Description of Intervention
Paraffin and moist heat treatment can help to decrease a patient’s chronic hand inflammation, joint stiffness and muscle spasms. These treatments also facilitate tendon gliding and may decrease pain. After these treatments, the patient will be more able to pursue strengthening exercises and daily functional activities.1 Tissue pliability and muscle fiber elongation is an additional benefit of heat therapy
Indications for Intervention
Candidates for paraffin and moist heat treatment are patients that present with stiffness, inflammation and/or reduced range of motion in the hands. Joint stiffness and chronic inflammation can be caused by hand osteoarthritis (OA), carpal tunnel syndrome, DeQuervain’s tenosynovitis and systemic sclerosis. Post-surgical patients may also be candidates for paraffin and moist heat treatment.
Diagnosis
- Ask for the patient’s medical history, including any experience of pain, sensitivity to cold, stiffness and skin elasticity. Record comorbidities, including diabetes, chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis (RA).
- Assess any changes in activities of daily living, including changes in playing a musical instrument.
- Check active range of motion in the hands and fingers. Evaluate the patient’s grip strength, finger flexion, finger extension and thumb abduction.
Intervention Options
Moist heat treatment is often used for patients with hand inflammation because water transfers heat more quickly than air does.1 The therapist can provide a moist hot pack for patients; it is important to place a towel between the hot pack and the patient’s hand, to avoid burns. If the patient has poor circulation and reduced sensation, burns may occur at a lower temperature than they usually would.2 Patients can also make hot packs at home, by using field corn or rice, sewn into a small pillowcase. These packs should be heated in the microwave.3
Paraffin treatment can be effective for patients with hand OA, carpal tunnel syndrome, DeQuervain’s tenosynovitis and systemic sclerosis. To make a paraffin bath, the therapist should mix mineral oil and paraffin, in a ratio of 1 to 7, and heat the mixture to 45-54°C.1 Patients should immerse the affected hand(s) in the mixture up to 10 times. After removing their hands from the bath, patients should wash their hands in warm water. Water is a conductor of heat and cold, therefore, it’s imperative that their hands are totally dry to prevent burns. The clinician should ensure there are no scabs, scrapes, paper cuts or skin integrity issues to prevent infection. The patient should be instructed to wash the affected area and remove any jewelery. Commercial paraffin baths are available, but they are not recommended because paraffin is highly flammable.3
For patients with carpal tunnel syndrome, paraffin baths improve blood flow and neural transmission speed. When baths are used in conjunction with splinting, patients show improvement in motor and sensory distal latency, sensory amplitude and median sensory nerve velocity.4 Patients with De Quervain’s tenosynovitis may find that paraffin treatment can relax smooth muscle fibers and promote circulation. Some patients also benefit from wearing a thumb spica splint.5 Patients with systemic sclerosis may find that paraffin baths, combined with hand exercise, can help to decrease skin stiffness and increase range of motion.6 For patients with RA, heat treatments can be used for chronic inflammation and to prepare for exercise. However, heat should not be used during times of acute inflammation.2
