What is the best splint for extensor tenosynovitis at the fingers/wrist?

Best Splint for Extensor Tenosynovitis at the Fingers/Wrist

For extensor tenosynovitis at the fingers and wrist, a wrist-inclusive resting splint that immobilizes the wrist in neutral to slight extension (0-30 degrees) with the fingers in a relaxed position is the most appropriate initial treatment, combined with activity modification and anti-inflammatory measures.

Splinting Approach

Wrist Position and Design

• Position the wrist in neutral to 30 degrees of extension to minimize stress on the extensor tendons while preventing contracture 1
• Include wrist immobilization as part of the splint design, as wrist-inclusive splints provide superior support and reduce extensor muscle activity during rest 2
• The splint should extend from the mid-forearm to just proximal to the fingertips, allowing some finger motion while protecting the extensor mechanism 1

Application Guidelines

• Use the splint primarily during rest periods and at night, as splinting during heavy activity can paradoxically increase extensor muscle activity by 7.9-23.9% and may be counterproductive 2
• Limit splint use to periods of no-to-light activity to maximize therapeutic benefit 2
• Remove the splint for gentle range-of-motion exercises to prevent stiffness 1

Clinical Reasoning

The evidence base for splinting in extensor tenosynovitis specifically is limited, requiring extrapolation from related conditions. The key principles are:

• Wrist immobilization reduces extensor tendon excursion and allows inflammation to subside 1
• Static splinting at rest decreases wrist extensor muscle activity (<4% maximum voluntary effort) when not gripping, providing mechanical unloading 2
• For inflammatory tenosynovitis, immobilization prevents further mechanical irritation while medical management addresses the underlying inflammation 3

Important Caveats

• Avoid splinting during work activities requiring grip strength, as this increases rather than decreases extensor muscle activity 2
• If tenosynovitis persists despite conservative management including splinting, consider that surgical tenosynovectomy may be necessary to prevent tendon rupture, particularly in inflammatory conditions like rheumatoid arthritis 3
• Dynamic splinting protocols (used for post-surgical extensor tendon repairs) are not appropriate for acute tenosynovitis, as they maintain motion rather than rest 4

Adjunctive Measures

• Combine splinting with topical NSAIDs for localized anti-inflammatory effect 5
• Consider corticosteroid injection if conservative measures including splinting fail after 4-6 weeks 1
• Monitor for signs of tendon rupture (sudden loss of active extension) which would require urgent surgical evaluation 3