Shoulder attachment measurements

1. Distance last arm tape to inside edge

of bra strap

2. Top of shoulder, circumferentially under opposite

breast

3. Top of shoulder, circumferentially under opposite

axilla

4. Top of shoulder, diagonal to waist

Bra Loop (cm) Female Body Strap (cm)Male/Child’s

Body Strap (cm)

Waist Attachment (cm)

(with clips) 1 2 3 4

Distance last arm tape to base of neck

2a 3a 4a

Garment styles

Code L R Description

0501 Arm Sleeve (wrist to axilla)

0503 Arm Sleeve with Shoulder Attachment

0506 Arm Sleeve with Bra Loop

0515 Forearm/Upper Arm

1140 Stump Sleeve (closed end to axilla)

1141 Stump Sleeve with Shoulder Attachment

Arm zipper locations

Location FullLength

Or Specify Length cmL R

Lateral/Radial Aspect

Medial/Ulnar Aspect

Other:

Options and modifications

Code L R Description

SBE Silicone Backed Elastic

1190 Anterior Elbow Insert

0000 Elbow Contracture Seam ...............degrees

0000 Elbow Contracture Seam ...............degrees

1164 Zippers (20cm or less)

1165 Zippers (over 20cm)

1172A Zipper Loop (leather)

ZCT Zipper Closure Velcro® Tab (top of zipper)

1163B Zipper Fastening Aids (along length of zipper)

0000 Zipper Lining Satin Elastic0027 Padded Zipper Lining

1167 Lining - Inside Elbow Satin Cotton1168 Lining - Full Elbow Satin Cotton1167B Lining - Posterior Elbow Satin Cotton1188 Lining - Elsewhere (indicate on TBSA map) Satin Cotton1195 Fully Lined Garment Satin Cotton

SilonTEX® lining – indicate location and size on either hand outline, TBSA map or printed photo

0027 Padding - Soft (indicate on TBSA Map) Pocket Attached0027 Padding - Velfoam Pocket Attached1202 Motif

Stump Sleeve with Shoulder Attachment 1141

Arm Sleeve Wrist to Axilla 0501

Arm Sleeve with Shoulder Attachment 0503

Arm Sleeve with Bra Loop 0506

Forearm/Upper Arm 0515

Stump Sleeve Closed End to Axilla 1140

Powernet colour selection guide

Fabric & Thread: Black, Brown, Beige, Light Beige, Purple, Navy, Royal, Light Blue, Red, Pink, White, Camouflage

Contrast Thread: Orange, Hot Pink, Lime, YellowDual Stitching: nominate 2 colours

Fabric Thread Qty

1 1

2 2

Must provide extra colour options

1 1

2 2

Towards

Axilla

Upper limb circumferences

Pleat Pleat

Left Wrist End Right

cm/mm cm/mm41/2

3

11/2

0

11/2

3

41/2

6

71/2

Elbow 9

101/2

12

131/2

15

161/2

18

191/2

Pleat Axilla End Pleat

0503

0506

0501

1140

1141

0515

0515

0503

0506

0501

1140

1141

0515

0515

0503

0506

0501

1140

1141

0515

0515

0503

0506

0501

1140

1141

0515

0515

0503

0506

0501

1140

1141

0515

0515

0503

0506

0501

1140

1141

0515

0515

0503

0506

0501

1140

1141

0515

0515

Comments

®Velcro is a registered trademark of VELCRO BVBA

Measurement Form – Page 1 of 1

Arm Sleeve

Patient details (Please print in black with CAPITAL letters)

Last name

First name

Date

DD/MM/YYYY

Garment returns

Unit 1, Level 1, 100 Station Street Nunawading Victoria 3131, Australia T 1800 772 577 F 1800 773 577 E customer.service@jobskin.com W www.jobskin.com

Unit 1, Level 1, 100 Station Street Nunawading Victoria 3131, Australia

Email, fax or return forms to:

All measurements taken with no tension and in centimetres only.

1

2

3

4

1

2a

3a

4aArm measuring tips Pleat instructions Reading the tapes

Position the arm straight and horizontal, and measure using a Purple JOBSKIN arm tape.

At elbow9

For a Full Length Sleeve begin by securing tape 9 directly around the elbow. The last tape should fall just below the wrist bone (distal to styloid process). Pleating at the spine occurs ONLY at the wrist and axilla if required.

For a Forearm Sleeve begin tape at wrist and pleat at proximal end if required.

When pleating the last tape, measure the distance between the pleated tape and its neighbour from mid point to mid point (see diagram). Measurements must be recorded in millimetres.

Always read along the straight edge in the direction of the arrows indicated below.

Standard Arm Sleeve: This will automatically include soft elastic at the proximal end.Elbow Contracture Seam: Measure as for a regular sleeve, then record the elbow contacture angle in the space provided. A photograph is also useful.Stump Sleeve: Apply measuring tapes to extend as far distally on the stump as possible. A photograph of the stump with the tapes in place is required.

Shoulder attachment options

Arm sleeve definition, hints and tips

Bra Loop1. Distance last arm tape to inside edge of bra strap.

Female Body Strap2. Top of shoulder

circumferentially under opposite breast.

2a. Distance last arm tape to base of neck.

1

2

3

4

1

2a

3a

4a

Waist Attachment4. Top of shoulder diagonal

to waist.4a. Distance last arm tape

to base of neck.

Male/Child’s Body Strap

1

2

3

4

1

2a

3a

4a

1

2

3

4

1

2a

3a

4a

3. Top of shoulder circumferentially under opposite axilla.

3a. Distance last arm tape to base of neck.

Pleat

Measurement from midline

of tapes

21.8cm not 22.2cm

22.1cm not 23.9cm

Scalloped edgeStraight edge

Last name: First name: Date: Left Pleat Wrist End: Left Arm -4 1/2cm: Left Arm -3cm: Left Arm -1 1/2cm: Left Arm 0cm: Left Arm 1 1/2cm: Left Arm 3cm: Left Arm 4 1/2cm: Left Arm 6cm: Left Arm 7 1/2cm: Left Arm Elbow 9cm: Left Arm 10 1/2cm: Left Arm 12cm: Left Arm 13 1/2cm: Left Arm 15cm: Left Arm 16 1/2cm: Left Arm 18cm: Left Arm 19 1/2cm: Left Pleat Axilla End: Right Pleat Wrist End: Right Arm -4 1/2cm: Right Arm -3cm: Right Arm -1 1/2cm: Right Arm 0cm: Right Arm 1 1/2cm: Right Arm 3cm: Right Arm 4 1/2cm: Right Arm 6cm: Right Arm 7 1/2cm: Right Arm Elbow 9cm: Right Arm 10 1/2cm: Right Arm 12cm: Right Arm 13 1/2cm: Right Arm 15cm: Right Arm 16 1/2cm: Right Arm 18cm: Right Arm 19 1/2cm: Right Pleat Axilla End: Garment Options/Modes: 1190 Left: OffGarment Options/Elbow1: 0000 Left: Off0000 Elbow Contracture Seam1: Degrees: 0000 Elbow Contracture Seam2: Degrees: Garment Options/Modes: 1164 Left: OffGarment Options/Modes: 1165 Left: OffGarment Options/Modes: 1172A Left: OffGarment Options/Modes: ZCT Left: OffGarment Options/Modes: 1163 Left: OffGarment Options/Zipper Lining: 0000 Left: OffG: Options/Zipper Lining: 0000 Satin: OffOptions/Zipper Lining: 0000 Elastic: OffOptions/Lining Inside Elbow: 1167 Satin: OffOptions/Lining Inside Elbow: 1167 Cotton: OffOptions/Lining Full Elbow: 1168 Satin: OffOptions/Lining Full Elbow: 1168 Cotton: OffOptions/Lining Post: Elbow: 1167B Satin: Off Elbow: 1167B Cotton: Off

Options/Lining Elsewhere: 1188 Satin: OffOptions/Lining Elsewhere: 1188 Cotton: OffOptions/Fully Lined Garment: 1195 Satin: OffOptions/Fully Lined Garment: 1195 Cotton: OffOptions/Soft Padding: 0027 Pocket: OffOptions/Soft Padding: 0027 Attached: OffOptions/High Padding: 0027 Pocket: OffOptions/High Padding: 0027 Attached: OffOptions/Motif: 1202 Left: OffOptions/Motif: 1202 Right: Off

Garment Options/Modes: 0027 Left#1: OffGarment Options/Modes: 1167 Left: OffGarment Options/Modes: 1168 Left: OffGarment Options/Modes: 1167B Left: OffGarment Options/Modes: 1188 Left: OffGarment Options/Modes: 1195 Left: 0: 0: Off

Silontex Left: OffGarment Options/Modes: 0027 Left#2: OffGarment Options/Modes: 0027 Left#3: OffGarment Options/Modes: SBE Right: OffGarment Options/Modes: 1190 Right: OffGarment Options/Elbow2: 0000 Right2: OffGarment Options/Modes: 1164 Right: OffGarment Options/Modes: 1165 Right: OffGarment Options/Modes: 1172B Right: OffGarment Options/Modes: ZCT Right: OffGarment Options/Modes: 1163 Right: OffGarment Options/Zipper Lining: 0000 Right#1: OffGarment Options/Modes: 0027 Right#1: OffGarment Options/Modes: 1167 Right: OffGarment Options/Modes: 1168 Right: OffGarment Options/Modes: 1167B Right: OffGarment Options/Modes: 1188 Right: OffGarment Options/Modes: 1195 Right: OffSilontex Right: OffGarment Options/Modes: 0027 Right#2: OffGarment Options/Modes: 0027 Right#3: OffPowernet Color Fabric 1: Powernet Color Thread 1: Powernet Color Fabric 1 Qty: Powernet Color Fabric 2: Powernet Color Thread 2: Powernet Color Fabric 2 Qty: Powernet Extra Color Option 1: Powernet Extra Thread Option 1: Powernet Extra Color Option1 Qty: Powernet Extra Color Option 2: Powernet Extra Thread Option 2: Powernet Extra Color Option2 Qty: 1: Bra Loop CM:

2: Female Body Strap CM:

2a: Female Body Strap CM:

3: Male/Child Body Strap CM:

3a: Male/Child Body Strap CM:

4: Waist Attachments CM:

4a: Waist Attachments CM:

Left Arm Zipper Location: Lateral/Radial Ascpect: OffLeft Arm Zipper Location: Medial/Ulnar Ascpect: OffLeft Arm Zipper Location: Other: OffArm Zipper Location: Other: Right Arm Zipper Location: Lateral/Radial Ascpect: OffRight Arm Zipper Location: Medial/Ulnar Ascpect: OffRight Arm Zipper Location: Other: OffFull Length cmLateralRadial Aspect: OffFull Length Medial/Ulnar Aspect: OffOther Arm Location Full Length: OffOr Specify Length cmLateralRadial Aspect: Or Specify Length cmMedialUlnar Aspect: Or Specify Length cmOther: CommentsRow1: Garment Options/Modes: SBE Left: 0: Off

0501 L: 0: 0: Off1: Off

1: 0: Off1: Off

2: 0: Off1: Off

3: 0: Off1: Off

4: 0: Off1: Off

5: 0: Off1: Off