Original Communications
Splinting in the treatment of arthritis of the first carpometacarpal joint*,**,*,**

https://doi.org/10.1053/jhsu.1999.jhsu24a0086Get rights and content

Abstract

Although much has been written about surgical treatment of arthritis of the first carpometacarpal joint, no literature exists on splinting as a conservative treatment. One hundred fourteen patients (130 thumbs) were retrospectively reviewed to determine the efficacy of splinting. Patients were grouped according to their stage of disease and whether they had carpometa-carpal joint surgery. Seventy-six percent of patients with stage I and II disease and 54% of patients with stage III and IV disease had improvement in their symptoms with splinting. There was no significant difference in the degree of improvement between the 2 groups. All patients who had initial improvement in their symptoms with splinting had between 54% and 61% average improvement in symptom severity 6 months after splinting. All groups were found to be equally tolerant of the splinting protocol and no group had a significantly higher rate of activity modification. Overall, splinting was found to be a well-tolerated and effective conservative treatment to diminish, but not completely eliminate, the symptoms of carpometacarpal joint arthritis and inflammation. (J Hand Surg 1999;24A:86–91. Copyright © 1999 by the American Society for Surgery of the Hand.)

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Materials and methods

Between December 1990 and December 1993, 125 patients (141 thumbs) were seen at our hand center for pain and disability resulting from first carpometacarpal (CMC) joint disease. Of this group, 130 thumbs in 114 patients were treated initially with a protocol of thumb splinting. Eleven of the 141 thumbs (8%) had reconstruction of the volar ligament of the first CMC joint (with or without resurfacing of the trapeziometacarpal and/or the scaphotrapezial joints) without prior splinting. The reasons

Results

Seventy-four patients with 85 involved thumbs (67%) responded to the questionnaire. Six patients with 6 involved thumbs (5%) were lost to follow-up due to death or mental incapacity. Fourteen other patients (16 thumbs; 13%) could not be located. The remaining 16 patients (19 thumbs; 15%) failed to respond to 2 postal questionnaires and multiple telephone reminders. Only patients who answered the questionnaire are considered in the following results.

Discussion

To our knowledge there are no studies that directly evaluate splinting as a conservative treatment for first CMC joint arthritis. Anecdotal mention of its use in the literature on surgical treatment lists poor patient compliance and limitation of hand function as its main disadvantages. 4, 5, 6, 7 At the time of initial consultation, however, most patients are reticent to commit to surgery because of concern about postoperative pain and fairly prolonged immobilization and therapy. The patient

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Reprint requests: Carrie R. Swigart, MD, Yale University School of Medicine, Department of Orthopaedics and Rehabilitation, Sports Medicine Center, One Long Wharf, 6th Floor, New Haven, CT 06511.

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J Hand Surg 1999;24A:86–91

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0363-5023/99/24A01-0013$3.00/0

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