What is the purpose of splinting in intrinsic hand position?

Purpose of Splinting in Intrinsic Hand Position

Splinting in the intrinsic hand position is primarily used to reduce pain, improve physical function, and prevent deformities in patients with hand and wrist involvement from conditions like rheumatoid arthritis.

Benefits of Intrinsic Hand Position Splinting

The intrinsic hand position (also known as the functional position) typically involves:

• 10-30 degrees of wrist extension
• Slight finger flexion
• Thumb in opposition
• Maintenance of the arches of the hand

Primary Purposes

• Prevention of contractures and deformities

  • Maintains proper joint alignment
  • Prevents shortening of muscles and tendons
  • Reduces risk of permanent deformity, particularly in inflammatory conditions 1

• Pain reduction

  • Stabilizes affected joints
  • Decreases inflammation by limiting movement
  • Provides rest to inflamed structures 2

• Functional improvement

  • Improves grip strength and manual dexterity
  • Enhances ability to perform activities of daily living
  • Maintains optimal hand positioning for function 2

Clinical Applications

Rheumatoid Arthritis

• The American College of Rheumatology conditionally recommends splinting for patients with hand/wrist involvement in rheumatoid arthritis 1
• Most beneficial for patients with moderate to high disease activity 2
• Can be used as part of a comprehensive hand therapy program

Osteoarthritis

• Recommended as initial management for degenerative changes of the first carpometacarpal joint 3
• Custom-made neoprene or rigid rest orthoses worn at night can be effective 3

Stroke Rehabilitation

• Evidence is mixed regarding effectiveness in preventing contractures after stroke 4, 5
• One high-quality trial found no significant difference in contracture formation with nightly splinting (mean difference 1°, 95% CI -3.7° to 6.1°) 4

Types of Splints

1. Static/Resting Splints

   • Immobilize the joint in functional position
   • Typically worn at night or during rest periods
   • Provide joint protection and pain relief

2. Dynamic Splints

   • Allow controlled movement while providing support
   • May be more effective for maintaining range of motion
   • Research suggests they may preserve flexion better than static splints 6

Considerations and Precautions

Potential Risks

• May increase focus and attention to the affected area
• Can lead to muscle deconditioning if used excessively
• Might promote learned non-use of the limb 1
• Serial casting for fixed functional dystonia has been associated with worsening symptoms 1

Best Practices

• Splints should be prescribed and fitted by experienced occupational therapists 1
• Regular monitoring is essential to prevent adverse effects
• Patients should be empowered to discontinue use if experiencing pain or skin breakdown 1
• Should be used as part of a comprehensive treatment approach that includes exercise therapy and joint protection techniques 3

Effectiveness

Research shows varying levels of effectiveness:

• In rheumatoid arthritis, splinting has demonstrated improvements in hand strength, dexterity, and pain reduction 2
• For flexion contractures in rheumatoid fingers, both dynamic and static splints showed significant improvement in correction of finger flexion contracture (p < 0.0005), grip strength (p = 0.001), and hand function (p < 0.0005) 6
• In stroke rehabilitation, evidence is insufficient to either support or refute effectiveness 4, 5

In conclusion, while splinting in the intrinsic hand position serves multiple therapeutic purposes, its application should be guided by the specific condition being treated, with proper fitting and regular assessment by qualified professionals.