Braces and Splints for Common Musculoskeletal Conditions

 

Am Fam Physician. 2018 Nov 15;98(10):570-576.

Author disclosure: No relevant financial affiliations.

Braces and splints can immobilize and protect joints, reduce pain, decrease swelling, and facilitate healing of acute injuries. They are also used for injury prevention and chronic pain reduction, and to alter the function of a joint. The medial unloading (valgus) knee brace is an option for patients with medial knee osteoarthritis, but evidence of long-term benefit is limited. The patellar stabilizing brace helps maintain proper patellar alignment but has mixed results in treating patellofemoral pain syndrome. The patellar tendon strap is effective in treating pain from patellar tendinopathy. The knee immobilizing splint is used after surgery to prevent reinjury and for acute or presurgical management of quadriceps rupture, patellar tendon rupture, medial collateral ligament rupture, patellar fracture or dislocation, and other acute traumatic knee injuries. Use of a functional ankle brace is more effective than immobilization or a compression wrap in terms of functional outcomes after an acute ankle sprain and prevention of future ankle sprains. The thumb spica splint is effective for the treatment of thumb carpometacarpal osteoarthritis and de Quervain tenosynovitis, and may be used for patients with suspected scaphoid fractures. A wrist splint has short-term effectiveness in treating symptoms of carpal tunnel syndrome but may not be more effective than other conservative therapies.

Family physicians often treat musculoskeletal conditions for which bracing or splinting can be useful (Table 1).1 In 2015, U.S. spending on orthopedic braces, casting supplies, and splints was estimated at $1.2 billion, and these expenses are expected to increase as insurance companies cover less of these products.2

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Medial unloading (valgus) knee braces are effective in decreasing pain from medial knee osteoarthritis in the short term and may delay surgical intervention.

B

35

There is insufficient and conflicting evidence to recommend for or against the use of patellar stabilizing braces for the treatment of patellofemoral pain syndrome.

B

810

Patellar tendon straps are effective in decreasing pain from patellar tendinopathy.

B

12, 13

Use of a functional ankle brace is more effective than immobilization or a compression wrap in terms of functional outcomes after an acute ankle sprain and for the prevention of ankle sprains.

A

16, 18, 19

A thumb spica splint is effective for the treatment of pain from thumb carpometacarpal osteoarthritis and de Quervain tenosynovitis.

B

2428

A wrist splint is effective for short-term treatment of the symptoms of carpal tunnel syndrome, but it may not be more effective than other conservative therapies.

B

3337


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Medial unloading (valgus) knee braces are effective in decreasing pain from medial knee osteoarthritis in the short term and may delay surgical intervention.

B

35

There is insufficient and conflicting evidence to recommend for or against the use of patellar stabilizing braces for the treatment of patellofemoral pain syndrome.

B

810

Patellar tendon straps are effective in decreasing pain from patellar tendinopathy.

B

12, 13

Use of a functional ankle brace is more effective than immobilization or a compression wrap in terms of functional outcomes after an acute ankle sprain and for the prevention of ankle sprains.

A

16, 18, 19

A thumb spica splint is effective for the treatment of pain from thumb carpometacarpal osteoarthritis and de Quervain tenosynovitis.

B

2428

A wrist splint is effective for short-term treatment of the symptoms of carpal tunnel syndrome, but it may not be more effective than other conservative therapies.

B

3337


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

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TABLE 1.

Braces and Splints for Common Musculoskeletal Conditions

Brace or splintMusculoskeletal condition

Medial unloading (valgus) knee brace

Medial compartment knee osteoarthritis

Patellar stabilizing brace

Patellofemoral pain syndrome

Patellar tendon strap

Patellar tendinopathy

Knee immobilizing splint

Acute knee injuries

Functional ankle brace

Ankle sprains (treatment and prevention)

Thumb spica splint

Thumb carpome

The Authors

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RYAN A. SPROUSE, MD, CAQSM, is an assistant professor of family medicine at West Virginia University School of Medicine–Eastern Campus, Harpers Ferry....

AARON M. MCLAUGHLIN, MD, is an assistant professor of family medicine at West Virginia University School of Medicine–Eastern Campus.

GEORGE D. HARRIS, MD, MS, CAQSM, is a professor and chair of the Department of Family Medicine at West Virginia University School of Medicine–Eastern Campus.

Address correspondence to Ryan A. Sprouse, MD, West Virginia University School of Medicine– Eastern Campus, 171 Taylor St., Harpers Ferry, WV 25425 (e-mail: rsprouse@wvumedicine.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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show all references

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