Night-time immobilization of the distal interphalangeal joint reduces pain and extension deformity in hand osteoarthritis.

Journal article

OBJECTIVE: DIP joint OA is common but has few cost-effective, evidence-based interventions. Pain and deformity [radial or ulnar deviation of the joint or loss of full extension (extension lag)] frequently lead to functional and cosmetic issues. We investigated whether splinting the DIP joint would improve pain, function and deformity. METHODS: A prospective, radiologist-blinded, non-randomized, internally controlled trial of custom splinting of the DIP joint was carried out. Twenty-six subjects with painful, deforming DIP joint hand OA gave written, informed consent. One intervention joint and one control joint were nominated. A custom gutter splint was worn nightly for 3 months on the intervention joint, with clinical and radiological assessment at baseline, 3 and 6 months. Differences in the change were compared by the Wilcoxon signed rank test. RESULTS: The median average pain at baseline was similar in the intervention (6/10) and control joints (5/10). Average pain (primary outcome measure) and worst pain in the intervention joint were significantly lower at 3 months compared with baseline (P = 0.002, P = 0.02). Differences between intervention and control joint average pain reached significance at 6 months (P = 0.049). Extension lag deformity was significantly improved in intervention joints at 3 months and in splinted joints compared with matched contralateral joints (P = 0.016). CONCLUSION: Short-term night-time DIP joint splinting is a safe, simple treatment modality that reduces DIP joint pain and improves extension of the digit, and does not appear to give rise to non-compliance, increased stiffness or joint restriction. TRIAL REGISTRATION: clinical trials.gov, http://clinicaltrials.gov, NCT01249391.

Authors: Watt, F; Kennedy, D; Carlisle, K; Freidin, A; Szydlo, R

• Publication status: Published
• Publisher: Oxford University Press
• Journal: Rheumatology (Oxford, England)
• Volume: 53
• Issue: 6
• Pages: 1142-1149
• Publication date: 2014-06-01
• DOI: 10.1093/rheumatology/ket455
• EISSN: 1462-0332
• ISSN: 1462-0324
• Language: English
• Keywords: Male; Aged; Single-Blind Method; Finger Joint; Hand Deformities, Acquired; Osteoarthritis; Patient Satisfaction; Middle Aged; Pain Measurement; Treatment Outcome; Range of Motion, Articular; Severity of Illness Index; Splints; Female; Humans; Pain; Immobilization