What type of hand splint is recommended for a patient with conditions such as arthritis or carpal tunnel syndrome?

Hand Splint Recommendations

For thumb base (trapeziometacarpal) osteoarthritis, prescribe a custom-made thermoplastic long thumb orthosis covering both the thumb base and wrist, worn during activities of daily living for at least 3 months. 1, 2

Splinting by Specific Condition

Thumb Base Osteoarthritis (Trapeziometacarpal Joint)

• Full splints covering both thumb base and wrist provide superior pain relief compared to half splints (effect size 0.64, NNT=4 for improving daily activities) 2
• Custom-made thermoplastic long thumb orthoses should be worn during activities of daily living for a minimum of 3 months to achieve beneficial effects on pain 2
• Do not expect improvement with splint use shorter than 3 months, as evidence shows no benefit with abbreviated wear periods 2

Hand Osteoarthritis (Finger Joints)

• The American College of Rheumatology conditionally recommends splints specifically for trapeziometacarpal joint OA, but does not make strong recommendations for splinting other hand joints 1
• For lateral angulation or flexion deformities, orthoses should be applied to prevent or correct these deformities 3, 4

Rheumatoid Arthritis

• Soft resting hand splints are superior to hard splints for pain relief and compliance in rheumatoid arthritis 5
• Soft splints achieve 82% compliance versus 67% for hard splints, with 57% of patients preferring soft splints 5
• Both soft and hard resting splints significantly reduce arthritis pain when worn nightly, but soft splints result in fewer painful joints 5
• Air pressure splints effectively reduce swelling, pain, and stiffness in rheumatoid hands, with benefits persisting throughout treatment 6

Chronic Wrist Pain

• Custom-made leather wrist splints are superior to commercial fabric splints for chronic wrist pain (effect size 0.79 vs 0.43 for pain reduction) 7
• Both splint types significantly reduce pain and improve hand function without increasing wrist stiffness when worn for 2 weeks 7
• 72% of patients prefer custom-made leather splints over commercially available options 7

Mallet Finger (Acute Type 1a or 1b)

• Custom-made thermoplastic thimble splints have zero treatment failure rates compared to 23.8% failure with Stack or dorsal aluminum splints 8
• All splint types must be worn continuously for 8 weeks followed by 4-week graduated withdrawal 8
• Patient compliance correlates negatively with extensor lag (medium correlation), making splint tolerability critical 8

Critical Implementation Points

Splint Selection Algorithm

1. Identify the specific joint(s) involved: Treatment differs significantly for interphalangeal, metacarpophalangeal, or trapeziometacarpal joints 2
2. For thumb base OA: Use full thermoplastic splint covering thumb and wrist 2
3. For rheumatoid arthritis: Prioritize soft resting splints for better compliance 5
4. For chronic wrist pain: Custom leather splints outperform commercial options 7
5. For mallet finger: Custom thermoplastic thimble splints minimize treatment failure 8

Duration and Compliance

• Thumb splints require minimum 3-month wear during daily activities to demonstrate efficacy 2
• Mallet finger splints require 8 weeks continuous wear followed by graduated withdrawal 8
• Rheumatoid arthritis splints should be worn nightly for pain relief 5
• Custom-made splints consistently achieve better compliance than prefabricated options 5, 7

Common Pitfalls to Avoid

• Do not prescribe splints for less than 3 months for thumb base OA, as shorter periods show no benefit 2
• Do not use prefabricated splints when custom options are available, as custom splints have superior outcomes and compliance 8, 7
• Do not prescribe hard splints for rheumatoid arthritis when soft splints achieve better pain relief and 15% higher compliance 5
• Do not rely on splinting alone—combine with joint protection education, range-of-motion exercises, and topical NSAIDs as first-line therapy 3, 4