Occupational therapy and thumb base OA

1. Occupational therapy and thumb base OA Simone Sheehan Senior Occupational Therapist

2. “On the length, strength, free lateral motion and perfect mobility of the thumb, depends the power of the human hand” ~Sir Charles Bell, 1833~

3. 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).

4. 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

5. Aggravated by.... Lateral pinch Tip pinch Grasp pinch Palmar pinch

6. Treatment hierarchy

7. Thumb CMC joint is a saddle joint aNATOMY

8. SHOULDER SIGN

9. We constantly encounter high forces in every day tasks

10. 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

11. Gadgets • Compensate

15. 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

16. 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.

17. 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

18. How do splints work?

19. We all use our hands in different ways and so it is important to look carefully at each individual, their characteristics, needs and lifestyle.

20. Many options available

21. 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).

22. Occupational therapy

23. Any questions?!