doubly thick seams. For many patients it may be more effective to make the whole garment out of a light fabric, such as our Soft Material.

Elbow linings are the most common lining option on an upper extremity garment. This would consist of a fully circumferential layer of lining fabric wide enough to include the whole elbow and the antecubital fossa.

Many patients experience difficulty in keeping their sleeve from slipping down the arm. In some cases the patient may have had a decrease in measurements, but in many cases the patient’s form will prevent a sleeve from staying up unaided. Look at your sleeve measurements, if the top one or two measurements are bigger than the next measurements, the sleeve may slide down. We suggest lining the top elastic band of a sleeve with Silon-TEX. Silon-TEX is resistive to the skin and acts as a very good mechanism to prevent the sleeve from falling. Indicate, “Silon top band” on the measurement chart on the “Lining” option. In some cases the standard 1 inch wide band may not provide sufficient support to hold up a sleeve, even with Silon-TEX lining. You may wish to request a 1 1/2 or 2 inch wide band instead. If this is not feasible due to involvement in the upperarm, scapular, or clavicular region, then a shoulder flap is required.

Additional Options
The distal opening of a sleeve normally does not end with an elastic band. A few patients find this uncomfortable. You may request a distal band on your sleeve order. Write “add distal band” in the “Additional Instructions.”