To Lift and To Hold: Management of limbs in orthopedic settings

Liftandhold

A caregiver must often lift and/or hold a patient’s limb in place while some type of treatment, for instance a cast application, is being given in orthopedic care. The caregiver should keep a neutral body posture – upright, not fully flexed – and adjust table height. It is important to ensure that the weight of the leg or arm does not exceed the strength capability of the caregiver. The following ergonomic tool has been designed to aid caregivers to determine if a specific lift and/or hold of an extremity is acceptable and whether a lift or hold device is required.

Patient weight

Body part

Body part weight

lbs         kg

Lift 1-hand

Lift 2-hand

Hold 2-hand

(1 min.)

Hold 2-hand

(2 min.)

Hold 2-hand

(3 min.)

<40 lbs

(< 18kg)

Leg

<6.3

3

+

+

+

+

+

Arm

<2.0

1

+

+

+

+

+

40–90lbs (18–41kg)

Leg

<14.1

6

*

+

*

*

*

Arm

<4.6

2

+

+

+

+

+

90–140 lbs (41–64 kg)

Leg

<22.0

10

*

+

*

*

*

Arm

<7.1

3

+

+

+

+

*

140–190lbs (64–86kg)

Leg

<29.8

14

*

*

*

*

*

Arm

<9.7

4

+

+

+

*

*

190–240lbs (86–109kg)

Leg

<37.7

17

*

*

*

*

*

Arm

<12.2

6

*

+

*

*

*

240–290lbs. (109–132kg)

Leg

<45.5

21

*

*

*

*

*

Arm

<14.8

7

*

+

*

*

*

290–340lbs (132–155kg)

Leg

<53.4

24

*

*

*

*

*

Arm

<17.3

8

*

+

*

*

*

340–390lbs (155–177kg)

Leg

<61.2

28

*

*

*

*

*

Arm

<19.9

9

*

+

*

*

*

390–440lbs (177–200kg)

Leg

<69.1

31

*

*

*

*

*

Arm

<22.2

10

*

+

*

*

*

> 440 lbs. (>200 kg)

Leg

<69.1

31

*

*

*

*

*

Arm

<22.2

10

*

*

*

*

*

+Lift and hold is acceptable but use clinical judgment and do not hold longer than noted.

*Do not lift alone; use assistive device or more than one caregiver.

This table is adapted from Waters et al., 2009 and it shows the calculation of the average weight for an adult patient’s leg and arm as a function of whole body mass. Normalized weight for each limb is calculated as a percentage of body weight where each complete arm weighs 5.1% and each leg weighs 15.7% of total body mass Maximum lift and hold loads are calculated based on 75th percentile shoulder flexion strength and endurance capability for United States adult females, where the maximum weight for a one-handed lift is 11.1 lbs and 22.2 lbs for a two-handed lift. The time limits help to prevent risk of muscle fatigue and musculoskeletal disorders. If the extremity exceeds the weight values listed, use assistive technology such as a ceiling lift or floor-based lift with a limb-supporting sling.  

The above table shows acceptable weights for limbs without a cast. If the caregiver is lifting a limb with a cast, the weight of the cast should be added to the weight of the limb to establish whether the lift is acceptable, as seen below:

Limb

Limb weight factor

Lift 1-hand

Lift 2-hands

Hold 2-hands (1 min.)

Hold 2-hands (2 min.)

Hold 2-hands (3 min.)

Leg

0.157

11.1 lbs

(5.1 kg)

22.2 lbs

(10.2 kg)

11.6 lbs

(5.3 kg)

7.8 lbs

(3.5 kg)

6.4 lbs

(2.9 kg)

Arm

0.051

 

Multiply the patient’s weight times the limb factor (0.157 for leg and 0.051 for arm) and add the weight of the cast to obtain the total limb weight and determine if it is appropriate to lift and hold a limb with a cast. Compare the calculated total limb weight to the value in the corresponding box; if the limb’s weight exceeds the weight in the box, then the caregiver should not attempt to manually lift the limb alone but should resort to an assistive device or extra caregivers instead. Conversely, if the calculated weight is less than the value in the box, then the caregiver can go ahead and manually lift and hold the limb, using clinical judgment and not holding longer than recommended.

Predicted Weights for a Fiberglass Cast

Short arm cast (adult)

Long arm cast (adult)

Short leg walking cast (150lbs adult)

Long leg cast (150lbs adult)

Infant body spica (20-30lbs)

Child body spica 3-5y/o (30-50 lbs)

0.5 lbs

1 lbs

2 lbs

3.0 lbs

2 lbs

4 lbs

2 rolls 3”

1 roll 2”

3 rolls 3”

4 rolls 4”

3 rolls 3”

3 rolls 4”

2 rolls 2”

3 rolls 3”

5 rolls 3”

5 rolls 4”

+Webril*

+Webril*

+Webril*

+Webril*

+Webril*

+Webril*

*Weight of webril is 0.25 lb per packet.