indications
- reduce inflammation
- decreasing pain
- supporting unstable joints
- properly positioning joints
- limiting undesired motion
- increasing ROM
special considerations for splinting cts with RA (5)
- splints should be as lightweight as possible (extra weight=more stress on joints)
- forces transferred to non-splinted joints (e.g. adjacent joints), these may become more symptomatic
- skin tolerance may be more fragile due to RA disease process and effects from meds
- may have sensory impairment–>closely monitor signs of pressure
- splint straps may need modification for ease of donning/doffing
Splinting indications by classification of RA progression
Stage I: Early
(no destructive changes; possible osteoporosis)
resting splints
- decrease acute inflammation
- decrease pain
- protect joints
Splinting indications by classification of RA progression
Stage II: Moderate
(osteoporosis with or without slight subchondral bone destruction, slight cartilage destruction, no joint deformities, limited joint mobility possible, muscle atrophy, extra-articular soft tissue lesions possible)
- day splints to PROVIDE COMFORT
- night splints to relieve pain and/or protect joints against potential deformity
- splints to increase ROM
Splinting indications by classification of RA progression
Stage III: Severe
(cartilage and bone destruction, joint deformity, extensive muscle atrophy, extra-articular soft tissue lesions possible)
- day splints to IMPROVE FUNCTION (decrease pain, provide stability, limit undesired motions, position joints properly)
- night splints to provide positioning & comfort
Splinting indications by classification of RA progression
Stage IV: Terminal
(criteria for stage III, with fibrous and bony ankylosis)
- day splints to IMPROVE FUNCTION (decrease pain, provide stability, limit undesired motions, position joints properly)
- -night splints to provide positioning & comfort
- *same as stage III
Resting hand splint
- useful in tx of ________
- primary function?
- other functions
- acute synovitis of the wrist and hand
- primary function: provide localized rest to involved joints
- other functions: relieve pain, decrease muscle spasm, protect joints vulnerable to contracture/deformity from synovitis
Resting hand splint: recommended joint positions during rest
- slight wrist extension (20-30*)
- MCP flexion (20-30*)
- slight PIP and DIP flexion (10-30*)
- thumb: *slight extension and abduction of CMC *slight flexion of MCP and IP joints
Resting splint: wearing schedule
- worn continually for duration of flare-up (removed @ least 1x/day for skin hygiene and gentle ROM)
- cont. full time use for @ least 2wks after flare-up subsides (w/gradual decrease in wearing time to allow joint recovery)
- later stages: use at night to increase comfort, protect from deformities
Wrist splint
- function
- crucial considerations for this kind of splint
- function: provide wrist stability, decrease pain, improve function (allows motion of thumb and fingers)
- considerations: fit and comfort–>wrist splint intended for support for functional use
Wrist and MCP support splint
-indications
- MCP joints and wrist are symptomatic
- PIPs/DIPs allowed motion
MCP ulnar deviation splint
-function
(wrist not splinted, see fig. 38-16 in Pedretti pg. 1025)
-function: relieve pain; provides stability, alignment, and reduced stress on painful/subluxed, deviated joints
CANNOT prevent or correct! CAN slow progression
Considerations for MCP ulnar deviation splints
- immobilizing MCP joints can impede function
- can increase pain and stress on PIP joints
- volar-based splints can interfere w/sensation and impair ability to grasp objects
- higher ct. satisfaction with dorsal splints
- ct’s preference should be primary for decisions to increase adherence
Splint for swan neck deformity
-can also be used for…
PIP hyperextension block
- blocked in slight flexion
- can also be used to provide lateral stability to unstable IP joints of fingers and thumb
Splint for boutonniere deformities
PIP extension splint
- PIP blocked INTO extension
- DIP free to flex
Thumb splints
-functions
- provide positioning opposite of developing deformity (early stages)
- provide stability and pain-free pinch for function (later stages)
Hand-based short thumb spica splint & opponents splint
- wrist and IP joints free
- used for problems at MCP or CMC joints
Forearm-based (long thumb spica)
-includes wrist
Silicone-lined digital sleeves and pads
-may be helpful for protecting painful nodes or nodules from trauma
