From the Guidelines
A PIP extension splint is conditionally recommended for patients with hand involvement, particularly those with proximal interphalangeal (PIP) joint injuries or deformities, as it can help reduce pain and improve physical function, according to the 2022 American College of Rheumatology guideline for rheumatoid arthritis 1. The use of a PIP extension splint is supported by low certainty evidence, which suggests that hand therapy exercises, including the use of splints, can result in pain reduction and improvement in physical function for patients with hand involvement 1. When using a PIP extension splint, it is essential to ensure proper fit, as the splint should be snug but not cause skin blanching, numbness, or pain. Some key considerations for the use of a PIP extension splint include:
- The splint should be worn for 6-8 weeks for most injuries, with the PIP joint positioned in full extension or slight hyperextension (0-5 degrees) 1.
- For acute injuries, continuous splinting is recommended for the first 1-2 weeks, followed by a gradual transition to night splinting only while performing gentle active range of motion exercises during the day.
- Regular follow-up with a hand specialist is crucial to monitor progress and adjust the treatment plan as needed. The 2022 American College of Rheumatology guideline for rheumatoid arthritis conditionally recommends the use of splinting, orthoses, and/or compression for patients with hand and/or wrist involvement and/or deformity, which supports the use of a PIP extension splint for these patients 1.
From the Research
PIP Extension Splint Overview
- A PIP extension splint is a type of orthotic device used to treat proximal interphalangeal (PIP) joint injuries or conditions, such as extension deficits or dislocations 2, 3.
- The primary goal of a PIP extension splint is to provide support and stability to the PIP joint, allowing for improved range of motion and reduced pain 4, 5.
Types of PIP Extension Splints
- There are various types of PIP extension splints, including:
- Extension block splints, which are designed to block excessive flexion or extension of the PIP joint 3.
- Figure-of-eight splints, which are used to provide controlled early mobilization and have been shown to yield excellent results in treating PIP joint dislocations 4.
- Active traction splints, which are dynamic splinting systems that allow for continued traction on the involved joint and aid in providing a dynamic force to unload the joint throughout its arc of motion 6.
Treatment Outcomes and Recommendations
- Studies have shown that PIP extension splints can be effective in improving range of motion and reducing pain in patients with PIP joint injuries or conditions 2, 4, 6.
- The recommended wearing schedule for a PIP extension splint is at least 6 hours a day for 8-17 weeks, with best results achieved when the splint is worn for a longer duration 2.
- Early controlled mobilization and active traction splinting have been shown to be effective in treating PIP joint dislocations and improving patient outcomes 4, 6.