Appliances for Arthritis

Various appliances are used for pain relief and proper functioning of joints as well as to prevent and correct deformities. Though the nature of these appliances varies according to individual joint, all of them aim at correcting joint alignment. The types and uses of these appliances are described in following sections. Individualized approach and assessment by an occupational therapist is desirable in each case.

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  • Appliances For Neck And Low Back

    Cervical (neck) collar limits neck movement, allows neck muscles to rest and avoids extra strain. A collar may be used by patients of cervical spondylosis associated with tingling and numbness in hands. Though stabilizing, collar should not be used continuously for more than a week. Prolonged use of collar weakens neck muscles and delays improvement. Use of collar increases neck pain in some cases whereas some develop skin allergy due to the collar material.

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    Collar should be of correct size as too high collar puts extra stretch on the neck muscles and a short collar does not serve its purpose. Soft collar with foam inside is advisable. Holes in the collar provide ventilation and avoid excess sweating. Rashes due to collar material can be avoided by placing a cotton handkerchief inside the collar and using talcum powder to keep the skin dry. Collar should not be used continuously for more than 3 hours at a time and should be removed while sleeping. Prolonged use of collar weakens neck muscles and nullifies the beneficial effects of exercise. A soft collar may not provide adequate immobilization whereas a rigid collar has problems of tolerance and compliance.

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    Traction involves applying weight to head-end so as to stretch neck muscles and vertebrae. This possibly reduces pressure on nerves emerging from spine. There is no sufficient scientific evidence for usefulness of traction in common neck pain. Traction helps to some extent only in those patients who have weakness of extremities.  One should start with intermittent traction using a small tolerable weight and increase weights later on. Continuous traction must be discouraged. Exercise is an integral part of management of neck pain and must not be discontinued while using collar or applying traction.  

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    As in the case of neck pain, the popular misconceptions about low back pain are back belt and traction. There is no scientific evidence to prove their efficacy in low back pain. Low back brace is for use after spine surgery only. Use of brace in common forms of back pain restricts movements and delays recovery. Another major disadvantage is developing dependence. It is not at all advisable to get hospitalized for traction for days together. Some patients feel better with traction due to pulling apart of vertebrae. They situation reverts back on releasing the traction. Patients can apply traction themselves at home intermittently for not more than 15-20 minutes each time. Traction-sets are available in market. Start with 2-3 kg weight and increase weight gradually. Stop traction if it increases pain.

  • Lower Extremity Appliances

    A knee cap (brace) can relieve pain to some extent in patients with knee arthritis. Knee cap should be of proper size (medium, large, extra-large). A tight knee cap can increase pain and cause swelling of feet. A loose knee cap does not serve the purpose. One should wear a knee cap during prolonged standing or walking and should remove it while sitting and sleeping. One may develop skin allergy in the form of rashes and itching due to the brace material. Wearing knee cap over a cotton handkerchief helps in such cases. Talcum powder may be used to get rid of excess sweating. Knee cap should be kept clean by regular washing with soft soap. It should be dried in a shade as sunlight can loosen its elastic threads. All such appliances slacken after some time. Such knee caps need to be replaced with new ones. A knee which is too unstable needs stabilizing knee cap which has hinged plastic stripes on either side. Pain under patella can be relieved by a patella stabilizing knee brace which has a hole to prevent patellar movements.    

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    Pain in one knee can be reduced by holding a stick in opposite hand. Stick should be hip-high so that one can easily put pressure on it with a straight hand.  Bring your painful limb and stick forwards, put a part of your body weight on the stick by pressing it with hand and move your other leg forwards to move ahead. A rubber tip at bottom prevents slippage. Worn out rubber tip should be replaced immediately. Some patients feel more stable with tripod lower ends. A walker should be used by patients having pain in both knees. Walkers with small front wheels are easier to manoeuver.  Walker should be light-weight and its height should be adjusted according to individual height. For those who are unable to walk can use a wheel chair. Motorized electric wheel chairs are also available though one needs to learn driving such wheel chairs. All these appliances need adequate strength in upper extremities.

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    Patients with painful knees should neither fold knees while sitting on ground nor bend them in positions such as offering Namaz or practicing Vajrasana.  One should never squat. Folding commodes (chair or stool) are available if required.  Height of commode can be increased by placing an extra seat over it.

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    Proper footwear is absolutely essential for patients with knee arthritis.  One should ideally wear shoes or sandals so that foot remains in a proper shape. Use of chappals or slippers is not advisable. Footwear with soft soles should be worn continuously even when indoors. Many patients with knee arthritis have flat feet or other foot deformities. These must be corrected by proper custom made insoles prepared by a specialized occupational therapist. One should not use high heel footwear except in situations such as Achilles tendonitis causing pain at back of heel. Heel pain can be relieved to some extent by using a soft heel rest. Foot deformities in arthritis lead to painful corns and callosities due to abnormal pressure effects. Such patients should always use corrected footwear under the guidance of an occupational therapist.

  • Upper Extremity Appliances

    Elbow brace is used during work to reduce muscle strain in cases of tennis elbow and golfer\'s elbow. The brace must be sufficiently tight to rest the muscles as these conditions are due to muscle strain related to overwork. A similar appliance, wrist band, is also available to protect wrist from abnormal straining of muscles during work and sports activities. Resting splint for tendonitis near wrist, such as de Quervain’s tendonitis, provides good pain relief and helps in reducing inflammation.  

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    Pain due to arthritis at the base of thumb (CMC 1 joint) in elderly people can be relieved by thumb spica. A thumb spica does not allow movement, thereby resting the thumb and reduces pain. Long standing rheumatoid arthritis leads to deformities of fingers. Functional splints make joints more stable by improving joint alignment and reducing pain. They support or immobilize affected joints and allow others to function properly. Splints are made of stiff plastic like material on one side and adjustable Velcro belts on the other side. These belts must be properly tightened while wearing splints as loose belts do not serve the purpose of immobilization. Deformed small finger joints can be corrected to some extent by different metal rings available in market. All appliances including splints and rings should ideally be prepared by an occupational therapist according to individual measurements.

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    Patients with deformed hand joints have problems in holding objects such as spoon, knife or utensils. A thick handle can be very useful in such cases. Door lock and door or drawer handles should also be suitably modified.