Arthritis is a very common disorder that includes more than 100 different types of joint diseases and can affect people of all ages. We give you a short introduction to arthritis, how it is diagnosed and how orthoses can help people who suffer from this common yet often misunderstood joint disease.
1. What is arthritis? What is the difference between osteoarthritis and rheumatoid arthritis?
Arthritis is a general term that means joint inflammation. It refers to conditions that cause joint pain, stiffness, swelling, and other related symptoms.
Osteoarthritis is the most common form of arthritis. In osteoarthritis, the cartilage in the joints wears away, causing the bones to rub against each other which causes pain and stiffness.
Rheumatoid arthritis is a systemic disease where the body produces excessive inflammation in and around the joints, leading to deformities. In advanced cases, the disease process may cause tendon rupture or tendon subluxation and even joint destruction.
2. What are the most common symptoms of arthritis?
- Morning stiffness that lasts 30 minutes or longer
- Joint pain
- Limited range of motion, or abnormal motion in the affected joint
3. What joints will be affected?
In the hand, Osteoarthritis commonly affects the small finger joints and/or the base of the thumb:
- The Proximal interphalangeal (PIP) joint can be affected by bony nodules called Bouchard’s nodes.
- The Distal interphalangeal (DIP) joint might be affected by Heberden’s nodes.
- The carpometacarpal (CMC) joint of the thumb can be affected by basilar joint arthritis.
Rheumatoid arthritis commonly affects the wrist joints and the metacarpal (MCP) joints of the hand.
The PIP joints in the fingers may display:
- The Boutonniere deformity.
- The Swan Neck deformity.
4. How do orthoses help?
Immobilisation of the affected joints in an orthosis can provide pain relief by eliminating the rubbing of bone on bone. Orthoses can offer stability to a weakened joint and help to hold the joint in its normal alignment, preventing unwanted postures.
Orthoses can also offer a comfortable resting position for the entire hand and wrist at nighttime, reducing symptoms and allowing for restful sleep.
5. Which orthoses are recommended for arthritis?
This depends on which joints are affected.
- Wrist orthoses and resting hand orthoses can be helpful for patients with wrist pain and/or pain in the entire hand.
- Thumb orthoses help with arthritis of the base of the thumb.
- The fingers can benefit from individual finger immobilisation orthoses or from specific orthoses designed to correct the unwanted posture of a swan neck or boutonniere deformity.
6. What are the goals of wearing an orthosis?
The goals of the orthosis should be patient-specific and might include the following:
- Provide pain and symptom relief.
- Improve positioning for functional tasks.
- Stabilise a weak joint.
- Realign a deformity in a joint.
- Prevent unnecessary joint motion.
7. What guidelines are recommended for the fabrication of orthoses for patients with arthritis?
The specific orthosis should be simple in design and relatively easy to don and doff. Only the affected joints should be included in the orthosis and it should not be too heavy or cumbersome. The orthosis should be custom-made for each patient.
Re-evaluate your patient periodically to make sure that the orthosis continues to fit well.
8. What Orfit materials are best suited for patients with arthritis?
Orfilight, Orfilight Black NS and Orfilight Atomic Blue NS are 30% lighter in weight than other thermoplastic materials while offering great support and positioning. The low weight creates a more comfortable orthosis. All of the Orfilight products are available in different thicknesses and perforation patterns.
Orficast and Orficast More are also excellent materials for treating any type of arthritis. These lightweight materials have a fabric-like feel and offer the possibility to fabricate many types of orthoses. Orficast orthoses will even fit easily underneath gloves.
9. Is there immediate relief of symptoms with an orthosis?
Patients with severe symptoms should wear the orthosis all of the time initially. Simply wearing the orthosis will not offer immediate relief, but over time, the patient will notice a lessening of the symptoms. The inflammation in the joint might settle down a bit due to the immobilisation provided by the orthosis. Patients might notice decreased swelling and stiffness. After a few weeks, they might not need to wear the orthosis all of the time, only when there is a flare-up of symptoms.
10. What are other benefits of wearing an orthosis besides pain relief?
Wearing the orthosis might enable the patient to do an activity that they had not been able to do previously due to pain, such as holding a knitting needle or paint brush. An orthosis that helps to position the fingers out of the swan neck or boutonniere deformity will allow for greater grasp and release. Ultimately, an orthosis can help to prevent an abnormal posture from becoming worse.
Written by Debby Schwartz, OTD, OTR/L, CHT
Physical Rehabilitation Product and Educational Specialist at Orfit Industries America.
Debby is a certified hand therapist with over 36 years of clinical experience. She completed her Doctorate of Occupational Therapy at Rocky Mountain University of Health Professions in 2010. She has worked at Orfit Industries America as Product and Educational Specialist since 2007.
Debby is also an adjunct professor at the Occupational Therapy Department of Touro College in NYC and has written many book chapters in the field of hand therapy and multiple articles for hand therapy journals, including the ASHT Times and the Journal of Hand Therapy. She has published a new textbook on orthotic fabrication together with Dr. Katherine Schofield, entitled “Orthotic Design and Fabrication for the Upper Extremity: A Practical Guide”.
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