Hand Therapy for Arthritis Mr Jonathan Kuan

In this podcast, Mr. Jonathan Kuhn, a physiotherapist and hand therapist at the Macquarie Hand Unit, provides a comprehensive overview of osteoarthritis in the hands and the role of hand therapy in managing this condition. He begins by outlining his qualifications and professional background, emphasizing his expertise in treating traumatic and complex upper limb conditions. Kuhn references an article by his colleague, Dr. Robert Crawley, which provides guidance on managing thumb injuries, particularly focusing on osteoarthritis.

Kuhn shares the common signs and symptoms associated with osteoarthritis, particularly in the hands. He describes the typical deformities seen in arthritis patients, such as the notable Z sign indicative of first CMC joint arthritis and the presence of Heberden's and Bouchard's nodes. As he explains, patients with osteoarthritis often experience joint instability, pain, and a progressive decrease in range of motion. In its initial stages, pain might present as dull after activity, but it intensifies into sharper pain that can persist even at rest. Additionally, he elaborates on the effects of the condition on muscle performance, specifically the tightening of the adductor pollicis muscle, which can lead to functional limitations in grip and pinch strength.

The lecture transitions into the role of hand therapy in managing osteoarthritis. Kuhn emphasizes that treatment is highly individualized, focusing on the patient's unique deformities, goals, and daily living requirements. He identifies the primary objectives of hand therapy: maintaining and improving upper limb function through personalized treatment plans that may include orthoses, joint protection strategies, exercises, and patient education. Kuhn highlights the importance of orthoses, which can significantly alleviate symptoms by reducing inflammation and providing structural support. He presents various types of orthoses used in therapy, including custom-made splints for specific conditions and functional braces that assist in joint positioning without restricting movement.

Exercise is another pivotal component of his exposition. Kuhn discusses the essential principles guiding exercise for patients with arthritis, stressing the need to avoid painful ranges of motion while promoting flexibility and strength. He illustrates several exercises aimed at specific muscle groups such as the first dorsal interosseous and opponent's pollicis, which are fundamental in restoring functional hand movements. These exercises not only target strength and mobility but also incorporate everyday activities, enhancing patient engagement and adherence to therapy.

In addition to exercise, Kuhn explores the use of thermal modalities, both heat and cold, in alleviating arthritic pain and stiffness. He provides practical examples of heat application methods, such as paraffin baths and arthritis gloves, as well as cold compresses for cases of acute inflammation. The efficacy and appropriateness of each treatment modality vary based on patient preference and specific symptoms.

Kuhn underscores the significance of patient education and joint protection principles in therapeutic practice. He discusses how educating patients about respecting pain, balancing activity with rest, and using adaptive equipment can significantly impact their overall well-being and enhance the management of their condition. By implementing strategies that promote joint protection early in the disease process, the goal is to mitigate further joint stress and facilitate better outcomes.

Throughout the lecture, Kuhn remains focused on practical application and the importance of collaboration in treatment approaches, inviting fellow therapists to reach out with questions or for further guidance. This thorough presentation not only enhances understanding of the...