Custom Splints Effective in Managing Symptoms of Mild-to-Moderate Osteoarthritis of the Distal Interphalangeal Joints
Osteoarthritis, often referred to as the wear-and-tear arthritis, can affect the joints in your fingers. The result can be not only pain, but difficulty performing every day tasks. Treatment of osteoarthritis depends on where the joint is and how severe the impact is on the patient. When the osteoarthritis affects the distal interphangeal joints, the joints closest to your finger tip, treatment may involve splinting or surgery, depending on the severity. In early-stage osteoarthritis with early symptoms, physicians generally prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) and/or immobilization with the splint. There are two reasons for the splinting. One is to reduce the movement of the joint, thus limiting the pain, but the splint also protects the finger from accidentally striking objects.

There have not been many studies that looked into the effectiveness of commercially made splints compared to custom-made splints. In fact, a textbook, published recently, claims that splints for the distal interphalangeal joints are not well tolerated. The authors of this article designed a custom-made splint that was made to provide the support and protection needed, but allowed for the fingertip to come out over the top, leaving the patient the ability to touch and feel with the affected finger.

Researchers recruited 25 patients (24 women) who had been diagnosed with osteoarthritis of the distal interphalangeal joints, some of whom required treatment for more than one digit. They ranged in age from 42 to 76 years and they had experienced pain and difficulty for between two months and two years prior to entering the study. Only six patients required one splint, while the remaining 19 patients had splints on two or more. In all, there were eight thumbs, 20 "pointing" and middle fingers, and 21 ring and "little" fingers.

Each joint was graded by a researcher, on a scale of zero to 4:

0: normal joint
1: small build up of bone (osteophyte) that did not seem significant
2: definite osteophyte
3: osteophyte and joint space narrowing
4: severe joint space narrowing

The splint was molded and fit onto the finger of each patient. The plastic is then and allows for a slight bend, which makes it easier for the patient to use the other fingers. The splints were to be worn all day, but the patients were allowed to remove them if they became too uncomfortable and stop using them when the pain went away. The patients did not take any NSAIDs during the course of the study.

The patients were assessed before and after treatment through interviews, physical examinations, and using questionnaires, such as the visual analog scale (VAS), which measures pain on a scale of zero to 100, with 100 being the worst possible pain. Function was assessed with the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) measure.

Upon gathering the data, the researchers found that, on average, patients rated pain at 56 out of 100, with a range from 24 to 75. After the treatment, the average pain rating was only 17, with a range from zero to 50. The disability scoring moved decreased from an average of 28 (range of nine to 64) down to 17 points (range zero to 59). When asked, most of the patients said they were satisfied with appearance of the splint and more than 76 percent of the patients did not refuse to use the splint. None of the patients removed the splints during social occasions and no patient complained of skin irritation from the splint. Three patients did report sweating under the splint when wearing it for extended periods. Other findings were:

- 19 patients wore the splint to immobilize the joint and protect it
- 9 patients used the splint as a protective device when performing manual labor
- No patients reported loss of fingertip sensation
- 4 patients reported splint loosening when using soap and water
- 1 patient reported that he was able to do fine motor tasks (such as turning a page or pinching), while wearing the splint
- Some patients reported limited ability to use their ring finger or little finger if they were splinted

The authors concluded that this type of splint would be useful for patients who had a flare-up of symptoms (pain, swelling) resulting from mild to moderate osteoarthritis.The splint is not designed to correct any deviation or dislocation of the joint, so it would not be used for this problem in patients with stage 4 grading. It could, however, help relieve pain.
Masayoshi Ikeda, MD, PhD, et al. Custom-Made Splint Treatment for Osteoarthritis of the Distal Interphalangeal Joints. In Journal of Hand Surgery. April 2010. Vol. 35. No. 4. Pp. 589-593.