The wrist is one of the most common joints to be affected by rheumatoid arthritis. In fact, about 75% of people with RA have arthritis in the wrists, marked by pain, inflammation, joint structure damage and loss of range of motion. Wrist splints, like splints for other joints, help stabilize the joint. There are many types of wrist splints, both for activity or complete rest. They can be made of fabric or harder materials and they can be pre-fabricated or custom made to fit your shape and needs.
Resting splints immobilize the wrist to allow for a decrease in swelling and to stabilize the joint. They allow less movement of the fingers. Resting splints are often used after surgery to protect the surgical site and joint and allow healing. They are also used at night or during periods of lesser activity.
Wrist working splints allow movement of the finger and thumb joints, enabling the wearer to perform regular activities. Working splints can be made of either fabric or harder materials like thermoplastic, but are often made of softer materials like fabric (with a stabilizing metal rod on the underside of the splint). People often use them for activities that place greater demands on the wrist and hands. And like resting splints, they can improve sleep both through the act of protecting and immobilizing the joint and through the subsequent decrease in pain. In fact, recent small study published in Arthritis & Rheumatism in December found that patients who wear them as much as possible during the day for four weeks had a significant (32%) decrease in wrist pain and a small (5%) increase in grip strength. Patients who did not wear the working splints had increased pain (+17%) and poorer grip strength (-8%) after the same period of time.
So despite all of the benefits of consistent splint use, why don't we wear them as much as our doctors or other health care practitioners prescribe? Studies have shown that compliance rates for splint wearing vary depending on use and type of splint. But all of the studies showed low compliance rates in general, from as little as 25% to 60-70% compliance. The rates also vary depending on the prescribed use and the definition of compliance in each study.
There are a variety of reasons we don't wear them, most often for comfort reasons or because they make activities more difficult. Splints can be uncomfortable. People tend to be less compliant in wearing hard splints than soft splints. Splints are uncomfortable if fitted incorrectly so that they rub or pinch. This is a common problem with hard splints, which often need some extra padding around bony prominences. Splints can also get sweaty, smelly, wet and dirty. They can take a long time to dry after washing them. Fasteners can get hooked on clothing or the splint may be bulky, narrowing clothing choices. Or some people find that the appearance of the splint or the questions/ comments they generate from others make them not want to continue wearing the splint to parties or social visits. In addition, people often wear them only during acute periods of swelling, tingling or pain. And they stop wearing them as soon as they start to feel like they have pain relief, decreased swelling or better movement. This is the same type of thing that people do with their medications. They abandon the splint or medication early. Finally, some people stop wearing splints because they are afraid that relying on the splint will actually make the joint weaker or will cause it to get stiff from immobilization.
I've had more splints, casts and strapping devices in my lifetime than I can even count and I've had them for many of my joints- toes, ankles, knees, elbows, wrists, fingers. I think the only joints that have escaped are the proximal body joints like my spine, hips and shoulders. So in light of all of these possible negatives to splint wearing, I've tried to think about some strategies to make wearing a wrist splint or any other splint more tolerable. If you have other strategies, please share them in comments.
- Have your splint fitted or created by an expert, such as an occupational therapist. If it's possible, you may want to try several kinds. Or if one just doesn't fit or isn't functional for you, the therapist may be able to modify it or add padding.
- Ask questions and make sure the OT or other professional understands what you want to get out of wearing it and your concerns about wearing or caring for it. BUT, also listen to his/her advice and instructions, even if it isn't what you want to hear.
- When having a working splint fitted, try to think about specific activities (like dressing or driving) that you will need to be able to do. Simulate those activities to make sure that the splint isn't rubbing, pinching or is too uncomfortable.
- Remember that you may need to modify the way you grip something or do a task with the splint on and work or adapting the splint to your daily activities.
- Get the wearing instructions and advice (length of time each day, activities, how to wash or care for the splint, etc) in writing from the health care professional who prescribed the splint.
- If you know that you'll be doing activities with it, like cleaning or washing dishes, that will get it wet or dirty, then you may want to have two identical splints that you can interchange.
- Keep a log of your splint usage and write down questions or problems to share with your doctor or therapist.