Comparison of Custom-made Versus Prefabricated Thumb Splinting for Carpometacarpal Arthrosis: A Systematic Review and Meta-analysis



1 Department of Orthopaedic Surgery, Montréal General Hospital, McGill University, Canada

2 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Department of Hand and Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, USA

4 Department of Hand and Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, USA


Background: The goal of this study was to compare the two types of orthoses, prefabricated soft splints versus short
thermoplastic custom-made splints, that are the most commonly used for the management of first carpometacarpal
(CMC) osteoarthritis (OA).
Methods: We conducted a meta-analysis and systematic review in the literature based on the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted the outcomes of disability
scores, pain scores, grip and pinch strength and gathered the unified data accordingly.
Results: We included five randomized clinical trials with 230 patients with the mean age of 61 years and the mean
follow-up of 8.1 weeks. The results of the pooled data demonstrated only a statistically significant difference in disability
scores among splints in favor of the prefabricated splints. The rest of the outcome measures consisting of pain, grip
strength, and pinch strength were not statistically different.
Conclusion: According to our systematic review and meta-analysis, both thumb-based splints improved pain and
function in the first CMC OA in a short-term follow-up, nevertheless the efficacy of prefabricated splints in abatement of
disability scores was significantly higher than custom-made splints. In contrast, the other outcome measures including
pain, grip and pinch strength were improved identically after wearing either of the splints.
Level of evidence: II


Main Subjects

1. Haara MM, Heliovaara M, Kroger H, Arokoski JP,
Manninen P, Karkkainen A, et al. Osteoarthritis in the
carpometacarpal joint of the thumb. Prevalence and
associations with disability and mortality. J Bone Joint
Surg Am. 2004; 86-A(7):1452-7.
2. Fitzgerald BT, Hofmeister EP. Treatment of advanced
carpometacarpal joint disease: trapeziectomy
and hematoma arthroplasty. Hand Clin. 2008;
3. Ghavami A, Oishi SN. Thumb trapeziometacarpal
arthritis: treatment with ligament reconstruction
tendon interposition arthroplasty. Plast Reconstr
Surg. 2006; 117(6):116e-28e.
4. Valdes K, Marik T. A systematic review of conservative
interventions for osteoarthritis of the hand. J Hand
Ther. 2010; 23(4):334-50.
5. Colditz JC. The biomechanics of a thumb
carpometacarpal immobilization splint: design and
fitting. J Hand Ther. 2000; 13(3):228-35.
6. Weiss S, Lastayo P, Mills A, Bramlet D. Splinting the
degenerative basal joint: custom-made or prefabricated
neoprene? J Hand Ther. 2004; 17(4):401-6.
7. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred
reporting items for systematic reviews and metaanalyses:
the PRISMA statement. Ann Internal Med.
2009; 151(4):264-9.
8. Wells GA, Shea B, O’connell D, Petersen J, Welch V,
Losos M, et al. The Newcastle-Ottawa Scale (NOS)
for assessing the quality of nonrandomized studies
in meta-analyses. Department of Epidemiology and
Community Medicine. Canada: University of Ottawa;
9. Stang A. Critical evaluation of the Newcastle-
Ottawa scale for the assessment of the quality of
nonrandomized studies in meta-analyses. Eur J
Epidemiol. 2010; 25(9):603-5.
10. Bellamy N. AUSCAN hand osteoarthritis index user
guide III. Queensland, Australia: Centre of National
Research on Disability and Rehabilitation Medicine;
11. Bani MA, Arazpour M, Kashani RV, Mousavi ME,
Hutchins SW. Comparison of custom-made and
prefabricated neoprene splinting in patients with
the first carpometacarpal joint osteoarthritis. Disabil
Rehabil Assist Technol. 2013; 8(3):232-7.
12. Becker SJ, Bot AG, Curley SE, Jupiter JB, Ring D. A
prospective randomized comparison of neoprene
vs thermoplast hand-based thumb spica splinting
for trapeziometacarpal arthrosis. Osteoarthritis
Cartilage. 2013; 21(5):668-75.
13. Sillem H, Backman CL, Miller WC, Li LC. Comparison
of two carpometacarpal stabilizing splints for
individuals with thumb osteoarthritis. J Hand Ther.
2011; 24(3):216-25.
14. Spaans AJ, van Minnen LP, Kon M, Schuurman
AH, Schreuders AR, Vermeulen GM. Conservative
treatment of thumb base osteoarthritis: a systematic
review. J Hand Surg Am. 2015; 40(1):16-21.e1-6.
15. Vegt AE, Grond R, Gruschke JS, Boomsma MF,
Emmelot CH, Dijkstra PU, et al. The effect of two
different orthoses on pain, hand function, patient
satisfaction and preference in patients with thumb
carpometacarpal osteoarthritis: a multicentre,
crossover, randomised controlled trial. Bone Joint J.
2017; 99-B(2):237-44.
16. Marks M, Schoones JW, Kolling C, Herren DB, Goldhahn
J, Vliet Vlieland TP. Outcome measures and their
measurement properties for trapeziometacarpal
osteoarthritis: a systematic literature review. J Hand
Surg Eur Volum. 2013; 38(8):822-38.
17. Allen KD, Jordan JM, Renner JB, Kraus VB. Relationship
of global assessment of change to AUSCAN and
pinch and grip strength among individuals with
hand osteoarthritis. Osteoarthritis Cartilage. 2006;