IMPLE ORTHETIC DEVICES can be made for the fingers and thumb S that will permit necessary functional use but prevent most of the persistent positions of fault that could lead to structural deformity. It therefore seems reasonable to believe that if these devices can be fitted at the earliest signs of persistent faulty alinement in arthritic joints, and if the patient will wear these devices, functionally dangerous deformities can be avoid-ed, or significantly controlled. Most of us have long used "rest splints" for the control of pain and deformity, and "corrective splints" to overcome or retard deformity. While these are orthetic devices of proven value, most of them are heavy, cumbersome, and poorly adapted to the functional requirements of the hand.
For the past several years, we have attempted to develop orthetic devices that could be used during both daily activity and nightly rest. To prevent deformity, such devices would be prescribed as part of a total program to retain joint mobility and muscle strength. The devices would be indicated as soon as the earliest deviations from normal alinement were noted.
A device to prevent deformity in an involved, but still mobile and responsible joint, must permit the normal planes of motion necessary for essential function, but block all faulty planes that might result in functionally significant deformity. Such a device must also have certain attributes before the patient will consent to wear it as it must be worn; both day and night.
First, it must be comfortable and light in weight. Second, it must be acceptable in appearance, stay in place during use, but slip on and off easily when desired, Third, it must be durable, and if at all possible, have no buckles, straps, clips, buttons, adhesive tape, or other holding devices that stretch, break, smell offensively, or deteriorate in any way.
These are the goals that we set for ourselves in the design, fabrication, and fitting of preventive devices. We are quite willing to admit that some patients would not wear splints even if they were invisible, weightless, and cost nothing.
Assuming that we could achieve the above objectives-the reasonable ones-what is the rationale for considering the use of such a device in the first place? For all practical purposes, a major factor-perhaps the major factor-in the pathogenesis of musculoskeletal deformities in arthritis may be simply stated: persistent faulty positioning of joint structures during rest or activity. The immediate causes of this faulty positioning may be pain, or muscle spasm which, if uncontrolled, cause eventual freezing of the joint