Simone Sheehan Senior Occupational Therapist. “On the length, strength, free lateral motion and perfect mobility of the thumb, depends the power of the.

Simone Sheehan

Senior Occupational Therapist

“On the length, strength, free lateral motion and perfect

mobility of the thumb, depends the power of the human hand”

~Sir Charles Bell, 1833~

Tends to occur in women older than 40 years of age (Dray & Jablon, 1987; Jonsson & Valtysdottir, 1995) and affects 1/3 of females over the age of 50 (Armstrong, 1994).

A painful thumb can truly limit the ability to perform activities.

In fact, a severely painful thumb can limit hand function by 45% (Swanson, 1973).

1. Pain / aching around base of thumb – may radiate down thumb or up forearm

(usually most intense during pinch)

2. Tenderness over the CMC joint3. Stiffness in the CMC joint in the morning or

after inactivity

If inflammation is severe – 1. Swelling2. Warmth3. redness

Tip pinch

Lateral pinch

Palmar pinch

Grasp pinch

Thumb CMC joint is a saddle joint

Reduce excessive loading on joints

Avoid pain in activities

Distribute as much load over several joints

Use stronger, larger joints

Avoid twisting forces

Use joints in their most stable and functional positions

Maintain ROM

Balance activity and rest

Avoid staying in one position for long periods / static grips (Melvin, 2002)

Reduce effort

Gadgets Compensate

Nice Guideline 59 – Osteoarthritis People with osteoarthritis who have biomechanical joint

pain or instability should be considered for assessment for bracing/joint supports as an adjunct to their core treatment.

Valdes & Marrik (2010) The current literature supports the use of orthotics, hand

exercises, application of heat, and joint protection education combined with provision of adaptive equipment to improve grip strength and function.

Rannou et al (2009) Night time splinting is an effective treatment of base of

thumb OA

Day et al (2004) Thumb splinting together with corticosteroid provides

relief – unable to solely attribute effects to either modality

Carreira, Jones & Natour (2007) Splint is effective to decreased pain scores in

trapeziometacarpal OA patients

Boustedt & Nordenskold (2007) Women with thumb base OA can expect

improvement concerning pain on motion and hand grip force post hand OA programme partipation and combining it with night splints they can expect decreased pain at night.

Stamm et al (2002) Joint protection and hand home exercises, easily

administered and readily acceptable interventions, were found to increase grip strength and global hand function.

Splinting aims to enhance pain-free use of the thumb and allow individuals to partake in previously aggravating activities, without pain

“A splint by its very presence is doing harm as it inhibits free movement. It is only justified if the specific good compensates for the general harm”

Paul W. Brand

We all use our hands in different ways and so it is important to

look carefully at each individual, their

characteristics, needs and lifestyle.

Client Centred-ness Comfort Cosmesis Convenience Less is more Follow up

McKee & Rivard (2004). Orthoses as enablers of Occupation: Client centred splinting. Canadian Journal of Occupational Therapy (71, 306-314).

Hours: 8.30 – 16.30

Monday - Friday

Cost: Inpatient:

Outpatient:

Included in bed rate

€70/hr, €60/45mins€50/30mins, €30/15mins

Aids / Appliances: Supplied and billed

Referrals to be sent to:

Occupational Therapy Department, Bon Secours Hospital, College Road, Cork.021 4801630

Details to be included:

Name, Address, DOB, contact number, medical history and presenting complaint.