1. Occupational therapy and thumb base OA
Simone Sheehan
Senior Occupational Therapist

2. “On the length, strength, free lateral motion and perfect mobility of the thumb, depends the power of the human hand”
~Sir Charles Bell, 1833~

3. 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).

4. symptoms
Pain / aching around base of thumb – may radiate down thumb or up forearm
(usually most intense during pinch)
Tenderness over the CMC joint
Stiffness in the CMC joint in the morning or after inactivity
If inflammation is severe –
Swelling
Warmth
redness

5. Aggravated by....
Lateral pinch
Tip pinch
Grasp pinch
Palmar pinch

6. Treatment hierarchy Education Task modification Medication Splints
Ice / heat
Exercise
Steroid injection
Surgical options

7. aNATOMY
Thumb CMC joint is a saddle joint

8. SHOULDER SIGN

9. We constantly encounter high forces in every day tasks

10. Joint protection Reduce excessive loading on joints
Avoid pain in activities
Distribute as much load over several joints
Use stronger, larger joints
Avoid twisting forces
Use joints in their most stable and functional positions
Maintain ROM
Balance activity and rest
Avoid staying in one position for long periods / static grips (Melvin, 2002)
Reduce effort

11. Gadgets
Compensate

15. EVIdence 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

16. 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.

17. The role of splinting
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

18. Provides external support
How do splints work?
Provides external support
Limits joint movement
Less pain

19. We all use our hands in different ways and so it is important to look carefully at each individual, their characteristics, needs and lifestyle.

20. Many options available

21. 6 ESSENTIAL CONSIDERATIONS IN SELECTING SPLINTS FOR PATIENTS
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, ).

22. Occupational therapy Hours: 8.30 – 16.30 Monday - Friday Cost:
Inpatient:
Outpatient:
Included in bed rate
€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.
Details to be included:
Name, Address, DOB, contact number, medical history and presenting complaint.

23. Any questions?!