Monday Medical: Physical therapy for hand and wrist arthritis
For Steamboat Pilot & Today
Editor’s Note: This story is Part 3 of a 3-part series on treating arthritis in the hands and wrists. Part 1 focuses on medical treatments, and Part 2 focuses on surgical options.
When dealing with arthritis in the hand and wrist, Emily Tjosvold, a certified hand therapist with UCHealth SportsMed Clinic in Steamboat Springs, likes to build a “toolkit” for patients.
“When patients get to us, we try to provide them with this idea of a toolkit,” Tjosvold said. “Arthritis isn’t something that’s going to go away, so we try to provide them with ways to manage pain and stabilize joints so they can return back to normal, or as normal-as-possible activity, but protect joints for long-term use.”
Modify regular activity
Joint protection is an important part of managing arthritis and can help patients prolong joint function.
Tjosvold teaches techniques to reduce stress from everyday movements such as pinching and grabbing.
“There are lots of joint protection techniques for activities such as kitchen tasks, garden and yard work, and getting dressed, that can offload some of those painful pinches,” Tjosvold said. “These techniques sound simple, but when you start adding them to your day, they make a big difference in helping to reduce joint pain.”
For instance, if you carry a heavy purse, wearing it on a strap across your body instead of holding it with your hand puts the load on larger joints instead of the smaller hand joints.
Building up a handle on a spoon means you can use a looser grip and don’t have to squeeze the utensil as hard, while using adaptive scissors that open for you can reduce the effort needed to cut.
Wear a splint
Wearing a splint can provide support and take pressure off the arthritic joint while people go about regular tasks. Tjosvold recommends having a custom splint made, as they’re lower profile and can be customized for use with activities such as skiing and biking.
“A cumbersome splint is a splint that sits on the counter,” Tjosvold said.
Ease pain with heat and strength
Tjosvold encourages patients to use heat to reduce arthritis pain at home, and during a physical therapy session, she may use manual therapy and cold laser treatment to help reduce pain.
Exercises to stabilize muscles around the joints can also help ease joint pain.
“Increasing strength around the base of the index finger can increase stability at the thumb joint,” Tjosvold said. “If we can direct some therapy at the tiny muscles in your hands and strengthen those without squeezing the joint, we can stabilize the joint and decrease pain.”
In some cases, stretching may be helpful as arthritis can decrease muscle length.
Maintain your program
Most patients have hand therapy once a week for six weeks, which provides time for education, splinting, exercises and treatments. Some people see Tjosvold once a year for maintenance visits to review their current program and make changes as needed.
Working with a hand therapist may help decrease pain significantly, but sometimes surgery is still needed.
“If we can protect the joint a little and bring the pain down a little, you may be able to live with the amount of pain you have without further intervention,” Tjosvold said. “Some people use joint protection and never have surgery, but some still have to do surgery right away – it’s very patient specific.”
For patients who do have surgery, hand therapy is a critical part of regaining motion and strength.
While hand therapy has different results for everyone, many people see a positive impact.
“There are a lot of people who are really happy after the therapy and will say that they’re going to work on their program for a long time,” Tjosvold said.
It’s helpful for people with arthritis to work closely with a rheumatologist, an orthopedist and a hand therapist.
“It’s important to see the whole team, as we all see the disease from different perspectives,” Tjosvold said. “Everyone supports each other in providing the best treatment for arthritis.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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