New York Physical Therapy Ebook Continuing Education

If wearing the orthosis causes difficulties with tasks requiring a tight pinch or grasp pattern, adapted devices should be issued or recommended to the client. Such devices might be large-diameter pens or the addition of plastic or foam tubing to increase the diameter of a pen or pencil. The handles of devices and utensils such as hairbrushes, toothbrushes, and kitchen tools can be modified easily in this way to increase functionality. In cases in which acute inflammation and edema are present, edema management techniques such as light retrograde massage, wearing compression gloves and sleeves, and gentle lymphatic stimulation exercises (e.g., diaphragmatic breathing, active trunk and cervical rotation exercises) can help to reduce and manage subsequent edema (Priganc et al., 2020). Compression gloves and sleeves made of nylon/spandex can be used in conjunction with an orthosis during wear as needed, especially because the neutral warmth of the glove or sleeve may reduce morning joint stiffness and decrease pain (Hammond et al., 2016). When acute pain subsides, the client in the subacute stage of OA can continue to experience stiffness and pain with overuse or straining of the joint. For this reason, it is important for the client to be educated on joint protection techniques and to use orthoses as needed due to the likelihood that pain will reoccur on return to heavy use of hands for daily activities. Clients with known subacute OA should consider the use of adaptive equipment and convenience tools when possible. Examples of adaptive equipment include built-up handles; lighter-weight cookware; and devices that reduce the need to pinch, such as spring-loaded scissors. Convenience tools reduce time and exertion, and are available commercially. Examples include mini electric food choppers, electric knives, electric can openers, electric screwdrivers, and light handheld electric mixers. The evaluation and intervention for specific joints for conservation and postsurgical management are discussed further in the sections on OA of proximal and distal finger joints, thumb, and wrist. Physical therapy provides a way to reduce pain, improve flexibility, strengthen muscles, increase endurance, and improve functional mobility. PTs also assist clients in improving body mechanics and posture, and develop strategies to manage OA daily, particularly OA in the larger joints of the body such as the hip, knee, and shoulder. Practitioners assess flexibility, muscle strength, physical functioning, mobility, and ambulation. Treatment might include instruction in exercises to improve joint ROM, endurance, and muscle strength, as well as gentle oscillatory joint mobilization, which can ease painful joints and enhance pain-free joint mobility. Low-impact aerobic conditioning exercises such as walking, bicycling, and swimming help decrease pain and functional disability, and help establish correct body weight, which is important to managing OA of hips and knees (Katz et al., 2021). When joints are inflamed, clients can perform isometric exercises designed to strengthen muscles while avoiding joint motion. PTs also work with the hand and wrist, but typically do so in the specialty practice of hand therapy. Hand therapy is a subspecialty of both physical and occupational therapy. Both disciplines contribute to the knowledge base of those who identify as hand specialists, and each discipline learns and uses the theories and techniques of the other for best client outcomes. According to the Hand Therapy Certification Commission (HTCC), approximately 87% of hand therapy specialists are occupational therapists (HTCC, 2022). Information specific to occupational therapy of the hand and wrist is expanded further in a subsequent section.

test is performed by having the client hold a flexed thumb in their palm with the digits fisted (Cooper, 2020). The wrist is then ulnarly deviated while keeping the thumb in the palm. A sharp pain extending along the thumb and into the radial wrist is a positive result, and could indicate De Quervain’s stenosing tenosynovitis. For some individuals, pain is naturally present during this maneuver, but is typically experienced to a lesser degree than in the presence of tenosynovitis. It is advisable to compare a client’s pain levels with pain levels on the noninvolved side, if possible, to determine whether the pain is indicative of an inflammatory condition. Figure 12: Finkelstein’s Test

Source: Erin Peterson Tools that assess hand skills include the Jebson Hand Function Test, the Purdue Pegboard Test, and the Moberg Pick-Up Test (Cooper, 2020). These tools each have a structured method of administration and demonstrate reliability and validity (Cooper, 2020). In addition to known assessment tools, the therapist should use clinical observation skills. The therapist should observe the client during functional activities and note how they use the thumb and fingers. The therapist should perform cursory assessment of other joints of the hand and the more proximal upper extremity joints to determine their status and functional abilities. For example, the presence of thumb CMC joint deformity should be noted and might indicate the degree of joint involvement. The arthritic CMC joint typically has a squared appearance to the base of the thumb as it articulates with the wrist. In more advanced cases, the CMC joint may become subluxed or fused and cause the metacarpal to become fixed in an adducted position. Therapeutic intervention General treatment of OA includes the provision of custom- fabricated or prefabricated orthoses (splints), which immobilize or support the affected joint during use of the wrist and hand. When an orthosis is applied to an acutely inflamed joint, the client should be instructed to wear the device during sleep hours to reduce pain and prevent deformity. The orthosis should also be worn during daily tasks involving force or repetitive movement. The orthosis can be removed several times during the day for ice, massage, and gentle exercise to prevent contractures, and can be removed for bathing if that activity does not aggravate the joint. See Appendix B for an example template of how to document and provide patient education to a client with an orthosis.

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Book Code: PTNY1024

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