Welcome to Arthritis New Zealand

Blog: Your community, your voice

Handhub’s blog

Handhub

Hand Therapist

I’m a hand therapist who regularly sees people overcoming difficulties with thumb and hand arthritis. It’s possible to make improvements with a willingness to learn new ways of doing things and I’m excited about using social media to share ideas and experiences.

Hand hub: Exercises for thumb arthritis

Hand hub: Exercises for thumb arthritis

Exercise for thumb arthritis
There is increasing evidence for the benefits of strengthening exercises for thumb arthritis. Exactly which exercises? Still nothing specific from the literature!

Go for pain-free
We try and give pain-free exercises whenever we can, particularly ones where the thumb joint remains in a stable position. Maintaining a stable position can be really hard for some people to start with, so this is where we would start.

Circular pinch

The trick is not allowing the middle joint (MP joint) to sag down when you are starting strengthening exercises.

Sometimes this position is called a ‘circular pinch’.

It is worth making sure you are able to get good control of this position, before progressing on to more difficult exercises against resistance.

 

 

Relearning a movement pattern can take time and concentration – it took many years to develop the old pattern, so be patient!

 

 

 

Effective motor learning happens when:

  • You give the task your full undivided attention – even for short bursts. You need as many motor nerves as possible focused on the job at hand.
  • You only continue the exercise when you are getting it right – otherwise you are practising doing it wrong!
  • When it all goes well, reward yourself (‘yay!’) – a squirt of endorphins makes the new pattern ‘stick’.

 

Catch yourself doing it right
What fires together, wires together.  In other words, the more you do it right, the better you will be at doing it right without thinking about it too much. You’ve made a ‘new normal’.

If the exercises are pain-free, you’ll be getting better at not having pain – double yay!!

If you need help getting the hang of it – hand therapists are a good starting point.

Ngā mihi, Alison

Alison Wilding: Exercises for thumb arthritis

Alison Wilding: Exercises for thumb arthritis

Exercise for thumb arthritis
An increasing body of evidence is out there for the benefits of strengthening exercises for thumb arthritis. Exactly which exercises? Still nothing specific from the literature!

Go for pain-free
We try and give pain-free exercises whenever we can, particularly ones where the thumb joint remains in a stable position. Maintaining a stable position can be really hard to start with for some people, so this is where we would start.

Circular pinch
The trick is not allowing the middle joint (MP joint) to sag down when you are starting strengthening exercises. Sometimes this position is called a ‘circular pinch’. It is worth making sure you are able to get good control of this position, before progressing on to more difficult exercises against resistance.

Relearning a movement pattern can take time and concentration – it took many years to develop the old pattern, so be patient!

Effective motor learning happens when:

  • You give the task your full undivided attention – even for short bursts. You need as many motor nerves as possible focused on the job at hand.
  • You only continue the exercise when you are getting it right – otherwise you are practicing it doing it wrong!
  • When it all goes well, reward yourself (‘yay!’) – a squirt of endorphins makes the new pattern ‘stick’

Catch yourself doing it right!
What fires together, wires together – in other words, the more you do it right, the better you will be at doing it right without thinking about it too much. In other words, you’ve made a ‘new normal’.

If the exercises are pain-free, you’ll be getting better at not having pain – double yay!! If you need help getting the hang of it  – hand therapists are a good starting point. You can find one here

Nga Mihi, Alison

 

 

 

Alison Wilding: OA of the thumb

Alison Wilding: OA of the thumb

Osteoarthritis of the thumb is one of the main arthritic problems that a hand therapist* can help with. The joint in question is the one at the very base of the thumb down near the wrist joint. You may hear the term ‘CMC’ joint being referred to, or the ‘basal joint of the thumb’. CMC stands for ‘carpometacarpal’ …in other words the joint between the metacarpal and the carpus (in this instance the trapezium bone).

This beautiful joint is in the configuration of a saddle – scooped up at the front and back, and also draped downwards at the edges. If you can imagine a cowboy (or girl!) sitting on top of a deep horse’s saddle, he can rock both backwards and forwards, as well as from side to side. So, the joint needs a strong but mobile joint capsule around it to support it, as well as muscles contracting in each direction to keep it stable. These keep the cowboy (base of the metacarpal) sitting steadily in the centre of the saddle (trapezium), no uneven pressure or unbalanced riding to unsettle the joint surfaces.

In the thumb, for a number of reasons, this joint configuration can let us down by becoming arthritic. Either the joint capsule has been damaged and stretched in the past allowing too much uneven movement, or the joint may already be naturally hypermobile allowing uneven pressure over the joint surface. Often, as we age, persisting uni-directional muscle action pulls the joint repetitively across one part of the articular surface resulting in arthritic changes in the joint.

So, what to do? There is good evidence in the literature that both splinting and exercises can prove effective relief for CMC joint osteoarthritis (Aebischer, Elsig & Taeymans, 2016) and this is certainly the case in clinical practice. The splint (or joint support) provides temporary ‘scaffolding’ to allow the joint to settle down and prevent excessive movement, whilst the exercises strengthen up the surrounding muscles, eventually to replacing the supportive action of the splint.

If you are experiencing pain in this joint, team up with a hand therapist sometime soon!

Aebischer, B., Elsig, S., Taeymans J. Effectiveneness of physical and occupational therapy on pain, function and quality of life in patients with trapeziometacarpal osteoarthritis: a systematic review and metaanalysis. Hand Ther (2016) 21:5-15.

*Hand Therapist – in NZ a Registered HT is either a Registered Physiotherapist or OT who has completed additional postgraduate training and experience in upper limb and hand injuries and conditions. For more information and location of providers see http://www.nzaht.org.nz/

Handhub: Give yourself a hand

Handhub: Give yourself a hand

Hand therapists treat people with hand, thumb and wrist arthritis on a daily basis and our clinic is no different. I often bring to mind a comment I heard in 2010 at the Christchurch opening of the Bone and Joint Decade. A local rheumatologist described arthritis sufferers as ‘stoic and uncomplaining’. I wondered (and still do) why this group of patients made this impression on the medical profession and hoped that the next ten years might offer up some solutions. I have also to admit that I had my fingers crossed not to be joining that group anytime soon – although 17 years later I now have!

The Bone and Joint Decade was launched to try and address the relatively low numbers of research projects undertaken for musculoskeletal conditions. While 18 percent of all medical consultations were for these types of problems, only 2 percent of the U.S. national research funding was for projects addressing musculoskeletal health. In 2010 the vision for the Bone and Joint Decade was restated as “A world where musculoskeletal health is a priority, where the prevention, treatment and care of any musculoskeletal disorders is of a high standard and consistently accessible in order to improve… the quality of life for people with, or at risk of a musculoskeletal condition.” Let me tell you, we are referring to a massive group of people worldwide.

Genes to blame for gout, not food

So how are we doing? Osteoarthritis is still a real problem for a great many people. The researchers are making ground but with a huge increase of people in the community aged over 70, the impact of hand pain on the individual is significant. There are things that you can do to relieve some of these symptoms, including splinting, strengthening and joint protection. I’m hoping to share some recent research from the world of hand therapy and physiotherapy in some upcoming posts. For too long, allied health professionals have been the silent partner at the table, so let’s start sharing…

Until next time,  

Handhub

Support us, so that we can support you