presented by Ann Porretto-Loehrke
Stiffness at the thumb carpometacarpal (CMC) joint can occur as a result of trauma, as seen with fractures at the base of the first metacarpal, and can also be present in the early stages of osteoarthritis (OA). Get reacquainted with the intricate anatomy of the thumb CMC joint and develop an understanding of how motion of the trapezoid and scaphoid play a role in thumb mobility. Gain knowledge in joint-specific techniques to address stiffness at the thumb CMC as well as the radial column of the wrist. This knowledge can be beneficial in restoring mobility for post-traumatic stiffness as well as for conservative management of mild CMC OA.
Ann Porretto-Loehrke is a skilled clinician and dynamic instructor. She is the therapy manager of a large department at the Hand to Shoulder Center. Ann is a Certified Hand Therapist (CHT) and a Certified Orthopedic Manual Therapist (COMT) for treatment of the upper quadrant through the International Academy of Orthopedic Medicine (IAOM). She has extensive training in the evaluation and treatment of the upper quadrant. Ann completed a post-professional Doctorate in Physical Therapy (DPT) degree from Drexel University with a specialty in hand and upper quarter rehabilitation. Most recently, Ann has become certified in dry needling through Myopain Seminars, as a Certified Myofascial Trigger Point Therapist (CMTPT). She previously served as the Vice-Chair of the Examination committee for the Hand Therapy Certification Commission (HTCC). Ann also previously served as the Northeast District chair for the Wisconsin Physical Therapy Association from 2004 to 2008. She is a lead instructor who developed the Hand & Upper Extremity Track through IAOM, a set of six manual therapy courses designed specifically for hand and upper extremity specialists. Ann has presented at American Society of Hand Therapists (ASHT) annual conferences, Canadian Hand Conferences, Philadelphia meeting, and Teton Hand Conference.
Through lecture and demonstration, this chapter covers the intricate anatomy of the thumb CMC joint, including the arthrokinematics of the saddle joint which provides a foundation for performing joint mobilization to this region. This chapter also covers the clinical reasoning of why the radial column is important to address in patients with limitations at the thumb CMC joint.
Knowing exactly where to place your hands when performing manual therapy techniques for the thumb and radial column is critical. This chapter covers the bony surface anatomy of the radial side of the wrist and thumb to gain an appreciation of where these structures lie below the skin.
Through lecture and demonstration, this chapter covers specific joint mobilization techniques for the thumb CMC in a step-by-step fashion to readily apply in the clinic! Techniques to address limitations with both radial and volar glide at the CMC will be covered.
Through lecture and demonstration, this chapter covers specific joint mobilization techniques to address limitations of the scaphoid-on-radius and trapezoid-on-scaphoid. This is critical to restore full thumb retroposition, as well as maximize motion at the midcarpal joint.