Transcript Osteoarthritis of the CMC Joint

Simone Sheehan
Senior Occupational Therapist
“On the length, strength, free lateral
motion and perfect mobility of the
thumb, depends the power of the
human hand”
~Sir Charles Bell, 1833~
 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).
1.
Pain / aching around base of thumb – may
radiate down thumb or up forearm
(usually most intense during pinch)
2.
3.
Tenderness over the CMC joint
Stiffness in the CMC joint in the morning or
after inactivity
If inflammation is severe –
1. Swelling
2. Warmth
3. redness
Lateral pinch
Tip pinch
Grasp pinch
Palmar pinch
Education
Task
modification
Medication
Splints
Ice / heat
Exercise
Steroid injection
Surgical options
Thumb CMC joint is a
saddle joint

Reduce excessive loading
on joints

Use joints in their most
stable and functional
positions

Avoid pain in activities

Maintain ROM
Distribute as much load
over several joints

Balance activity and rest

Use stronger, larger joints


Avoid twisting forces
Avoid staying in one
position for long periods /
static grips (Melvin, 2002)

Reduce effort

 Gadgets
 Compensate
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
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.
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
Provides
external
support
Limits
joint
movement
Less pain
We all use our hands
in different ways and
so it is important to
look carefully at each
individual, their
characteristics, needs
and lifestyle.
 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).
Hours:
8.30 – 16.30
Monday - Friday
Cost:
Inpatient:
Included in bed rate
Outpatient:
€70/hr, €60/45mins
€50/30mins, €30/15mins
Aids / Appliances:
Supplied and billed
Referrals to be sent to: 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.