Description of Intervention
Joint protection therapy is needed for patients with hand or wrist osteoarthritis (OA) and rheumatoid arthritis (RA), particularly in the later stages of these diseases. With this therapy, the patient should work on increasing muscular strength, aiding shock absorption, and lessening mechanical stress.1 In order to progress towards these goals, the patient may need orthoses or adaptive equipment. The physical or occupational therapist can provide guidance and support.
Indications for Intervention
Joint weakness and loss of hand function can be caused by OA of the distal interphalangeal (DIP) joint, OA of the proximal interphalangeal (PIP) joint, or OA of the carpometacarpal (CMC) joint of the thumb.
Diagnosis
- Ask for the patient’s medical history. Assess any changes in activities of daily living, including changes in daily practice for musicians.
- Check for swelling, stiffness and loss of function in the joints of the hands, thumbs or wrists.
- Examine active range of motion in both hands and thumbs.
Intervention Options
A combination of hand therapy and orthoses can be effective in treating OA in older adults. General strength-training, such as rows and shoulder press, may improve the function of the hand, over an extended time.2 Nutrition may help to lessen inflammation. An interdisciplinary approach has the potential for aiding in hand function, pain reduction and aesthetics.3
Hand therapy should include wrist flexion and extension, gentle digital flexion and extension, and thumb opposition. These exercises can produce some improvement in grip and pinch strength. However, excessive grip strengthening may increase inflammation and pain, so it is important to achieve a balance between exercise and rest.1,4 As therapy continues, the therapist should measure for improvement in active range of motion.
Orthoses, also referred to as splints can be used to aide in function and/or provide resting posture relief. Adaptive equipment can help prevent further injury and improve functionality in patients with hand OA. Therapists should recommend which orthoses to use, keeping in mind the patient’s most common activities. Some orthoses may only be needed at night. After an orthosis is fitted, the patient should attend at least one follow-up visit, to check whether any adjustments are necessary.4
There are some prefabricated / over the counter braces / splints which provide proper fit and comfort, however, often the occupational therapists and physical therapists will fabricate custom splints.
For musicians, OA of the CMC joint of the thumb is common. In the early stages, local steroid injection and slow manual traction by the patient can be helpful.5 Thumb splints can also be used for OA of the CMC joint.2
