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A Systematic Review of Postoperative Hand Therapy Management of Basal Joint Arthritis

  • Symposium: Thumb Carpometacarpal Arthritis
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

There are a variety of postoperative immobilization and therapy options for patients with basal joint arthritis. Although prior systematic reviews have compared surgical procedures used to treat basal joint arthritis, none to our knowledge compares therapy protocols for this condition, which are considered an important part of the treatment.

Questions/purposes

(1) We sought to determine whether differences in the length and type of postoperative immobilization affect clinical results after basal joint arthritis surgery. (2) We also compared specific therapy protocols that were prescribed. (3) Finally, we evaluated published protocols to determine when patients were released to full activity to see whether these appeared to affect clinical results.

Methods

A systematic review of English-language studies in the PubMed and Cochrane databases was performed. Studies were then reviewed to determine what postoperative immobilization and therapy protocols the authors used and when patients were released to full activities. A total of 19 studies were identified using the search criteria.

Results

All but one of the studies included a postoperative period of immobilization in either a cast or splint. Immobilization time varied depending on whether Kirschner wires were used for the surgery and whether an implant was placed. Postoperative therapy protocols also varied but followed three general patterns. Some therapy protocols involved teaching patients a home exercise program only, whereas some authors described routine referral to a therapist. The third group consisted of studies in which patients were only referred for therapy if the physicians determined it was necessary during followup. Many studies did not give a specific time for full return to activity and instead described a gradual transition to full activity after immobilization was discontinued. Because of the variability and small numbers, no conclusive recommendations could be made on any of the three study questions.

Conclusions

Comparative, multicenter studies comparing different immobilization and therapy protocols after the surgical treatment of basal joint arthritis would be helpful for both surgeons and therapists looking to refine their treatment protocols.

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Author information

Authors and Affiliations

  1. Hand and Upper Body Rehabilitation Center, 300 State Street, Suite 206, Erie, PA, 16507, USA

    Terri Wolfe ORT/LCHT

  2. UPMC Hamot, Erie, PA, USA

    Jennifer Y. Chu MD & Tammy Woods MD

  3. Hand Microsurgery and Reconstructive Orthopedics, LLP, Erie, PA, USA

    John D. Lubahn MD

Authors
  1. Terri Wolfe ORT/LCHT
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  2. Jennifer Y. Chu MD
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  3. Tammy Woods MD
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  4. John D. Lubahn MD
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Corresponding author

Correspondence to Terri Wolfe ORT/LCHT.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at both the Hand and Upper Body Rehabilitation Center and at Hand, Microsurgery, and Reconstructive Orthopedics, Erie, PA, USA.

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Wolfe, T., Chu, J.Y., Woods, T. et al. A Systematic Review of Postoperative Hand Therapy Management of Basal Joint Arthritis. Clin Orthop Relat Res 472, 1190–1197 (2014). https://doi.org/10.1007/s11999-013-3285-z

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  • DOI: https://doi.org/10.1007/s11999-013-3285-z

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