[Orthoses for rheumatic hand deformities]

Treatment of rheumatic hand deformities is a very sensitive task, requiring profound knowledge of functional anatomy as well as extensive rheumatologic experience. Assistive devices such as orthoses in the therapy of typical deformities aim to prevent continuing loss of function. Furthermore reduction of pain, economization of movements and maintaining postoperative results are important. Contraindications for surgical interventions are also an indication. Static orthoses are to be distinguished from individually produced dynamic devices, which may protect anatomical structures while providing relatively free motion. The indication for this treatment must be agreed by the physician in charge, the patient and the occupational therapist together, assisting functional exercises are strongly recommended. The condition of the skin must be considered and regular follow-up has to be arranged. Each region of the hand and characteristic deformities require individual orthotic devices, according to the capabilities of the patient. The patient's possible improvement of daily activities in relation to the disadvantages of having to use orthoses determines the therapy. Given indications for surgical procedures are taken into consideration from the onset of the treatment plan.