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Types of orthotic interventions and immobilization methods following arthroplasty procedures for thumb
Takaya Sonoda1, Keisuke Irie2, Kengo Fujiwara2
1Clinical Cognitive Neuroscience, Advanced Occupational Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rehabilitation, Jyujyo Takeda Rehabilitation Hospital, Kyoto, Japan.
Background:
Orthotic intervention is widely used after carpometacarpal joint arthroplasty to stabilize the joint and alleviate pain. However, standardized protocols remain unestablished due to significant variations in methods, duration, and materials.
Purpose:
This review aimed to (1) identify the types of orthotic interventions used postoperatively in adults who have undergone arthroplasty for thumb carpometacarpal joint osteoarthritis; (2) summarize the current knowledge regarding the duration of immobilization, outcome measures, and effectiveness of orthotic interventions after thumb carpometacarpal joint arthroplasty; and (3) identify issues associated with orthotic management after thumb carpometacarpal joint arthroplasty.
Study Design:
Scoping review.
Methods:
Four databases were searched. Six reviewers extracted and analyzed the data related to orthotic interventions after thumb carpometacarpal joint arthroplasty.
Results:
Reported orthoses were classified into six categories based on the joints involved in immobilization. The most prevalent type was the forearm-based thumb spica splint, which immobilizes the wrist as well as the metacarpophalangeal joints. Immobilization was typically performed in a functional position or in extension and abduction, with a standard duration of 6 weeks. Evaluation items primarily included pain, muscle strength, and upper limb function. Identified clinical challenges included contractures resulting from prolonged immobilization and a lack of sufficient evaluation during the early postoperative period.
Conclusions:
At present, there is no standardized protocol for postoperative orthotic therapy following thumb carpometacarpal joint arthroplasty. Some studies suggest that a fixed period shorter than the standard 6 weeks may be beneficial. Further research is needed to investigate intervention methods for postoperative metacarpophalangeal joint hyperextension and outcomes related to hand performance.