Wednesday, July 3, 2013

Rheumatoid Arthritis: Splinting And The Hand Occupational Therapist

For the patient with rheumatoid arthritis, splinting is a common management utilised by the hand occupational therapist, during all stages of the disease. Its uses includes therapeutic benefits, pre-operative and post-operative management as well as splinting can help to improve the function of the hand and upper limb.

Splinting for therapeutic purposes decreases the amount of joint pressure (P=F/A; the wider the surface area the lesser the amount of pressure experienced) and inflammative results by stopping any painful movements and reflex muscle tensions and spasms during the acute stage of the disease. An example will be the resting hand splint for the fingers, hand and wrist; although a gutter splint for the finger joint can also be fabricated for the finger. This kind of splints protects and supports the joints and its structure and limits muscle spasms that encourages positions of deformity.

The resting position for the wrist is at 15-25 degrees extension in neutral position for supination; metacarpalphalangeal (MCP) joint in zero deviation and 30 degrees flexion, and finger joints in 5-15 degrees flexion. There is to be balance between wearing the splint in immobility coupled with gentle active and passive exercises to the point of discomfort to the joints, at least 1-3 daily.

Functional splinting aims to manage unstable and/or painful joints and is used very often during the sub-acute and chronic stages of the disease. Painful and unstable joints have decreased mobility because of pain and impaired biomechanics, limiting mobility and function. Having a splint that positions the joints in optimal biomechanical position stabilizes joints in optimal positions for movement and stability. This often results in improved mobility, lesser pain, and better function.

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