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Objectives
RA Hand
Chronic, systemic,
autoimmune disease
Symmetrical peripheral
polyarthritis
Irreversible hand
deformities
VCH
RA Hand
VCH
VCH
More effective RA
medications
severe hand
deformities
VCH
Presence is predictor
of disease severity
Correlated with
positive RF, active
synovitis & disease
duration
Intrinsic ms spasm
common in first 3
years develop
contractures
VCH
Akhavani 2011; Horsten 2010; Johnsson 2009; Madenci 2003; Eberhardt 1991
VCH
Functional consequences
& impact QOL
Horsten 2010; Johnsson 2009; Adams 2008; Vliet Vlieland 1996; Eberhardt 1991
RA Hand
Occupational
limitations & job loss
common among
active, working-age
RA with hand
deformities
VCH
Understanding
pathomechanics &
early recognition of
deformities crucial for
proper management
RA individuals often
reluctant to report
hand-related problems
early
VCH
10
VCH
VCH
Swan-Neck Deformity
(SND)
44%
24%
VCH
Boutonniere Deformity
(BD)
24%
11
Johnsson 2009
Volar Subluxation
VCH
12
VCH
Johnsson 2009
UDD
Ulnar Deviation Pathomechanics
VCH
VCH
13
UDD
Volar Subluxation Pathomechanics
PP
CL
VP
EFF (FDS & FDP)
VCH
VCH
14
15
Impairment of tripod
pinch lateral key
pinch UD (DI vs
thenar / hypothenar)
Compromised power
grip d/t involvement of
ulnar digits ( hypoxia
radial ulnar)
Inability to extend
MCPJs impairment
of grasp
VCH
Management of UDD
Splinting
Hand Exercises
16
Splint
Tripod
No
Limitation:
No control group
17
Evaluated
movement
Showed
18
19
Porter 2012
Purpose
Design/Type Thermoplastic
Wear
instructions
Precautions
Porter 2012
20
Purpose
Pain
Flexion force during grip
Function by realigning fingers
or prevent intrinsic-plus position
Design/Type
Wear instructions
Precautions/
Contraindications
21
Porter 2012
Management of UDD
Splinting
Hand Exercises
22
23
hand
No
Appropriate
24
25
Porter 2012
26
VCH
27
Porter 2012
1
4
1
3
Porter 2012
28
VCH
Porter 2012
29
VCH
30
VCH
Porter 2012
VCH
VCH
Porter 2012
31
Interossei Stretch
(Passive)
VCH
VCH
Porter 2012
32
Lumbrical Stretch
(Active)
VCH
33
Porter 2012
Porter 2012
34
VCH
VCH
Swan-Neck Deformity
(SND)
44%
24%
VCH
Boutonniere Deformity
(BD)
24%
35
Johnsson 2009
SND
VCH
Pathomechanics complex
36
Porter 2012
SND
VCH
37
Chronic inflammatory
state triggers IM spasm
PP volarly subluxes
overactivity of IM create
excessive extensor
force PIPJ
hyperextension
38
Attenuation of
transverse retinacular
ligament dorsal
migration of lateral
bands PIPJ
hyperextension
39
flexion initiation
Activities
requiring tip to
tip or tripod pinch
Activities
requiring
composite grip
Application
of pressure
at finger tip
VCH
Comprehensive
hand-
related tasks
van der Giesen 2010
40
Management of SND
Splinting
Hand Exercises
41
Both
42
For
43
SRS
44
45
Porter 2012
Pain
Swelling
Risk of intrinsic / extrinsic flexion
contractures
Purpose
Design/Type Thermoplastic
Supports PIPJ in 10-150 flexion
Wear
instructions
Precautions
46
3 Point Splints
VCH
Purpose
Pain
PIPJ hyperextension
Hand function
Porter 2012
Management of SND
Splinting
Hand Exercises
48
Porter 2012
49
VCH
Porter 2012
50
VCH
51
Porter 2012
VCH
Porter 2012
52
VCH
Porter 2012
53
54
Porter 2012
VCH
VCH
Swan-Neck Deformity
(SND)
44%
24%
VCH
Boutonniere Deformity
(BD)
24%
55
Johnsson 2009
VCH
56
Synovitis @ PIPJ
PIPJ flexion
DIPJ hyperextension
@ VCH
BD
Pathomechanics
VCH
Hand Clinic
57
Synovitis @ PIPJ
PIPJ flexion
DIPJ hyperextension
@ VCH
BD
Pathomechanics
VCH
Hand Clinic
58
Functional Consequences of BD
VCH
59
Management of BD
Splinting
Hand Exercises
60
Splints for BD
Li-Tsang et al. The Effect of Corrective Splinting on
Flexion Contracture of Rheumatoid Fingers. J Hand
Ther 2002;15:185-191.
Compared
Both
61
Porter 2012
62
Compression Dressings
VCH
Purpose
Purpose
Design/Type Thermoplastic
Supports PIPJ in 00 extension
stress central slip; prevents tightening
of ORL & lateral bands
Wear
instructions
64
Purpose
Precautions /
Skin irritation; pressure points; limit ADLs
Contraindications Metal 3 point splint contraindicated for
acutely inflamed PIPJ
Porter 2012
65
Management of BD
Splinting
Hand Exercises
66
Porter 2012
67
VCH
Porter 2012
68
VCH
69
Porter 2012
ORL Stretch
(Passive)
VCH
Porter 2012
70
Summary of BD Management
Porter 2012
71
CESEI
72
amrah
73
74
Questions
75
References
76
References
77
References
Formsma SA, van der Sluis CK, Dijkstra PU. Effectiveness of a MPblocking splint and therapy in RA: A descriptive pilot study. J Hand
Ther. 2008; 21:347-53.
78
References
Li-Tsang CW, Hung LK, Mak AF. The effect of corrective splinting on
flexion contractures of rheumatoid fingers. J Hand Ther 2002;15:185191.
79
References
van der Giesen FJ, Nelissen RGHH, van Lankveld WJ et al. Swan
neck deformities in rheumatoid arthritis: a qualitative study on the
patients perspectives on hand function problems and finger splints.
Musculoskelet Care 2010;8:179-188.
80
References
Vliet
Vlieland TP, van der Wijk TP, Jolie IM et al. Determinants of hand
function in patients with rheumatoid arthritis. J Rheumatol 1996;23:835840.
Welsh RP, Hastings DE. Swan neck deformity in rheumatoid arthritis of
the hand. Hand 1977;9:2:109-116.
Wessel J. The effectiveness of hand exercises for persons with
rheumatoid arthritis: a systematic review. J Hand Ther 2004;17:174-180.
Westby MD, Minor MA. Exercise and physical activity. In Bartlett SJ,
Bingham CO, Maricic MJ et al., editors. Clinical care in the rheumatic
diseases. 3rd ed. Atlanta: ARHP; 2006. pp. 211-220.
Zilstra TR, Heijnsdijk-Rouwenhorst L, Rasker JJ. Silver ring splints
improve dexterity in patients with rheumatoid arthritis. Arthritis Care Res
2004;51:6:947-51.
81
Appendix:
Functional MCP Splint for UDD
Index
Long
Web
space
A
B
Thenar
VCH
VCH