A 54-year-old client with rheumatoid arthritis is demonstrating a swan neck deformity at the third and fourth digits of her dominant (right) hand

She has full active flexion of the digits but reports some difficulty in initiating digit flexion after extending her digits fully. This causes her to have difficulty with keyboarding and grasping larg-er objects. The patient is in a sales position, and cosmesis is important to her on the job. What splint should the therapist recommend?
A. A Silver Ring custom metal splint or polypropylene (Oval-8) splint providing slight proximal interphalangeal (PIP) flexion
B. A custom fabricated thermoplastic finger based splint in slight PIP flexion
C. A resting pan splint at night only in PIP flexion
D. A wrist extension splint that will then encourage PIP flexion

ANS: A
A and B will allow activities of daily living while preventing PIP joint hyperextension that is seen in the swan neck deformity. Because cosmesis is important and long-term use of the splint will be necessary, the Silver Ring or Oval-8 splint will be the most durable and the most cosmet-ically appealing.