New York Physical Therapy Ebook Continuing Education

of the treatment. Due to this, most medical-grade units offer waveforms with combined high and low rates to capitalize on both theories of pain reduction. Clients can be taught how and when to use their TENS unit by therapists and can then use it independently at home. When electrodes are placed around the painful area, TENS has been shown to reduce pain associated with OA (Wu et al., 2021). al., 2011). The following section discusses postsurgical protocols. The reader is advised that the values mentioned in the protocols are guidelines. Postsurgical protocols vary considerably across clinical settings. It is important that therapists work closely with surgeons; the number of weeks might vary depending on the individual surgeon’s protocol, the experience of the therapist working with a surgeon, the client’s joint condition at the time of surgery, and other factors.

stimulation from the unit instead (Bellew et al., 2016). Low- rate TENS utilizes the endorphin and enkephalin theory, which suggests the body’s own pain mediators, like serotonin, are activated by the stimulation and therefore reduce pain (Bellew et al., 2016). While high-rate TENS immediately reduces pain, the relief will end once the unit is removed. Conversely, low-rate TENS takes at least 45 minutes to begin alleviating pain but will continue with pain relief for several hours after discontinuation Surgery Surgery is an alternative only if conservative measures have failed and there are major mechanical symptoms (Hochberg, 2012). Surgical options include total joint replacement (arthroplasty), joint fusion (arthrodesis), cartilage transplantation, or arthroscopy to clean the joint by removing pieces of cartilage or bone that have broken off. These procedures are typically performed by orthopedists or plastic surgeons who have been specially trained in surgery of the hand and wrist. Hand surgeons work closely with OTs and PTs who specialize in hand rehabilitation (Taylor et


the hand often report that it starts with morning soreness and stiffness of the affected joints. They describe increasing difficulty with pinching and grasping, and note pain and crackling when moving the joint (Harvard Health Publications, 2017). OA of the PIP and DIP joints eventually causes enlargement of the joints and might create deformities with possible spontaneous fusion. People with OA of the hand might eventually find it impossible to open jars, turn a key, write, or type. Many people with OA of the hand find that with age, their hands thicken and become stiff. The DIP joint can also be immobilized in isolation of the PIP joint. This orthosis can be fabricated as volar based with a tip cover, or as seen in Figure 14, as a clamshell design. This orthosis protects and immobilizes painful DIP joints, and it can also be used to help a client understand the outcome of an elective joint fusion (Cooper, 2020). Figure 14: Clamshell Distal Interphalangeal Immobilization Orthosis

Several conditions associate commonly with OA of the wrist and hand, including OA of the proximal and distal finger joints. A brief overview of each of these conditions is presented below, followed by a discussion of conservative medical management, surgical management, and appropriate therapeutic interventions. The distal interphalangeal (DIP) joint is the most common site for OA of the hands. These joints are the site for the fibrous and bony nodules known as Heberden’s nodes . Bouchard’s nodes can develop on the proximal interphalangeal (PIP) joints, and OA of these joints can cause the fingers to stiffen and swell (Harvard Health Publications, 2017). Clients experiencing OA of Conservative management Conservative therapeutic management of PIP and DIP joints focuses on pain control, prevention of deformity, and prevention of occupational dysfunction. Pain control and deformity prevention are most commonly achieved with an orthosis that holds the affected joint in a pain-free extended and laterally aligned position. For a painful DIP joint, this positioning is best accomplished with a thin thermoplastic custom orthosis held in place with hook and loop straps such as Velcro (Cooper, 2020). The orthosis can be either volar or dorsally based. A circumferential plaster cast can also be used, but might not be appropriate in the case of enlarged joints or those with nodes. Since plaster is not a water-resistant material, this will need to be replaced and refabricated often. For the PIP joint, a gutter orthosis extends from the proximal end of the proximal phalanx to just before the DIP joint. This preserves DIP joint function if the joint is not also involved. The DIP joint can be included in the orthosis if it is painful or becoming deformed (Figure 13). Figure 13: Volar-Based Proximal Interphalangeal Joint Gutter Orthosis

Source: Erin Peterson In addition to use of orthoses, a client with painful

interphalangeal joints can benefit from education concerning joint protection techniques and from adaptive equipment that makes use of the hands for functional tasks easier; less painful; and in some cases, possible. Physical agent modalities, including ice packs applied for 20 minutes, can be used to reduce pain in an acutely inflamed PIP joint. Chronic pain that is noninflammatory can also be reduced with heat modalities such as hot packs applied for 20 minutes or paraffin wax dips. Both hot packs and paraffin baths can be purchased commercially.

Source: Erin Peterson

Page 11

Book Code: PTNY1024 Physical-Therapy

Powered by