Ring splints for Ehlers-Danlos syndrome & hypermobility spectrum disorders
What are ring splints used for?
A splint is a support or device that is used to restrict motion in a part of the body. Ring splints help limit movement in the finger joints, which are often hypermobile in people with a type of Ehlers-Danlos syndrome (EDS) or hypermobility spectrum disorder (HSD).
Ring splints can help with finger and thumb stability, improving alignment, and controlling the movement of the joint. Ring splints can help if you have unstable joint hyperextension, lateral (side to side) joint instability, dislocations, or subluxations, reducing the risk of injury and pain in the hands.
There are several types and styles of ring splints that can address different issues. Ring splints are available in plastic, often called oval-8 splints. Silver ring splints, gold ring splints, and stainless-steel ring splints are also available. Various ring splints can be purchased online. The process for getting ring splints through health insurance or through medical systems varies country by country.
Each finger joint that requires splints must be measured to determine the right splint size for that joint. Some people who wear ring splints wear them on all of their finger joints all of the time. Other people may only need ring splints on specific joints or may only need them sometimes. If you have pain and instability in your hands that impact your daily life, consider consulting a hand therapist.
Ring splints can be covered by health insurance in the United States; however, it highly depends upon what a person’s specific health insurance plan covers. Some plans cover them under orthotics and some cover them under durable medical equipment so you should look in each section of your plan to see what is covered under your plan.
To be covered by insurance, if your plan allows coverage of them, you will need to see a hand specialist (often an Occupational Therapist (OT)) or work directly with an approved ring splint distributer. Ring splints on Etsy or from local jewelers may be a more affordable option depending on insurance coverage.
Jason Parry, Clinical Specialist Physiotherapist in Hypermobility/Extended Scope Practitioner, explains the current process in the UK:
“Hand therapists in the UK can order plastic ring splints on the NHS at no cost to the patient. Should you want silver ring splints, then sometimes the hand therapist can help with the measuring and fitting process, but you would need to pay for the splints yourself. You can also order plastic ring splints yourself directly from suppliers but need to make sure that you have accurately undertaken the measuring process before ordering.
“If you are keen on getting silver ring splints, then you would most usually have to do this either through a private hand therapist, or alternatively, take the chance on measuring and ordering one directly yourself through a supplier. Doing it yourself obviously means that you are also determining what splint you think best suits your needs, but this may not necessarily be the most appropriate. I would usually suggest seeing a hand therapist in the first instance to make sure that they are identifying the most appropriate splint for your needs, even if you go on to then order it yourself afterward.”
Oval 8 and Silver splints are available in Australia, primarily obtained through hand therapists (Occupational therapists or Physiotherapists) and some private practice therapists.
Oval 8 splints are readily available for purchase through hand therapy clinics and can be used for trial before moving to silver splints. These can be a more cost-effective option for young children while their hands are still growing.
Silver Ring Splints need to be custom ordered and imported from overseas. You can self-refer to a hand therapist, Occupational Therapist, or Physiotherapist, so do not need a referral from your doctor. Not all hand therapists have access to the required sizing kit for the Silver Ring Splint Company splints, so it is best to check when you book your appointment.
Funding for finger splints
Public and self-funded Some public hospital outpatient therapy departments may have sizing kits and stock the Oval 8 splints but the cost is covered by the patient. They may also have the silver splint sizing kit and have an arrangement to order the splints from overseas but this should be checked. Again, these would be funded by the individual.
The National Disability Insurance Scheme (NDIS) may (though not always) cover the cost of ring splints if they are deemed reasonable and necessary and are prescribed by a health professional. You should discuss this with your therapist and Support Coordinator or Local Area Coordinator. The NDIS is unlikely to cover the cost of splints you order yourself without therapist input.
Private Health Some private health insurance funds cover the cost of braces and splints. You will need to check with your individual fund and may need to obtain a letter from your prescribing health professional.
Karen explains how they accessed ring splints in Belgium:
“A specialist can make a prescription and then ring splints will be custom-made in silver according to what the specific issue is. They are fully paid by health insurance.
This ring splint (pictured above) is made to stabilize the joint in my thumb as it is subluxing with almost every movement. The ring splint is stabilizing the joint to reduce the pain, but also to avoid further damage to the joint, all while maintaining the mobility in my thumb.
Ring splints can be gotten through the public health care system in Finland; however, they are approved on a need basis. First the assessment of the occupational therapist, and then whether their recommendation is approved or not, remains if the person is seen as needing ring splints to improve function.
Ring splints can also be purchased outright through medical aid companies, but this is quite expensive.
“I received my finger and thumb splints through our public health care system in Finland. I was being assessed at University Hospital and met with an occupational therapist who assessed my hand function, among other things. She gave me plastic ring splints to wear. I used those for a year and a half until they started to get so worn out that I was afraid they’d break.
“I contacted my city’s local Heath Station and asked to see a doctor. When I met with the doctor, I inquired about a referral to the city’s occupational therapist to receive new finger splints.The OT then assessed my hand function, observed me performing tasks, and asked me about the use of my current splints and whether those helped me. After a discussion, she recommended I would be granted metal splints instead.
“After the approval and payment commitment from the city for silver ring splints came through, I contacted the assistive products and aids company that was mentioned in the approval papers. There an occupational therapist assessed my hand function again to see the type of splint that would work best for me, took measurements, and ordered the splints. After they arrived at the company, I went in for a fitting and adjusted the splints for my hands.
“After some months, the MCP joints of my thumbs started to be too painful to use and I contacted the occupational therapist again as my old referral was still valid. She assessed that all three joints of my thumb needed support. We tested all sorts of braces, but they did not work for the CMC joint. I got recommended for an individually made silver splint for my thumb too. The rest of the process was the same as with the finger splints.”
Britt explains how they accessed ring splints in the Netherlands:
“In the Netherlands, people are obliged to be part of a health insurance company, those all have different policies on what they cover and how much. As I am underage my insurance is included in my parents’, they have a large package which in fact did cover my splints fully. The insurance system here has a basic package that everyone needs to pay and packages you can add to this like coverage for PT (Physical Therapy), to get this you need to pay more. I am not sure if my insurance company covered my splints through the basic part of the insurance or the extended packages and I am sure this will also differ a lot between all the different companies around.
“The Dutch public healthcare system is basically a lot of Insurance companies either denying or approving requests. Certain things like my EDS specialist and crutches were not covered while others were, when having a chronic illness, it is choosing the largest package of the best company you can in order to have as much as possible covered or try to pay everything on your own, which is almost impossible for most people.Some cheaper companies also only have a certain budget for everyone which can be given to a hospital, for example, if this budget happens to be spent halfway through the year you cannot get medical help anymore, in some cases people who need surgery must wait until the start of the next year to get help. Therefore, it is necessary for people with chronic illnesses to choose their companies very carefully.
“In the Netherlands, it is not possible to get any kind of orthotics without a medical professional prescribing it, at least as far as I know. When I got my diagnosis from an EDS specialist, he investigated what kind of devices would help me, he decided which type of splints I was allowed to get and sent me to an OT. The OT simply takes the measurements and either make the splints themselves or orders an external company to do this, in my case this happened. The costs of making the splints go directly to your insurance company for them to either cover it or deny it, in the case of the latter it is likely you won’t get the device or have to pay a large sum of money. I was lucky enough to get mostly approved.
“After the insurance has chosen to cover the cost of the splints, they will be made. In my case, the insurance refused to cover everything at once as they have a limited budget that can be spent at a time. Therefore first 6 finger splints were made for my thumbs and the first two fingers for both joints and sometime later the c-splints for my wrists were approved for making. In my case this was about a month after the first approval, which is rare, most of the time this takes longer. If I ended up needing other splints soon after it would likely be refused, but there is never a guarantee.”
The company that makes the splints cannot be chosen by you; it is simply set by the OT you go to. In my case, the company my OT works with is We Design, but I am not sure if there are other companies around. The making in these companies of all my splints lasted a bit over a month per batch which was approved, so within three months after diagnosis, I had finger splints for 6 fingers and c-splints for both my wrists.
Tamara shares her story:
“First I was checked by a rehabilitation doctor. She gave me a few oval 8 splints to try for some time and referred me to the Hand and Wrist Center. There a therapist evaluated how I have been doing with the trial splints, and once they were sure the splints help and do not cause any problems, a technician fitted me for silver finger splints. Later on, the palm and wrist splints were added.
For both the palm and wrist, we also had a few week’s trial with temporary ones before the silver ones were made. I have these splints on both hands. From time to time I see my therapist and technician to fix the fit of the splints. As the silver can change shape with regular use, this process is important to ensure that my splint can continue to provide my joints with the best support. All costs are covered by basic insurance.”
Do you know the process for obtaining ring splints in your country?
Please include information about the type(s) of provider that helped you get your splints.
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