protectyourthumbs.com 1 strategies to...

STRATEGIES TO PROTECT YOUR THUMBS FROM THE EFFECTS OF

BASAL JOINT ARTHRITIS

Lisa M. Cyr, OTD, OTR/L, CHT

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1ProtectYourThumbs.com

Table of Contents:

Slides 3-10; Background on basal joint arthritis, who gets it, and potential causes

Slides 11-16; Basic skeletal and muscular anatomy Slides 17- 23; Joint protection strategies, ergonomic suggestions,

adaptive equipment ideas Slides 24-41; Home exercise program Slide 42; Orthoses (Splints/ Braces) Slide 43; X-ray of the disease process Slide 44; Summary Slide 45; Helpful resources Slides 46-48; Definitions Slides 49-51; Reference list

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ProtectYourThumbs.com

The following information is designed to:

Decrease pain

Improve function

Prevent the progression of arthritic changes at the joint at the base of your thumb

Allow you to continue to participate in the activities most important to you!

cracked.com

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This can be accomplished with:

*Joint protection techniques

*Adaptive equipment

*Thumb muscle strengthening

*Temporary use of a protective orthosis(Barron, Glickel, & Eaton, 2000; , Lefler & Armstrong, 2004; Rogers, & Wilder, 2007; Roundtree, 2011; Sillem, Backman, Miller, & Li, 2010; Valdes & Marik, 2009; Wajon & Ada, 2005; Weiss, LaStayo, Mills & Bramlet, 2004).

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Basal Joint Arthritis:

Pain at the base of the thumb where the thumb meets the wrist

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Also known as degenerative joint disease (DJD) or carpometacarpal (CMC) arthritis

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Who is at risk for basal joint arthritis?

1 in 4 women (Armstrong, Hunter, & Davis, 1994)

especially after menopause evidence shows up to 75% of women over 70 have pain

and limited motion associated with arthritis in one or more joints of the hand (Kjeken et al. 2005)

1 in 12 men• it’s likely that it occurs more often but isn’t reported because people deal with it on their

own and don’t seek medical attention

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Thumbs contribute 40%-60% of the use of our hands and allow us to complete both delicate and forceful tasks (Dickson, & Morrison, 1979)

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Potential Causes of Basal Joint Arthritis:

Cumulative trauma from repetitive tasks

Injury

Repeated forceful pinching

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5# PINCH AT THE THUMB TIP CAN CREATE OVER 25# OF FORCE AT THE CMC JOINT,! ( COONEY, 1981)

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noelhenley.com

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http://www.greenshandsurgery.com/

The thumb has 3 joints:

noelhenley.com

infovisual.info

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It may be a fun party trick, but try to avoid purposefully hyperextending your MCP joint:

People who are “double jointed” are actually hypermobile, which means the stabilizing ligaments are loose. When this occurs at the MCP joint it may increase risk for developing arthritis at the cmc joint (Moulton, Parentis, Kelly, J acobs, Naidu, Pellegrini. (2001); Koff, Ugwonali, Strauch, Rosenwasser, Ateshian, & Mow. (2003) Cooney & Chao. (1981)

Example of hyperextension of the MCP joint

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Thumb motion and function is accomplished by a complex balance of the different muscles that control the thumb and index finger

In a normal thumb, these muscles work together to move the thumb correctly with precision

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Many muscles are involved in moving the thumb in different directions. When there is basal joint arthritis, the muscles become unbalanced causing abnormal movement patterns

Extensor pollicis longus Extensor pollicis brevis Flexor pollicis longus Flexor pollicis brevis

Adductor pollicis Abductor pollicis brevis Opponens pollicis 1st dorsal interosseous Diagrams from: Flashpak Anatomy.By Flash Anatomy - Bryan Edwards Publishing (1994)

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An imbalance in the muscles creates uneven pressure at the cmc joint

This causes changes to the cartilage that covers the bones (= osteoarthritis)

= more muscle imbalance as the joint shifts position

= pain, loss of motion and loss of function15ProtectYourThumbs.com

This muscle imbalance can cause a normal thumb to become deformed and painful

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http://www.e-hand.com/jpg/JPG00523.JPG

Joint Protection Principles

Use larger, stronger joints when able:

Use a shoulder bag rather than a clutch purse to avoid pinching motions

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Writing

• Large diameter pens• Pen grips • Felt tip or gel pens

All require less pressure to write

promopeddler.com

working-well.org

assistivetech.net

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https://mail.google.com/mail/u/0/?ui=2&ik=dd2c053190&view=att&th=135ef909f6bc02ba&attid=0.1&disp=inline&realattid=1395826735181725696-1&safe=1&zw

Choose options to protect your joints when given a choice:

Click on a water bottle to start a video clip

Protect your thumbs and the environment!

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THERE ARE MANY NEW TOOLS FOR THE KITCHEN AVAILABLE AT STORES THAT SELL KITCHEN SUPPLIES

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wrightstuff.biz

goldviolin.comBeabletodo.com

Large diameter handles help decrease force on the thumb These handles allow you to

grip with your fingers instead of your thumb

These make it easier to open different size bottles

This breaks the seal on a new jar to open it effortlessly

Electric can openers are helpful 20ProtectYourThumbs.com

http://ep.yimg.com/ca/I/makinglifeeasier_2194_82589720.jpg

http://www.simplysmartliving.com/assets/images/pg_all_purpose_opener_6.jpg

http://ep.yimg.com/ca/I/makinglifeeasier_2201_66152158.jpg

Ergonomic garden tools minimize force on the thumb

gardeningwithease.com

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gardenofedenlocation.com

perfectgardeningtips.com

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USE ADAPTIVE EQUIPMENT TO DECREASE FORCE ON YOUR THUMBS

Lever doorknobs are trendy and require much less force than turning a doorknob

Bookstands eliminate the need to hold a book for prolonged period of time

Magnetic jewelry clasps make it easier to apply a necklace

goldviolin.com

hugabook.com a

Easy grip toenail clippers require less force and can be squeezed with your fingers instead of your thumb

Double click clippers for video


http://search.goldviolin.com/search?p=R&srid=S3-USCDR01&lbc=goldviolin&w=arthritis&url=http://www.goldviolin.com/ProductDetails.asp?ProductCode=91221&rk=23&uid=366912259&sid=2&ts=custom&rsc=RTmJTXk25znJzsIZ&method=and&isort=score&view=grid&Click=null

Double click each picture for video:

Spring loaded scissors Large diameter pan scrubber

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Thumb Exercise Program

None of these should increase pain!

Start with ~10 repetitions each 2-3x/ day

Gradually increase repetitions to 20 and use more pressure as long as NO increase in pain

Proper form is very important to make sure the correct muscles are being strengthened

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The goal of this exercise program is to strengthen the muscles around the base of your thumb as well as a thumb stabilizer muscle of the index finger

Abductor pollicis brevis Extensor pollicis brevis Flexor pollicis brevis

Opponens pollicis 1st dorsal interosseous

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Tightness of the adductor pollicis muscle is a very common complication with basal joint arthritis

It’s important to try to help soften this muscle before you do the strengthening exercises.

This will make the exercises more effective.

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Tightness of this muscle prevents us from moving the thumb away from the index finger normally.

This can create abnormal hyperextension motion at the MCP when you attempt to grasp a larger object such as a coffee mug (or an extra large water bottle)

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MCP joint

http://www.e-hand.com/jpg/JPG00523.JPG

Deep pressure or massage to this muscle is very important before completing other exercises

Apply firm pressure with your other hand or apply a large clip for 30 seconds to 5 minutes:

Then use your other hand to try to open the CMC joint wider.

Be careful not to overstretch the MCP joint further massgeneral.org

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Click on the link below for a video demonstrating the proper technique to soften the adductor pollicis muscle

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Some people also get relief by gently pulling (distracting) the thumb, as if trying to make it longer

This helps to re-position the bones in better alignment

Placing your hand palm down, then sitting on it may also provide pain relief

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Re-teach your thumb muscles how to work correctly by going through the next 5 exercises in a PAIN FREE manner

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Palmar abduction:abductor pollicis brevis muscle

Keep a slight bend in the mcp and ip thumb joints

Try to form the letter “C” with your thumb and fingers

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Click on the picture below for a video demonstrating the proper technique to activate the abductor pollicis brevis muscle

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Radial abduction:extensor pollicis brevis muscle

First pull your thumb away from your index finger to make an “L”

Then try to pull thumb backward so it is in line with your fingers Keep the ip joint of your thumb semi- bent in order to help isolate the muscle we are trying to strengthen

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Click on the picture below for a video demonstrating the proper technique to activate the extensor pollicis brevis muscle

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Opposition:opponens pollicis muscle

Try to form the letter “O” with your thumb and each fingertip one at a time

Apply light pressure as long as you stay pain-free and can maintain the slight bend in the thumb joints

Sometimes it helps to use your other hand to position your thumb in this “O”, then try to hold it there for 3-5 seconds

This demonstrates a collapse of the mcp joint. It is important that you try to prevent this from happening since it reinforces the muscle imbalance

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Click on the picture below for a video demonstrating the proper technique to activate the opponens pollicis muscle

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MCP flexion:flexor pollicis brevis muscle

Bend your thumb across your palm toward the bottom of your pinky finger.

Try to keep your thumb tip (ip joint) straight

You can use also your other hand to give light resistance as shown here:

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Click on the picture below for a video demonstrating the proper technique to activate the flexor pollicis brevis muscle

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Index finger abduction:first dorsal interosseous

Place palm flat on table, slide your index finger away from the middle finger

Use your other hand or a thin rubber band to apply resistance to this motion

Make sure to keep fingers flat on the table to prevent other muscles from taking over

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Click on the picture below for a video demonstrating the proper technique to activate the 1st dorsal interosseous muscle

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IF YOUR THUMB PAIN PERSISTS OR INCREASES, SEEK MEDICAL ATTENTION!

Ask your doctor for a referral to a certified hand therapist (CHT).

She/he can provide you with a custom formed or pre-fabricated orthosis

These temporarily rest the joint, and help to decrease pain at the cmc joint by immobilizing it.

Examples of orthoses: (splints/ braces)

The goal is to wean out of the orthosis as pain decreases

handlab.com

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This series of x-rays shows the progression of basal joint arthritis

Stage 1 is very early in the disease process so the cmc joint still looks almost normal, by stage IV, there is no joint space left and it is difficult to reverse the pain and loss of function without surgery in most cases

eorif.com

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The techniques presented here show different methods to help protect your thumbs.

Doing some parts of this program is good, doing more of it is great and may help you avoid becoming one of the 1 in 4 women who develop basal joint disease.

This will allow you use your hand normally for the things you want to do.

This program may also help delay the very common problem of basal joint arthritis from developing, and ultimately reduce the need for surgery that many women face as they age

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Helpful Resources

American Occupational Therapy Association; www.AOTA.org American Society of Hand Therapists; www.ASHT.org American Physical Therapy Association www.APTA.org American Association of Hand Surgeons ; www.handsurgery.org American Society of Surgery of the Hand; www.ASSH.org Arthritis Association; www.Arthritis.org

[email protected]

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http://www.aota.org/

http://www.asht.org/

http://www.apta.org/

http://www.handsurgery.org/

http://www.assh.org/

http://www.arthritis.org/

What is Occupational Therapy?

“Occupational therapy is a skilled health, rehabilitation, and educational service that helps people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations) (AOTA.org).

Some common examples of daily occupations include: Bathing and dressing, Meal preparation, eating, washing dishes Writing or using the computer Working, and all the duties associated with your particular job Exercise, hobbies, sports, leisure activities Driving or using public transportation Any activity that is important to you!

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What is Occupational Therapy?

“It is covered by private insurance, Medicare, Medicaid, workers’ compensation, vocational programs, behavioral health programs, early intervention, and school programs.

Services also may be covered through Social Security, state

mental health agencies or those serving individuals with intellectual impairment, health and human services agencies, private foundations, and grants. Many providers accept private payments.” (AOTA.org)

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Prevention strategies such as these are an integral element of the American Occupational Therapy Association’s (AOTA) Centennial Vision:

“to promote occupational therapy’s practice of enabling people to improve their physical and mental health, secure well-being and enjoy higher quality of life through preventing and overcoming obstacles to participation in the activities they value.” (AOTA, 2007a, p. 613).


What is Hand Therapy?

“Hand Therapy is a type of rehabilitation performed by an occupational or physical therapist on patients with conditions affecting the hands and upper extremities.

Such therapy is performed by a provider with a high degree of specialization that requires continuing education and, often, advanced certification.

This enables the hand therapist to work with patients to hasten their return to a productive lifestyle.” (ASHT.org)

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ReferencesAlbrecht, J . (2004). Caring for the painful thumb. North Mankato, Minn. J an Albrecht.Angier, N. (2012). A gripping tale: each flick of a finger takes five. Retrieved from

www.nytimes.com/2012/02/28/science/a-gripping-tale-each-flick-of-a-finger-takes-the-work-of-five.html?pagewanted=2&smid=FB-nytimesArmstrong, A., Hunter, J ., & Davis, T. (1994). The prevalence of degenerative arthritis of the base of the thumb

in post-menopausal women. The Jo urnal o f Hand S urg e ry: Jo urnal o f the B ritis h S o c ie ty fo r S urg e ry o f the Hand , 1 9(3), 340-341. doi:10.1016/0266-7681(94)90085-X

Barron, O. a, Glickel, S. Z., & Eaton, R. G. (2000). Basal joint arthritis of the thumb. The Jo urnal o f the Ame ric an Ac ade my o f Ortho pae dic S urg e o ns , 8(5), 314-23. Retrieved from www.ncbi.nlm.nih.gov/pubmed/11029559

Cooney, B. Y. W. P., D, M., & Linscheid, R. L. (1981). The Kinesiology of the Thumb Trapeziometacarpal. Jo urnal B o ne and Jo int S urg e ry, 63 (9), 1371-1381.

Dickson, R. A, & Morrison, J . D. (1979). The pattern of joint involvement in hands with arthritis at the base of the thumb. The Hand , 1 1 (3), 249-55. Retrieved from www.ncbi.nlm.nih.gov/pubmed/520867

Eaton R.G., (1984). Thumb basilar joint classification eaton littler staging. Jo urnal o f Hand S urg e ry;9A:692. Retrieved from: eorif.com/thumb-basilar-joint-arthritis-71514

Kjeken, I., Dagfinrud, H., Slatkowsky-Christensen, B., Mowinckel, P., Uhlig, T., Kvien, T. K., & Finset, A. (2005). Activity limitations and participation restrictions in women with hand osteoarthritis: Patients' descriptions and associations between dimensions of functioning. Annals o f the R he umatic Dis e as e s , 64(11), 1633-8. doi:10.1136/ard.2004.034900

Koff, M. F., Ugwonali, O. F., Strauch, R. J ., Rosenwasser, M. P., Ateshian, G. a, & Mow, V. C. (2003). Sequential wear patterns of the articular cartilage of the thumb carpometacarpal joint in osteoarthritis1. The Jo urnal o f Hand S urg e ry, 28(4), 597-604. doi:10.1016/S0363-5023(03)00145-X

Lefler, C., & Armstrong, W.J . (2004). Exercise in the treatment of osteoarthritis of the hands of the elderly. C linic al Kinis io lo g y, 5 8(2), 13-17.

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http://www.nytimes.com/2012/02/28/science/a-gripping-tale-each-flick-of-a-finger-takes-the-work-of-five.html?pagewanted=2&smid=FB-nytimes

http://www.ncbi.nlm.nih.gov/pubmed/11029559


http://eorif.com/thumb-basilar-joint-arthritis-71514

References continued…

Moulton, M. J ., Parentis, M. A., Kelly, M. J ., J acobs, C., Naidu, S. H., & Pellegrini, V. D. (2001). Influence of metacarpophalangeal joint position on basal joint-loading in the thumb. The Jo urnal o f B o ne and Jo int S urg e ry. 83 -A(5), 709-716. Retrieved from www.ncbi.nlm.nih.gov/pubmed/11379740

Rogers, M. W., & Wilder, F. V. (2007). The effects of strength training among persons with hand osteoarthritis: A two-year follow-up study. Jo urnal o f Hand The rapy, 20(3), 244-9. doi:10.1197/j.jht.2007.04.005

Roundtree, L.C., (2010). Making a difference: Hand therapy. R e hab Manag e me nt, April 2011. Retrieved from www.rehabpub.com/issues/articles/2011-04_01.asp

Sillem, H., Backman, C. L., Miller, W. C., & Li, L. C. (2010). Comparison of two carpometacarpal stabilizing splints for individuals with thumb osteoarthritis. Jo urnal o f hand the rapy, 24(3), 216-25. Doi:10.1016/j.jht.2010.12.004

Stamm, T. A., Machold, K. P., Smolen, J . S., Fischer, S., Redlich, K., Graninger, W., Ebner, W., et al. (2002). J oint protection and home hand exercises improve hand function in patients with hand osteoarthritis: A randomized controlled trial. Arthritis C are & R e s e arc h, (8), 44- 49. doi:10.1002/art1.10246

Valdes, K., & Marik, T. (2009). A systematic review of conservative interventions for osteoarthritis of the hand. Jo urnal o f hand the rapy, 23 (4), 334-50. doi:10.1016/j.jht.2010.05.001

Wajon, A., & Ada, L. (2005). No difference between two splint and exercise regimens for people with osteoarthritis of the thumb: a randomised controlled trial. Aus tralian Jo urnal o f P hys io the rapy, 5 1 (4), 245-249.

Weiss, S., LaStayo, P., Mills, A., & Bramlet, D. (2004). Splinting the degenerative basal joint: Custom-made or prefabricated neoprene? Jo urnal o f Hand The rapy, 1 7(4), 401-406. doi:10.1197/j.jht.2004.07.002

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Feedback Survey

1. This program helped me understand why I have thumb pain: strongly agree agree disagree strongly disagree

2. This program explained the purpose of wearing a supportive orthosis: strongly agree agree disagree strongly disagree

3. This program helped me understand some ways to protect my thumb joints: strongly agree agree disagree strongly disagree

4. This program showed me helpful exercises to help prevent arthritis pain and deformities from worsening: strongly agree agree disagree strongly disagree

5. Overall this program seems like something I can add to my daily routine: strongly agree agree disagree strongly disagree

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