Health Library
Underarm Orthosis (TLSO)

What is Underarm Orthosis (TLSO)?

The underarm orthosis stabilizes and prevents the progression of a spinal deformity. The time frame the brace will need to be worn will be outlined by your child's physician.

Stage I

  • Apply the brace properly and wear it for two hours. Take it off and check the skin for redness and irritation.
  • If the skin is red and sore, keep your child's brace off for a half hour, and then put it back on for two more hours. Once the irritation is resolved, put the brace on for another two hours. You, or whoever is helping with the brace, and your child must be able to judge when the skin can tolerate having the brace back on.
  • After two hours, remove the brace and check the skin again. Give skin care as directed below. Put the brace on again if the skin will tolerate it for two more hours.
  • After two hours, remove the brace and give skin care.

Stage II

If the brace was tolerated the first day, put the brace on after your child's morning bath. Remove it after four hours to check the skin and follow skin care instructions. If the skin will tolerate it, put the brace back on until suppertime. Remove it, check the skin and leave the brace off until bedtime. Put the brace back on at bedtime. It should be worn all night, without checking it, unless your child complains.

Stage III

When the brace can be worn as described in Stage II, it should be worn all day and all night except for one hour (usually before bedtime). Your child's skin should be checked and skin care instructions should be followed every four hours during the day, if possible, or three times a day: when you get up in the morning, at mid-afternoon (after school) and at bedtime. During the one hour out of the brace, exercises should be done.

Skin Care

It is very important to prevent skin breakdown sore, red, raw skin. The skin under the brace needs to be toughened up, especially where the brace presses hard.

To protect the skin:

  • Bathe daily (bath or shower)
  • Apply rubbing alcohol with friction to all parts of the skin that are pink and the areas where the brace presses a lot
  • Always wear a 100 percent cotton (not blended cotton or synthetic material) undershirt, tubular knit without side seams
  • Frequently check the skin for pink areas when the brace is first used

Do not use cream, lotion or powder under the brace.

If there is skin breakdown (sore, red, raw skin) the brace must not be reapplied until the skin heals – one day or more. Sometimes the skin over the waist and hips get darker. That is common and is not a problem. When the brace treatment is over, this color will go away.

Cleaning the Brace

The hard plastic outer shell and the inner soft foam plastic should be cleaned every time you bathe.

A cloth with soap and water can be used to clean the lining, followed by a damp rinsing cloth. A terry towel can help dry the foam plastic. If the lining is damp, a very cool hair dryer can be used. The outer plastic can tolerate rough cleaning.

The plastic brace should not be left in the hot sun or near a warm radiator because the plastic may soften and get out of shape.


As a rule, loose fitting clothes will not reveal the outline of your child's brace. Pants usually need to be one size larger when worn over the brace. Pants with elastic waistbands may fit more easily.


If your physician recommends specific exercises, he / she will order a referral to physical therapy.

Call Your Child's Doctor If:

  • Numbness, stinging or burning places occur under the brace
  • A different, foul (bad) smell comes from the brace
  • Pain occurs that is steady or increases, and is not relieved by medicine or a change in position
  • The brace cracks
  • When a problem occurs that prevents your child from wearing the brace for the amount of time recommended by your doctor

If you need to reach the orthopaedic nurse between 8 am-4 pm Monday through Friday, call 513-636-4567. After 4 pm and during weekends and holidays, call 513-636-4200 and ask for the orthopaedic resident on call.

Last Updated 03/2022

Reviewed By Andrea Rusk, RN

Conditions and treatments.

Cincinnati Children's provides orthopaedic health and wellness educational content for our patients and families.