Dynamic Splinting of the Rheumatoid Hand

The effect of orthotic devices in the modification of hand de­ formities in rheumatoid arthritis is essentially unknown. Immobil­ ization of acutely involved joints has long been known to provide symptomatic relief, and it was recently shown that immobilization also results in local improvement of joint involvement. (Fig . l ,2) Beyond this, however, little is known about the prevention of de­ formities caused by rheumatoid diseases. There is little agreement as to the significance of multiple fac­ tors in causing rheumatoid hand deformities, but there is a con­ sensus among most authorities that synovitis, capsular distension and instability are the primary etiologic features. Mechanical stresses and various types superimposed upon an unstable joint then result in progressive deformities. ( F i g . 3 , 4 , 5 ) Intimately associated with the soft tissue involvement is the destruction of articular cartilage and bone. Many clinicians believe that prolonged splinting to protect diseased joints from the adverse effects of mechanical stress might prevent or retard the development of typical deformities. This contention, however, has not been established. The ideal splint, as described by Bennett, "must permit the normal planes of motion necessary for essential function, but block all faultv planes that result in functionally significant deformity." (Fig. 6 ) For the past seven years, a dynamic hand splint designed to maintain motion, improve function, relieve pain and prevent the progression of deformity has been used on the Rheumatoid Arthritis