Therapists also assess web space extensibility. Patients with limited web space extensibility will have a decreased ability to position their thumbs in true opposition, resulting in less stable joint positions and increased lateral forces applied to the thumb. Gentle stretching of the web space can be included in the exercise program if decreased web space extensibility is present.
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Explore This IssueMarch 2014
Thermal physical agent modalities (PAMS): Although there is only weak-to-moderate evidence to support the use of thermal PAMS, some patients may experience pain relief with the application of ice or heat.9 Therapist preference and patient response guide modality use. Some patients with high levels of pain may feel relief with cryotherapy, yet others prefer not to have cold on their hands. Paraffin baths and heat wraps can also provide relief.13
Joint protection: In joint-protection programs, patients are trained to be aware of how various activities affect their joints and modify how they perform activities to reduce joint stress. There are several principles of joint protection: using larger, more stable joints during activities; providing appropriate rest or break periods; decreasing muscle force; and using adaptive equipment if appropriate. For example, a patient with thumb CMC joint OA could be taught to avoid tasks that require significant thumb force such as lateral-pinch activities (see Figure 5a), and trained to perform the task with larger joints (see Figure 5b). Patients can be provided with adaptive equipment, such as a built-up pencil grip to assist with writing or a wall-mounted jar opener (see Figure 6).
As with the splinting and exercise programs, therapists can determine joint-protection strategies based on patients’ activity profiles. The benefits of joint-protection programs have been extensively studied for patients with rheumatoid arthritis, but these principles have been found to be appropriate for people with OA as well.9,13 In a prospective study, Berggren et al examined the benefits of joint protection and splinting for thumb OA patients awaiting joint replacement surgery.14 Following a seven-month period, 70% of the patients no longer felt surgery was needed.
Thumb CMC joint OA can cause pain and disability. Conservative treatments provided by therapists who have expertise in hand-function issues, can reduce pain and improve function. Splints provide support and pain relief, allowing patients to use their hands for necessary occupations such as work and hobbies. Strengthening and stretching exercises reduce compressive forces by improving muscle balance and overall hand motion. Thermal physical agent modalities can provide pain relief. Joint-protection techniques can help patients manage their symptoms and provide them with knowledge on how to reduce stress on their joints. Physicians should consider referring patients for hand therapy as part of an overall strategy to reduce the impact of thumb CMC joint OA, and thus improve their quality of life.