title: Splinting and hand exercise for three common hand deformities in rheumatoid arthritis:  a clinical perspective.
abstract: OBJECTIVE
  Hand deformities (ulnar drift, swan neck and boutonniere) are prevalent in rheumatoid arthritis and develop early in the disease process. These deformities cause significant functional impairment and impact quality of life. This review will provide a clinical perspective using the most recent evidence regarding the role of splinting and hand exercise in their management. The pathomechanics and functional consequences of these deformities are also described.
  
  
  RESULTS
  Patients tend to under-report their hand problems and are often reluctant to seek treatment for their deformities. There is limited evidence to support or refute the role of splinting and hand exercises in their management. Clinical experience suggests splinting and hand exercise are most beneficial when prescribed for early, flexible deformities.
  
  
  CONCLUSIONS
  More research is required to guide clinicians on the most effective approach to the management of these three hand deformities. It is imperative that clinicians assess for and recognize these deformities in order to ensure timely and appropriate treatment. Until more evidence becomes available, an evidenced-informed approach is recommended.
authors.affiliation: Vancouver Coastal Health, Mary Pack Arthritis Program, Vancouver, British Columbia, Canada. barbara.porter@vch.ca
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Porter
authors.forename: Asuko
authors.initials: A
authors.lastname: Brittain
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications*; D005081:Exercise Therapy; D006227:Hand Deformities, Acquired / Q000209:etiology / Q000628:therapy*; D006801:Humans; D013165:Splints