Occupational therapy and thumb base OA

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Occupational therapy and thumb base OA

• Simone Sheehan
• Senior Occupational Therapist

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• On the length, strength, free lateral motion and
  perfect mobility of the thumb, depends the power
  of the human hand
• Sir Charles Bell, 1833

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• Tends to occur in women older than 40 years of
  age (Dray Jablon, 1987 Jonsson Valtysdottir,
  1995) and affects 1/3 of females over the age of
  50 (Armstrong, 1994).
• A painful thumb can truly limit the ability to
  perform activities.
• In fact, a severely painful thumb can limit hand
  function by 45 (Swanson, 1973).

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symptoms

• Pain / aching around base of thumb may radiate
  down thumb or up forearm
• (usually most intense during pinch)
• Tenderness over the CMC joint
• Stiffness in the CMC joint in the morning or
  after inactivity
• If inflammation is severe
• Swelling
• Warmth
• redness

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Aggravated by....
Lateral pinch
Tip pinch
Grasp pinch
Palmar pinch
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Treatment hierarchy
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aNATOMY

• Thumb CMC joint is a saddle joint

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SHOULDER SIGN
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We constantly encounter high forces in every day
tasks
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Joint protection

• Reduce excessive loading on joints
• Avoid pain in activities
• Distribute as much load over several joints
• Use stronger, larger joints
• Avoid twisting forces

• Use joints in their most stable and functional
  positions
• Maintain ROM
• Balance activity and rest
• Avoid staying in one position for long periods /
  static grips (Melvin, 2002)
• Reduce effort

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• Gadgets

• Compensate

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EVIdence

• Nice Guideline 59 Osteoarthritis
• People with osteoarthritis who have biomechanical
  joint pain or instability should be considered
  for assessment for bracing/joint supports as an
  adjunct to their core treatment.
• Valdes Marrik (2010)
• The current literature supports the use of
  orthotics, hand exercises, application of heat,
  and joint protection education combined with
  provision of adaptive equipment to improve grip
  strength and function.
• Rannou et al (2009)
• Night time splinting is an effective treatment of
  base of thumb OA
• Day et al (2004)
• Thumb splinting together with corticosteroid
  provides relief
• unable to solely attribute effects to either
  
• modality

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• Carreira, Jones Natour (2007)
• Splint is effective to decreased pain scores in
  trapeziometacarpal OA patients
• Boustedt Nordenskold (2007)
• Women with thumb base OA can expect improvement
  concerning pain on motion and hand grip force
  post hand OA programme partipation and combining
  it with night splints they can expect decreased
  pain at night.
• Stamm et al (2002)
• Joint protection and hand home exercises, easily
  administered and readily acceptable
  interventions, were found to increase grip
  strength and global hand function.

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The role of splinting

• Splinting aims to enhance pain-free use of the
  thumb and allow individuals to partake in
  previously aggravating activities, without pain
• A splint by its very presence is doing harm as
  it inhibits free movement. It is only justified
  if the specific good compensates for the general
  harm
• Paul W. Brand

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How do splints work?
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We all use our hands in different ways and so it
is important to look carefully at each
individual, their characteristics, needs and
lifestyle.
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Many options available
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6 ESSENTIAL CONSIDERATIONS IN SELECTING SPLINTS
FOR PATIENTS

• Client Centred-ness
• Comfort
• Cosmesis
• Convenience
• Less is more
• Follow up
• McKee Rivard (2004). Orthoses as enablers of
  Occupation Client centred splinting. Canadian
  Journal of Occupational Therapy (71, 306-314).

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Occupational therapy
Hours 8.30 16.30 Monday - Friday
Cost Inpatient Outpatient Included in bed rate 70/hr, 60/45mins 50/30mins, 30/15mins
Aids / Appliances Supplied and billed Supplied and billed
Referrals to be sent to Occupational Therapy Department, Bon Secours Hospital, College Road, Cork. 021 4801630 Occupational Therapy Department, Bon Secours Hospital, College Road, Cork. 021 4801630
Details to be included Name, Address, DOB, contact number, medical history and presenting complaint. Name, Address, DOB, contact number, medical history and presenting complaint.
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Any questions?!