Join Nicola Goldsmith, MSc, SROT in this Around the Thumb in 60 Minutes webinar to explore the complexities of splinting the thumb and common treatment modalities for conditions such as osteoarthritis to the CMC joint and De Quervain’s Disease. Plus, briefly look at ideas for exercises, assessment of pinch and kinesiology taping.
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Q&A with Nicola Goldsmith, MSc, SROT
1. I usually make my CMC orthosis on the volar side of the hand. Do you disagree with this way to fabricate? I find that people find the dorsal side of the hand to be uncomfortable.
Great question. I always discuss with the patient first. And also take into account what that person does mainly with their hand and what activities need to be done with the splint in situ.
On a dominant hand I will always aim to do dorsal to allow more sensory area free and also help with picking up objects. If the CMCJ is very painful – some support can help volarly but it can also irritate. Balancing pros and cons.
For a non-dominant hand, the choice is either. Again – for function I prefer dorsal and use a material with a little bounce in it to ensure it is not uncomfortable.
Be wary of the angle you work in. If you make the splint with the hand positioned for a pinch primarily and then the person uses a keyboard most of the time, this fabrication position will be uncomfortable for sure.
2. Do you ever use the WHAT's test Wrist Hand Abd Thumb test to aid diagnosis of De Quervains?
When testing for De Quervains I will always take a very detailed history. Then test away from the presumed problem first. Try out all the differential diagnoses. Finally test for De Qu. I will palpate the anatomical snuffbox and compare to other side. Will test active and resisted thumb EPB and APL and then do Finklestein’s (the real one with the fingers straight). Always compare to the other side.
3. I have a question about your technique regarding tape for unused muscle to increase its work. Are you using tension over the muscle?
I am not entirely sure what you mean but I will try to answer it. When I am trying to enhance a muscle or help with trigger points in the muscle, I will place the proximal anchor with no tension and then move the muscle into its elongated position. Then tape in this position for the main length of the tape. Max tension would be 10% at that point as the muscle is already at length. Then restore back to neutral position and place the distal anchor.
4. Would you splint the same for CMCJ OA and post trapeziectomy surgery?
No. Post trapeziectomy I will always start with a full radial sided splint which only allows IPJ movement. For OA CMCJ, I will look at all three joints of the thumb and consider the biomechanics in the whole digit. I use a whole variety of splints from both thermoplastic and neoprene.
5. What's the name of the bottle opener? I want to buy one :)
This is the link: https://www.performancehealth.co.uk/multi-opener-6-in-1-uk
It does so many things!
6. Please share reference to the article for OA thumb study discussed in last question.
You can view this paper here.
7. If the pain is centred in the MCPJ of the thumb, not red or swollen, pain on passive movement and palpation, no pain on cmcj at all, no signs of subluxation. No pain on IPJ either, will you imobilise with splint or try kinesiotape first?
Firstly, I will look to be sure of the diagnosis. There are other pathologies that might be affecting the MCPJ of the thumb. I will often try taping before splinting. Or taping and/or neoprene before thermoplastic. If there is some hypermobility, tape is brilliant to control movement.