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. long-term use (Quismorio et al., 2011). While taking these medications to reduce joint damage, clients should be advised to use joint protection strategies (e.g., avoid straining hand joints through actions such as forcing a jar open or carrying a heavy shopping bag; Hochberg et al., 2012). COX-2 inhibitors are a form of NSAID that targets COX‑2, an enzyme responsible for inflammation and pain. COX-2 inhibitors appear to have fewer side effects than other NSAIDs. They also block prostaglandin production and protect the stomach better. However, many COX-2 inhibitors were removed from the U.S. market in 2005 when research showed an increased risk of serious cardiovascular events associated with their use (Howes, 2007). The only COX-2 inhibitor that remains on the market in the U.S. is celecoxib, which is sold under the manufacturer’s name of Celebrex and is now approved in some generic versions (U.S. Food and Drug Administration [FDA], 2014).
Figure 12: Finkelstein’s Test
Source: Erin Peterson
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. 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, Pharmacology Despite considerable research, no drug prevents or repairs cartilage damage. Nevertheless, pharmacological intervention can help reduce pain associated with OA. Pain-relieving and anti-inflammatory medications can be important components of the management paradigm. Medications are delivered orally, injected directly into the joint, or applied topically (Hochberg et al., 2012). Generally, pharmacological intervention follows a progression of drugs. The first line for discomfort is acetaminophen, in doses from 1 to 5 g per day (Hochberg et al., 2012; Quismorio et al., 2011). This medication is as effective as nonsteroidal anti-inflammatory drugs (NSAIDs). If acetaminophen is not sufficiently effective, NSAIDs are tried, though 15% of individuals taking them have an increased risk of side effects such as gastrointestinal bleeding and peptic ulcer disease. Common NSAIDs in the treatment of OA are ibuprofen and naproxen. The NSAID family blocks prostaglandins that trigger inflammation, but there is concern that their use accelerates joint destruction; individuals might develop allergies following
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Book Code: PTOH1324
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