HandLab Clinical Pearls

October 2011 No. 16

THE Push® METAGRIP® Thumb CMC ORTHOSIS

Judy Colditz, OT/L, CHT, FAOTA

SIZE IT, SQUEEZE IT, AND USE IT…

For the MetaGrip to be a successful solution to thumb CMC joint hurting, it must exist correctly SIZED and SQUEEZED!

SIZING KEY
The size of the thenar eminence varies and there is no style to mensurate it accurately. The ideal way to determine the right size for your patient is to have all three sizes of the MetaGrip bachelor in your clinic for patient trial. Some individuals have a very slender paw only well adult thenar muscles and may do all-time with the side by side larger size. The sizing nautical chart is a guideline as a starting indicate for plumbing fixtures.

The secret is in the SQUEEZE

The metal insert is manually squeezed and then it snuggly fits the patient'southward thenar muscles when relaxed (and in the ideal posture.) We propose that you lot gently open the curved metal insert before the first application of the MetaGrip orthosis. You merely need to squeeze it the FIRST time it is applied and then information technology fits your patient precisely! (Encounter online HandLab video for application technique.)

Push MetaGrip

COMMON CLINICAL QUESTIONS
1. What if in that location is a pressure area over the dorsal aspect of the base of the thumb?
This is a mutual challenge with the fitting of all thumb CMC orthoses. We suggest that you lot open the metallic insert widely before awarding and so bend (squeeze) the insert and then there is no pressure level on the bony prominences. Additionally, you may want to add a thin layer of cocky-adhesive silicone gel sheeting to the within of the MetaGrip BEFORE squeezing the metal insert for those slender patients with thin subcutaneous tissue. Additionally, advise patients Not to pull the straps every bit tightly as possible, as that maximizes force per unit area on any dorsal bony prominences.

2. Can I modify the MetaGrip?
• The MetaGrip is fabricated of a high temperature plastic and cannot be remolded or adapted with heat. Although it is possible to cut the textile, doing and so voids the warranty and the resulting sharp border will need smoothing.
• The metallic insert can be reshaped a number of times but excessive reshaping will cause the metallic to fatigue and can result in breakage of the metal.
• The MetaGrip is like a new pair of shoes…it may take some "wearing in" for the tissues of the hand to go accustomed to information technology.

3. The patient complains of hurting at the thumb CMC joint, simply the MetaGrip does not cover the joint--why not?
In addition to CMC joint pain the patient ofttimes complains of referred hurting proximally over the radial attribute of the wrist. Although the patient wants coverage over the pain site, it is not coverage that volition command the pain: it is elimination of the painful translation of the articulation during load. Clinch the patient that pain in this area volition diminish past stabilizing the 1st metacarpal, not by covering the area where the pain is perceived.

4. The patient can motion the thumb CMC articulation while in the MetaGrip--so what good does it do?
The purpose of the MetaGrip is not rigid immobilization of the thumb CMC joint, just dynamic stabilization of the joint during use/load, stabilizing the 1st metacarpal to prevent painful translation of it on the trapezium. With the MetaGrip, the patient is using his/her own thenar muscles to stabilize the CMC joint in the optimal position. Splints which provide rigid immobilization permit the thenar muscles to weaken whereas the MetaGrip encourages active contraction of the thenar muscles.

5. Why is the pollex MP articulation not included in the MetaGrip?
Virtually patients with osteoarthritis take isolated thumb CMC joint pathology and the thumb MP does not need to be included. If the thumb MP articulation hyperextends during compression it is important to teach the patient to apply the MetaGrip with the thumb CMC articulation more extended (the thumb out of the palm). Restraining the CMC articulation from flexion will forbid the MP joint hyperextension during employ. If pathology exists at the thumb MP articulation, another orthotic intervention may exist more useful.

vi. What are the precautions with employ of the MetaGrip?
• Every bit with any device practical to a patient, the MetaGrip should exist removed daily for skin hygiene and cleaning of the MetaGrip.
• It should be discontinued if pressure level areas develop and the patient should seek your communication for adjustments.
• The MetaGrip is not intended for use in hands with lack of sensibility in the thumb/hand.

vii. What can I tell my patients about the immovability of the MetaGrip?
The high temperature plastic cloth is far more durable than orthoses made from any depression temperature plastic. The surface will not easily abrade nor discolor and it tin can be left in a hot car and washed in the washing machine (do not put in the dryer!) The claw and loop straps have been tested to clinch long term immovability.

Download Clinical Pearl No. 16, The Push button MetaGrip Pollex CMC Orthosis - Size It, Squeeze It, and Utilize Information technology, October 2011

ADDITIONAL SUGGESTED READING

Book Chapter - Obstetrical Brachial Palsy: The Hand Therapist's Part, Tendon and Nerve Surgery in the Hand: A Third Decade – 1997

Journal Article - Dynamic Loading Posture of the Thumb: The Colditz Tear Exam, Periodical of Hand Therapy – 2013

Periodical Commodity - Alphabetic character to the Editor, Journal of Hand Therapy – 2013

Journal Article - The Biomechanics of a Thumb Carpometacarpal Immobilization Splint: Design & Fitting, Journal of Manus Therapy – 2000

Video Clip - Drawing the Thumb Muscles

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Disclaimer: BraceLab Clinical Pearls are intended to exist an informal sharing of practical clinical ideas; non formal testify-based conclusions of fact.