The splint that lost to a conversation

Method of the week

I bought a thumb splint in March. Twenty-two dollars, neoprene, a strip of plastic sewn into the palm.

It helped, or I thought so. Wearing it I could open a jar without the wince, and I told Carol it was the best twenty-two dollars I had spent all year.

Then I went and read the trials… which is a habit that regularly costs me my good mood.

So today: the thumb splint. What it does, what it does not, and why a guideline and a good trial can both be right at once.

First, the good news

A splint for the base of the thumb does beat nothing. That much is settled.

A network meta-analysis in the Archives of Physical Medicine and Rehabilitation pooled eleven trials and 619 people with thumb base arthritis. It compared four kinds of splint against a placebo: short and long, rigid and soft. Every one of them came out ahead of placebo on pain.

The longer rigid splint ranked best for easing pain. The shorter rigid one ranked best for what people could do with the hand. So the reviewers suggested starting long, then moving to short.

European guidelines agree, and go further. The 2018 EULAR recommendations say orthoses should be considered for symptom relief in thumb base arthritis, and that long term use is advocated. Orthosis is just the formal word for a splint… and long term means months, not two weeks.

Then, the trial that spoiled it

But look at what a splint is usually compared against. Placebo. Nothing… a sham. Beating nothing is a low bar for anything you pay for.

In 2021 a British team asked a harder question, and published it in Rheumatology. They took 349 people with thumb base arthritis and split them three ways.

One group got supported self-management from a therapist: the exercises, the joint protection, the advice about how to hold things. The second got that plus a real splint. The third got that plus a placebo splint.

Everybody improved. And at eight weeks, on the hand pain score, the gaps between the three groups came out at half a point, a tenth of a point, and four tenths of a point. On a scale where those are rounding errors. None of them reached significance. The authors concluded there was no additional benefit from adding a thumb splint to a good self-management program.

Anyway, I still wear mine. Not every day, and not to bed. I put it on for the jobs that used to make me wince, which is mostly jars and the garden shears.

Twenty-two dollars for a bit of comfort on the bad afternoons is fine by me. I have just stopped telling myself it is the treatment.

The treatment is two minutes, twice a day, and the way I pick things up. We will get to the picking up.

Here is to an honest twenty-two dollars,
Walt