the bivalve orthosis was discontinued. Mr. Chen was instructed in AROM exercises to address supination and pronation; the initial measurements of active motion indicated a limitation of approximately 50%. He was able to supinate to 45 degrees and pronate to 54 degrees (n = 90 and 85, respectively). Mr. Chen was encouraged to engage in moderately resistive daily activities such as vacuuming, laundering clothes (e.g., picking up garments one or two at a time), washing dishes, and preparing simple meals while using a wrist orthosis. Weekly therapy visits continued with provision of heat, followed by active and passive ROM exercise of fingers and forearm. He also worked on various functional tasks to address compensation techniques and increase ROM and strength in a natural context. At 12 weeks postsurgery, the surgeon was satisfied that bone consolidation was complete. Mr. Chen was advised to reduce orthosis wear slowly to be completely without an orthosis at 14 weeks. His current abilities were assessed, and he scored 77/80 on the MAM-20, with a pain score of 1 on a 0 to 10 scale. AROM of all joints, including fingers and forearm, was within normal limits. He reported that he is having no difficulties using his hand for schoolwork, driving, or desired leisure activities (e.g., yard work and fishing). He was discharged at 12 weeks. modalities, strengthening, and exercise, to increase ROM. Of utmost importance, a therapist empowers clients about their disease and instructs them in how to minimize its effects on their occupational performance. This course has examined the pathophysiology, anatomy, and causes of OA of the hand and wrist. It has outlined the diagnostic process and has highlighted various medical interventions, including surgical and conservative approaches. Therapists are important members of the healthcare team, working with individuals experiencing OA of the hand and wrist. Rehabilitation professionals are known for their skill and expertise in addressing the medical-based rehabilitation needs of both pre- and postsurgical clients. They are experts in providing education and training to clients about the disease itself and methods by which they can continue to participate in desired occupations, including daily activities, in a full and pain- free manner.
On his return to therapy at three weeks postsurgery, an increase in TAM of all digits between 20 and 30 degrees was noted. Gross grasping abilities had improved, and extensor lag was not noted. His home program had increased by 10 repetitions of each exercise. Mr. Chen is scheduled to return to therapy in another three weeks, following his doctor’s visit. He was instructed to contact the therapist with concerns or questions. On return at six weeks postsurgery, Mr. Chen was fitted with a bivalve thermoplastic orthosis to provide continued protection for his healing bones. The orthosis can be removed for hygiene, scar massage, and therapy. Treatment included gentle PROM to digits, which were now limited by only 10 degrees of total active motion and did not show signs of extensor lag. The client was instructed in a PROM home program in addition to scar massage. Treatment continued one time per week and included active and passive ROM exercises and scar massage following 15 minutes with a hot pack. He engaged in functional tasks of his choosing that provided additional movement and slight resistance to his digits. At week eight postsurgery, progressive strengthening of Mr. Chen’s hand was initiated, and a home program of therapy putty and a light gripper was provided. The dorsal component of Conclusion Hand and wrist OA are especially debilitating forms of arthritis, secondary to their impact on fine motor coordination and the ability to grip, pinch, carry, and use objects. It is essential to assist a client with preserving occupational identity through adaptation and modification of the environment; protecting small joints of the hand and wrist; and gently exercising to maintain flexibility, mobility, and strength. Occupational therapy is a profession based on the understanding that humans are occupational beings who experience satisfaction in life through their ability to participate in engagements they find meaningful. Occupational therapy recognizes the power of occupations themselves in their ability to improve functioning by addressing the status of underlying client factors (e.g., body functions and structures) and skills (e.g., motor, process, and social; AOTA, 2020). Additionally, physical therapists can have a profound effect on people’s lives. They help people achieve fitness goals, regain or maintain their independence, and lead active lives. (APTA, n.d.) PTs and OTs address pain and dysfunction through biomechanical approaches, including orthoses, physical agent
APPENDIX A
Principles of Joint Protection, Work Simplification, and Fatigue Management
● Develop a light touch to decrease static pressure on thumb joints during activities such as writing. ● Use tools, adaptive implements and handles, and modified lifting techniques to decrease pain and stress during activities. ● Stop prolonged activities for at least 10 minutes per hour for rest or stretching exercises. ● Maintain muscle strength and range of motion through a program suggested by a healthcare provider. ● Avoid positions that put undue stress on arthritic joints and that could create deformities. ● Apply cold before, during, or after activity, depending on which method is most effective in reducing pain and inflammation. ● Use orthosis as recommended. ● Use the strongest joints available. For example, try to substitute the elbow for carrying a purse when hands show signs of arthritic changes. ● Avoid staying in one position for too long. ● Avoid starting an activity that cannot be stopped. Regular rest breaks take stress off delicate or painful joints. Adapted from Cooper (2020)
● Pack handbags, briefcases, or luggage as light as possible. Use ergonomically designed carrying handles when carrying grocery or trash bags. ● For prolonged telephone use, use a headset that lessens pressure on the neck, shoulder, or elbow while talking. Consider a speakerphone for hands-free conversations. ● When cooking, use ergonomically friendly tools such as an electric can/jar opener, utensils with cushioned grips, and spring-activated scissors. ● When purchasing clothing, buy shirts with larger buttons that are easier to work. Buttonhooks with special grips are also available to make buttoning simpler, or try loose-fitting, pull- on clothing to avoid buttons and zippers. ● Reduce force and effort. Whenever possible, consider aids such as lamp switch enlargers, special doorknob/key turners, gas cap turning aids, zipper pulls, dressing sticks, long shoehorns, and sock pulls to make daily tasks easier or to change the position of the hand. ● Respect pain. Do not engage in activities that cause pain and swelling of the joints of the hand. ● If activities that cause pain must be completed, attempt them only if pain lasts less than one hour following the activity.
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