Is a splint necessary for an older adult with a history of right arthritis and potential joint instability, but no current pain?

Splinting for Painless Arthritis

For arthritis without pain, splinting is not necessary and should be reserved for specific indications: joint instability, deformity prevention, or functional support during activities requiring strength. 1

When Splinting Is NOT Required

• Absence of pain alone does not mandate splint use 1
• Splinting is a conditional intervention recommended primarily for symptomatic arthritis (pain, swelling, dysfunction) or structural concerns 1
• The 2022 American College of Rheumatology guidelines conditionally recommend splinting specifically for patients with hand/wrist involvement and/or deformity, not for asymptomatic arthritis 1

Specific Indications Where Splinting May Still Be Considered (Even Without Pain)

Joint instability or deformity:

• If your right arthritis involves visible deformity, lateral angulation, or flexion contracture, splinting may prevent progression regardless of pain status 2, 3
• Structural abnormalities warrant orthotic intervention to prevent mechanical deterioration 2

Functional support during specific activities:

• Patients with rheumatoid arthritis report wearing splints more frequently for activities requiring greater strength than dexterity, even when not experiencing acute pain 4
• Working wrist splints may be used selectively during heavy activities for joint protection 4, 5

Joint protection strategy:

• If there is concern about progressive joint damage despite lack of symptoms, joint protection techniques (which may include selective splinting) are conditionally recommended 1

Important Caveats

Potential downsides of unnecessary splinting:

• Working wrist splints can decrease grip strength and dexterity when worn continuously 5
• There is no evidence that prophylactic splinting in asymptomatic arthritis prevents future symptoms or slows disease progression 5
• Patient compliance is poor when splints are prescribed without clear symptomatic benefit 4

Proper splint prescription requires professional guidance:

• Splinting should be prescribed and fitted by an experienced occupational or physical therapist to ensure appropriate selection and fit 1
• Improper splint use can lead to decreased range of motion or muscle weakness 5

Clinical Decision Algorithm

1. No pain + no deformity + no instability = No splint needed 1

2. No pain + visible deformity or instability = Consider splinting under therapist guidance to prevent progression 2, 3

3. No pain + functional limitations during specific activities = Consider activity-specific splinting (e.g., during heavy lifting) 4

4. Develops pain or dysfunction = Initiate splinting as part of comprehensive management including joint protection education and exercise 1, 2