Helpful Tips for Helping Hands handout

Jennifer Ottowitz, CVRT

Illinois AER 2016

I. Structure of the Hand

  • Bones = 29
  • Muscles = 34
  • Major joints = 29
  • Ligaments = 128
  • Nerves = 48

Specifics about the Thumb

  • The thumb is controlled by 9 different muscles and all 3 hand nerves.
  • There are 6 descriptive terms for the directions of movement of the thumb.
  • 90% of women and 80% of men aged 75-79 have x-ray evidence of osteoarthritis. in the thumb
  • Contrary to popular opinion, humans - homo sapiens -are not the only primates possessing opposable thumbs. Chimpanzees and monkeys can oppose the thumb to the index digit. What makes the human hand unique in the animal kingdom is the ability of the small and ring fingers to rotate across the palm to meet the thumb, owing to a unique flexibility of the carpometacarpal joints of these fingers, down in the middle of the palm. This is referred to as "ulnar opposition" and adds unparalleled grip, grasp, and torque capability to the human hand.

II. Functional Difficulties with Hands

  • Pain
  • Stiffness
  • Swelling
  • Limited range of motion
  • Weakness
  • Tremors
  • Neuropathy
  • Poor circulation
  • Missing or extra fingers

III. Common Causes of Hand Difficulty

  • Arthritis: osteoarthritis, inflammatory arthritis (including rheumatoid), juvenile arthritis
  • Carpal tunnel syndrome
  • Dupuytren's Contractures
  • Diabetes
  • Stroke
  • Parkinson's disease
  • Cerebral palsy
  • Multiple sclerosis
  • Accidents/injuries

IV. Common Treatments

  • Medication--available as pills, syrups, creams or lotions, patches or they areinjected into a joint; including nonsteroidal anti-inflammatory drugs, intraarticular long-acting steroid injections and biologics
  • Splinting
  • Surgery
  • Diet
  • Exercise--strengthening exercises build muscles around affected joints, easing the burden on those joints and reducing pain; range-of-motion exercise helps maintain and improve joint flexibility and reduce stiffness; aerobic exercise helps to improve stamina and energy levels and also help to reduce excess weight
  • Heat/cold therapy--Heat treatments, such as heat pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Cold is best for acute pain. It can numb painful areas and reduce inflammation.
  • Adaptive devices/techniques--including techniques ways to properly use joints and for energy conservation
  • Natural and alternative therapies--nutritional supplements, acupuncture or acupressure, massage, relaxation techniques and hydrotherapy
  • Positive attitude--Studies show that having a positive attitude can boost the immune system and increase the ability to handle pain

V. Functions of the Hand

  • To grip
  • To grasp
  • To stabilize
  • To pinch
  • To push
  • To pull
  • To turn/twist
  • To Manipulate

VI. Functional Adaptations

  • Use both arms to lift instead of just one
  • Keep arms closer together rather than extending them in order to use larger muscle groups
  • Use of arm rather than wrist to stir
  • Take frequent breaks
  • Use more automated devices such as battery operated or electric can opener
  • Use items with built-up handles (Good Grips products homemade built-up handles, etc.)
  • Use glasses or mugs with handles rather than tumbler style cups
  • Use dycem or rubber shelf liner under items for increased stability
  • Use utensils and other items with weighted handles
  • Use pencil grips and folder style writing guides
  • Create a built-up handle for a stylus using a rubber ball
  • Use a brailler with or without extension levers or a braille notetaking device for extended brailling
  • Use an illuminated magnifier with a light that automatically turns on when raised
  • Perform strengthening exercises using theraputty, stress/squeeze balls, squeeze bottles, sponges, dish cloths, etc.

VII. Resources

eHand: The Electronic Textbook of Hand Surgery

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International Essential Tremor Foundation