Hello my name is Susan Khan and I'm an Occupational Therapy student working within the Pulvertaft
Hand Unit within Derby.
As an Occupational Therapy student my role within the team is to help people resume hand
function and get back to the day to day activities that they need and want to do.
Part of the role is also to assist in the treatment of long term conditions such as
Osteoarthritis of the base of the thumb.
In this video I will talk about what is osteoarthritis and some of the different types of splints
used within the treatment of your condition.
According to Arthritis Research UK, Osteoarthritis is a degenerative condition where the cartilage
that covers the surface area of the bone becomes damaged.
In a healthy joint the end of our bones are surrounded by a shiny substance called articular
cartilage.
This cartilage acts like a shock absorber for our joints and also creates a smooth surface
which helps our bones to glide.
Each joint is protected by a fluid filled capsule and is stabilised by ligaments.
Over time, mechanical forces may lead to wear and tear of the joint which may lead to osteoarthritis.
As the condition progresses, the cartilage may begin to thin and coarsen leading to the
narrowing of the joint space
and bone on bone contact making the joint, painful, stiff and more difficult to move.
Over a period of time the body may react by trying to repair itself.
This can result in the creation of bony spurs distorting the shape of the joints.
This X-ray shows a picture of a normal hand on the left.
Whilst the picture on the right hand side, shows a hand with Osteoarthritis.
In the right hand picture you can see the narrowing of the joint space at the base of
the thumb and bony growths can clearly be seen on the finger joints.
Osteoarthritis of the base of the thumb
Osteoarthritis may commonly first appear within the joint at the base of the thumb.
A reason for this is that this joint is estimated to do as much as 40-60% of all the work carried
out by the hand.
The joint at the base of the thumb is very versatile, it enables us to go from the most
delicate pinch to the most powerful of grips.
It allows us to move our thumb in and out and move forwards and backwards and to touch
our finger tips.
These actions help us to use our hand effectively to participate in the activities of our daily
lives.
Common symptoms of osteoarthritis to the base of the thumb may include;
Swelling and stiffness around the joint.
Reduced pinch and grip strength.
Muscle weakness and instability of the joint.
And Pain.
When discussing pain it is important to realise that as individuals we all have different
tolerances to pain.
Your osteoarthritis pain may worsen after activity and may be relieved with rest.
In more severe cases of osteoarthritis, pain may also occur during periods of rest.
Splints
Splints are commonly used in the treatment of osteoarthritis.
They can be used to rest the hand or support the hand in doing work.
Evidence shows that splinting can have a positive impact on reduction of pain and lead to an
increase in pinch and grip strength.
Splints are an important non-surgical treatment as part managing the condition alongside use
of anti-inflammatory medications,
exercises for the hand and modification of everyday tasks.
They come in many different types, sizes and materials and they have different jobs.
They may include support at the wrist, base of the thumb and the knuckle joint of the
thumb.
Your therapist may fit you with a ready-made splint which is usually made from a soft fabric
material.
However should your joints require more support, your therapist may choose to custom make a
splint from a special mouldable plastic material.
Additionally you may even be given several splints,
each with a different job to be worn at specific times of the day or to support you with specific
activities.
Your therapist will assess and discuss with you which type may be most useful for you.
Comfort may also influence your splint choice.
Resting splints
Resting splints are commonly worn at night but your therapist may also suggest that you
wear them during the daytime
should you have a flare up of osteoarthritis symptoms.
Wearing a resting splint can support the hand and thumb in a good position leading to a
reduction in pain
and can also help with reducing morning stiffness and swelling.
The wrist thumb brace is an example of a resting splint that may be provided to limit movement
and enforce the resting of the thumb joints.
This splint has a wrist and thumb support incorporated into its design
To put on the splint
Firstly undo the straps.
Place your hand into the splint.
Making sure that your palm has contact with the splint.
To do up the straps, start with the strap nearest your elbow.
Make sure that the splint is not too tight.
You can re-adjust if necessary.
Working splints can help to reduce wrist and thumb pain by increasing support and stability
at the joint,
which will help to protect and support your thumb when carrying out your day to day activities
as well as helping you to increase your grip strength.
However, you may feel that you have less flexibility at the joint whilst wearing the splint this
is because they hug the joint firmly.
Working splints are usually removed for rest, sleep, exercises of the hand and bathing.
An example of a working splint is the T-restriction splint.
This fabric splint incorporates support at the base of the thumb joint and wrist offering
protection during activities of daily living.
It has a strap that wraps around the base of the thumb and through the web space.
To put on the splint.
Firstly put your thumb though the support.
Doing up the Velcro on the back of your hand first.
Take the thinner strap and wrap it around the palm of your hand.
Though the web space and secure on the back of your hand.
Make sure the splint is well fitted but is not too tight.
You can re-adjust if necessary.
On a cautionary note.
Splints should be worn as directed by your therapist;
constant wearing of splints may cause joints to stiffen up and in the long term may lead
to a weakening of the surrounding muscles structure.
When you take the splint off you may do some gentle exercises to stop the joint from stiffening
up, your therapist can advise you on this.
Should wearing of the splint create any redness, numbness, tingling, swelling, discomfort or
pain, you should seek the advice of your therapist.
In caring for your splints remember it is best to hand wash your splint and splints
should not be dried in a tumble dryer as this may distort the shape of the splint.
The wearing of splints is just one treatment in the management of osteoarthritis.
Thank you for watching this video I hope that it has helped with your understanding of osteoarthritis
and use of splints.
For more information go to www.pulvertafthandcentre.org.uk.