November 2018 No. 53
What’s in your Thumb CMC Arthritis Toolbox?
Karol Young OTD, OTR/L, CHT
One of the most common conditions hand therapists treat is thumb CMC joint arthritis. Individuals are referred to therapy by primary care providers, rheumatologists, hand surgeons, and chiropractors. Although thumb CMC joint arthritis is a progressive condition, we can make a positive impact on the way individuals with arthritis use their hands by decreasing symptoms and improving function.
Several years ago, I travelled to outpatient clinics to provide hand therapy services and always made sure I had my arthritis toolbox.
What is in an arthritis toolbox? It contains (see Figure 1 below):
- Skeletal model of the hand
- Patient educational handouts with images explaining the diagnosis and treatment options
- Samples of prefabricated orthoses in different sizes for determining proper fit
- Adaptive equipment such as spring-loaded scissors, jar openers, pens, and grips, etc. to relieve strain on arthritic joints
- Tubular silicone compression sleeves for protection of fragile or painful IP joints
- Chip clip (spring-loaded clip used for keeping food bags closed) to apply pressure to a tight thumb adductor muscle in preparation for stretching
- Rubber bands for isometric CMC exercises while performing contract relax or gentle thumb extension exercises
- Self-adherent elastic tape used to support painful joints either via buddy taping or circumferential wrapping
Although patients are often referred to therapy only for an orthosis, treating an individual with thumb CMC arthritis goes beyond fitting for an orthosis. It should include a patient evaluation that screens for arthritis in other upper extremity joints, patient education regarding diagnosis, discussion of treatment options, instruction in joint protection principles, training in use of adaptive equipment, and recommendations for interventions as the disease progresses.
I continue to enhance to my arthritis toolbox. What is in your toolbox?
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Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.