Speaker: Splinting is effective for ligamentous laxity with thumb basal joint pain
Click Here to Manage Email Alerts
Ligamentous laxity in patients with thumb basal joint pain sometimes calls for surgical management. However, a presenter said she prefers and has had good results with more conservative approaches and splinting, in particular.
“This is a difficult patient for sure,” Jennifer Moriatis Wolf, MD, PhD, said during a symposium at the American Society for Surgery of the Hand Annual Meeting, where she said that being conservative in treating patients with thumb ligamentous laxity avoids disaster.
“I will use splint as a key [approach] for base of thumb sprain or laxity. For me, it is a true mainstay of conservative treatment. Splinting at night is emphasized; I prefer the long thumb opponents that’s firm, but short is consistently patient preferred,” she said, citing a meta-analysis in which splinting provided superior pain relief vs. not splinting or placebo, and a short thermoplastic splint was associated with the highest function.
“The neoprene splint, however, is what patients prefer,” Wolf, of The University of Chicago Medical and Biological Sciences, said.
Splinting must be done consistently, she said.
“I have found that if I tell these patients they’re going to live in their splints, the splint is their friend. They usually can do well, and we can calm down their joint,” Wolf said.
She discussed being less reliant on injections of either steroids other substances, like hyaluronate or platelet-rich plasma, in patients with this type of ligamentous laxity.
“I’m judicious with the use of injections, although more aggressive with therapy,” Wolf said.
Early data on active strengthening therapy vs. standard therapy for patients with this condition in a study by Kimberly H. McVeigh, MBA, OTR/L, CHT, and colleagues are encouraging, she said. Results showed a small, positive difference that the strengthening group had in VAS pain scores and quick DASH scores at 6 weeks.
Therapy should also be focused in such a way as to increase joint stability, deliver joint protection education, facilitate use of adaptive equipment, and provide first dorsal interosseous activation, adductor stretching and opponent pollicis strengthening, Wolf said.
“I consider diseases of hypermobility in young persons, and then I have my surgical procedures as my backup if all of these fail,” she said.
References:
McVeigh KH, et al. J Hand Ther. 2021;doi:10.1016/j.jht.2021.06.002
Collapse
Wolf JM, et al. Thumb basal joint arthritis: Lifeboats and bailouts — Management of the ligamentous lax patient with thumb pain. Presented at: American Society for Surgery of the Hand Annual Meeting. Sept.30 - Oct. 2, 2021; San Francisco (hybrid meeting).
Read more about
Click Here to Manage Email Alerts