Treatment2Go dba Exploring Hand Therapy

�

OsteoarthritisUnloaded

Treatment2Go dba Exploring Hand Therapy

1�

View the picture depicting the synovium and synovial fluid within the joint.

unDerSTanDInG THe joInT In acTIon:Joint motion is nearly frictionless, with a coefficient of 0.001 – 0.05 which is better than most commercial bearings. Joint stability is provided by several factors including the congruity of the articular surface, muscular forces, and the integrity of ligaments.

As people move, the intermittent cartilage compression and release provides for imbibition of synovial fluid into the cartilage interstitial fluid. Negatively charged glycosaminoglycan side chains repel one another and attract water, increasing matrix volume. Expansion is limited by the collagen meshwork. Compression of the matrix pushes glycosaminoglycan side chains together, releasing water and decreasing matrix volume. Decompression allows for the re-expansion

vIDeo joInT MoTIon

Treatment2Go dba Exploring Hand Therapy

��

Some other possible joint end-feels include:Soft SpringyCapsularLoose

There are numerous resources to assist therapists in understanding joint end-feel. End-feel is important because it can help to guide therapists as they proceed with treatment.

STaBILITy:Stability testing is a necessary aspect of assessment with OA. Many deformity patterns as well as functional limitations are the result of joint instability so assessment is vital to identify the source of dysfunction.

Of course, all affected joints should be assessed for stability from the shoulder girdle to the hand. In the hand, the thumb CMC is most commonly assessed for stability as well as the PIP and DIP joints of the fingers.

Thumb Stability:Thumb MP / IP stability can be tested by having the patient attempt a tip pinch.Thumb CMC / MP stability can be tested by having the patient attempt a lateral pinch.During the pinch and observe the thumb CMC/MP/IP joints. If the joints are unable to maintain a neutral position during the pinch, instability should be suspected.Remember, a deformity at a joint does not necessarily imply that the joint in question is unstable. Many times the deformity results from instability at another joint with resulting mechanical imbalance.

►►►►

►

►

►

►

Treatment2Go dba Exploring Hand Therapy

��

In the following picture, observe the stress applied to the MP and CMC joints just using a pinch gauge.(Chapter 3 – Image 8) Try it yourself.

Finger Stability:Assessment of lateral joint stability is important at the PIP and DIP joints.To test, stabilize the proximal phalanx to the joint and gently move the distal phalanx laterally in each direction.Compare the contralateral side.

Finger Stability Testing Video

Strength:Strength is not always tested because the position required during testing only serves to exacerbate the symptoms and progression of the disease process.

►

►

►

Treatment2Go dba Exploring Hand Therapy

100

Chapter 7The Finger

(MCP/PIP/DIP) JointsAside from the thumb, OA affects the IP joints of the hand with less deformity, other than aesthetic appearance. Patient complaints for IP joints of the digits usually consist of:

SwellingRednessWarmthMorning stiffnessPainLimitations performing grip or prehension tasksAppearance of enlarged joints or “nodules”

The following images depict patients suffering from OA in the hand. Pay attention to

►►►►►►►

Treatment2Go dba Exploring Hand Therapy

101

the PIP and DIP joints particularly. Patient’s symptoms and complaints will usually lead the therapist to evaluate the IP joints to discover the underlying cause.

Of course during evaluation ROM of the IP joints will be evaluated. Therapists should pay attention to both active and passive ROM. During assessment of passive ROM, therapists need to note the quality of motion. Check for the following:

End-feelCrepitusPainTriggering

rEmEmbEr, no moTion sHould bE forcEd. bE surE To mainTain rom THaT is as pain-frEE as possiblE during assEssmEnT and TrEaTmEnT.

If there is diffuse swelling, volumetric measurements can be used to assess edema. In addition, therapists can perform circumferential measurements of specific areas.

One area that should not be overlooked as part of finger IP joint assessment is stability testing. When there is instability of an IP joint, patients will experience pain with ROM and pinch. In addition, if IP joints are unstable, this will predispose patients for deformity patterns and further joint destruction.

►►►►

Treatment2Go dba Exploring Hand Therapy

11�

Take a look at an x-ray of a patient with SLAC.

There are 3 stages of SLAC arthritis. Some authors include a 4th:

Degenerative changes at the scaphoid waist and radial styloid.

Degenerative changes at the proximal pole of the scaphoid and scaphoid fossa of the distal radius.

Degenerative changes at the capitolunate joint.

Scaphoid Nonunion:Nonunion of the scaphoid can lead to the SLAC wrist patterns.When scaphoid nonunion is involved, this is known as SNAC (Scaphoid Nonunion Advanced Collapse)

There are 3 stages of SNAC:

Rounding or breaking of the radial styloid.

Radioscaphoid joint arthrosis

Arthrosis extending into the capitolunate joint

1)

2)

3)

►►

1)

2)

3)

Treatment2Go dba Exploring Hand Therapy

1��

Appendix BSplint Patterns

radial-basEd THumb spica wrisT/THumb immobilizaTion spica