Splints for Thumb Arthritis: Are They Worth It?
Pain at the base of the thumb — on gripping, pinching or turning — is the hallmark symptom of thumb arthritis (rhizarthrosis). For many patients, the question of whether to use a splint comes up early, either because their GP has recommended one or because they have read about them online. It is a reasonable question, and the answer is more nuanced than it might first appear.
A splint does not treat the underlying arthritis. What it does is reduce the mechanical load on the worn carpometacarpal (CMC) joint, giving the joint less to do during activities that would otherwise provoke pain. Used in the right way, at the right stage, it can make a meaningful difference to day-to-day comfort. Used incorrectly — or relied upon as the only strategy — it is less likely to help.
In short: A thumb splint is a useful tool in the management of thumb arthritis, particularly in the early and moderate stages of the condition. A night splint rests the joint during sleep and often helps with morning pain and stiffness. A daytime functional splint reduces pain during activities without immobilising the wrist. Neither replaces other treatments — including hand therapy, injections or surgery when the time is right — but splinting is a practical, low-risk starting point for many patients.
What does a splint actually do for thumb arthritis?
A thumb splint for arthritis works by stabilising the CMC joint — the small saddle-shaped joint at the base of the thumb where the wear occurs. By holding the joint in a supported position, the splint reduces the amount of grinding and abnormal movement that occurs with use, which in turn reduces pain.
A splint can help to:
limit the painful pinching and twisting movements that aggravate the joint during daily tasks,
reduce pain and swelling during an acute flare,
rest the joint overnight to ease morning stiffness,
and allow patients to continue activities they would otherwise find too painful.
It is important to be clear about what a splint cannot do: it will not reverse cartilage loss, stop the progression of the arthritis or provide a lasting cure. It is a management tool, not a treatment in the curative sense.
What is the difference between a night splint and a daytime splint?
There are two main types of thumb splint, used in different situations.
Night splint. A night splint holds the thumb — and often part of the wrist — in a resting position during sleep. It is more rigid and more enveloping than a daytime splint and is designed to prevent the thumb from moving at all during the night. For many patients, the joint is more inflamed after a day of use, and the night splint allows it to recover during sleep. Morning pain and stiffness — a very common complaint in thumb arthritis — often improve with regular night splinting. It is frequently the first splint recommended and the most straightforward to try.
Daytime functional splint. A daytime splint is designed to be worn during activities. It is lighter and more discreet than a night splint and is constructed to stabilise the thumb joint while leaving the wrist free, so that the hand can still function. Crucially, a good daytime splint should be low-profile enough to allow the thumb to be used — many off-the-shelf splints are so bulky that patients find them more hindrance than help, and abandon them within days. A well-fitted, low-profile splint allows patients to cook, write, use a keyboard or manage most daily tasks with less pain than they would experience unsupported. It is not intended to completely immobilise the thumb — that would make it impractical — but rather to reduce the load at the critical point of pinch and grip.
Many patients end up using both: a night splint for rest and an intermittent daytime splint for activities that are particularly provocative.
Does a splint need to be custom-made?
Off-the-shelf thumb splints are widely available from pharmacies and online. For mild symptoms and a straightforward thumb anatomy, a standard splint may be adequate to try initially.
However, custom-made splints — designed and fitted by a hand therapist or orthotist — offer meaningful advantages, particularly as the condition progresses:
a custom splint is moulded precisely to the shape of the individual hand, which improves both comfort and effectiveness,
it can accommodate deformity or instability at the joint that a standard splint cannot address adequately,
the materials used are generally more durable and breathable for extended wear,
and it can be adjusted over time as symptoms change.
In my practice, I refer patients for a custom thumb splint when off-the-shelf options have not provided adequate relief, when the joint has begun to drift or deform or when the patient needs to wear a splint for extended periods. A hand therapist will take a mould of the hand and fabricate the splint to fit precisely — the process typically takes one or two appointments.
When is splinting most useful?
Splinting tends to be most helpful at the following stages:
Early and moderate thumb arthritis. When symptoms are intermittent — present during certain activities but not constant — a splint during those activities and at night is often enough to keep patients comfortable and functional without the need for other interventions.
During a flare. An acute inflammatory flare, with swelling, heat and more constant pain, often responds well to a period of rest in a night splint combined with anti-inflammatory medication. The splint reduces the mechanical provocation to the inflamed joint.
Alongside other treatments. Splinting works well in combination with hand therapy exercises and corticosteroid injections. The exercises maintain the strength and mobility of the muscles around the joint; the splint protects it during provocative activities.
After surgery. Following thumb arthritis surgery — whether trapeziectomy or joint replacement — a splint is an essential part of the recovery protocol. The post-operative splint is always custom-made and is adjusted as the hand heals. This is distinct from the use of a splint for symptom management in a non-operated hand.
Are there any downsides to using a splint?
A splint is a low-risk intervention, but there are a few practical points worth noting. Wearing a splint continuously during the day — rather than during provocative activities — can lead to weakening of the small muscles around the thumb over time. For this reason, splinting is best combined with appropriate hand therapy exercises rather than used as the sole measure. There is also an adjustment period with any new splint: some patients find a custom splint initially uncomfortable before it is broken in, and it is worth reporting any rubbing or pressure points to the therapist so they can be corrected.
My approach to splinting in thumb arthritis
For patients who present with early or moderate thumb arthritis, I almost always recommend a trial of splinting before any discussion of injections or surgery. A well-fitted thumb splint, combined with advice from a hand therapist on joint protection and activity modification, can substantially reduce symptoms and improve function — and for some patients that is sufficient management for a considerable period.
Where splinting has been tried and has not provided adequate relief, or where the arthritis is more advanced and symptoms are more constant, the conversation naturally shifts towards corticosteroid injection or surgery. Those decisions are made together, based on what the patient most wants to achieve and what their hand examination and X-rays show.
For further information on the full range of treatments for thumb arthritis — from splinting and injection through to surgery — mythumb.co.uk has a comprehensive guide to splinting and bracing for rhizarthrosis that complements what is covered here. A full overview of thumb arthritis surgery options is also available on this site.
If you would like to discuss your thumb symptoms, you are welcome to book a consultation at my clinics in Hertfordshire or London.
Frequently asked questions about thumb splints
Can I buy a thumb arthritis splint without seeing a doctor? Off-the-shelf thumb splints are available from pharmacies and online without a prescription. They are a reasonable first step for mild symptoms. If symptoms persist, worsen or you are unsure of the diagnosis, it is worth seeing your GP or a specialist who can confirm the cause of your symptoms and advise on the most appropriate splint for your situation.
How long should I wear a thumb splint each day? This depends on the type of splint and the stage of your symptoms. A night splint is typically worn during sleep. A daytime functional splint is generally worn during activities that provoke pain rather than continuously. Your hand therapist or surgeon will advise on the appropriate regime for your situation.
Will wearing a splint make my thumb weaker? Prolonged full immobilisation of any joint can contribute to muscle weakening. For this reason, daytime splinting is best targeted at provocative activities rather than used continuously, and it should be combined with appropriate hand therapy exercises to maintain muscle strength around the thumb.
How long does a custom thumb splint take to make? A custom splint is usually ready within one or two appointments with a hand therapist or orthotist. The therapist takes measurements or a mould of the hand, fabricates the splint and then fits and adjusts it at a follow-up appointment.
Does a splint help with thumb arthritis at night? Night splinting is one of the most consistently useful applications of splinting in thumb arthritis. Keeping the CMC joint in a rested position during sleep often reduces morning stiffness and pain, which is a common and disruptive symptom. Many patients notice an improvement within a few weeks of regular night splinting.
If a splint helps, does that mean I won't need surgery? Not necessarily. A splint that provides good symptom control in the early or moderate stages of thumb arthritis may mean that surgery is not needed for some time — or in some patients, at all. However, thumb arthritis is a progressive condition and the degree of benefit from a splint typically reduces as the arthritis advances. If and when that happens, other treatment options are available.
About the author
Mr Gavin Schaller FRCS(Tr&Orth) — Consultant Hand & Wrist Surgeon The Schaller Hand & Wrist Clinic, Hertfordshire & London
This article is for general information only and does not constitute medical advice. If you are concerned about thumb pain or arthritis, please seek assessment from a qualified medical professional.
