Quick Links: Activities List for Table 3



                      Self Care: Squeezing toothpaste tube
                                      Buttoning a shirt
                                      Pulling zippers

              Kitchen Tasks: Turning a stove switch

          Household Tasks: Turning a key
                                     Turning lamp switch
                                     Opening caps of small bottles and containers
                                     Opening envelopes and other packages
                                     Writing

 
 
 
   

   

                            TABLE 3: Activities which aggravate the
                         Boutonnière and Swan Neck Deformities
                                              of the thumb and fingers.


The weakest point on a finger with a zigzag deformity is on its tip. Any force applied on the tip and directed towards the long axis of the finger (axial loading) can aggravate the collapse or "buckling" of successive finger joints. Resistive pinching tasks place an axial load on the tip of your thumb, index, and middle fingers which accentuate the zigzag deformity pattern. Lateral pinching, that is, pinching with the thumb pad and side of the index finger, takes the load off the finger tips and is less deforming.
Activities Joint Protection Techniques Assistive Device Recommendation

Self- Care Tasks:

1. Squeezing tooth paste tube.

 

Technique 1: Avoid squeezing or pinching the toothpaste tube with the fingers. Place the tube on the counter and press with the palm instead.  

Technique 2: Buy toothpaste tubes with flip caps instead of twist on caps to avoid pinching with fingers. Plastic tubes are easier to squeeze compared to tin tubes.

Technique 3:  Use assistive toothpaste dispensers. Some brands of toothpaste have a push button dispensing mechanism which is very convenient to use.


 

Toothpaste dispensers.

2. Buttoning a shirt.
Technique 1: Use lateral pinch (pinching with thumb pad and side of index finger) instead of fingertip pinch when buttoning. It may be difficult at first but practice makes perfect!

Technique 2: Use button hooks that allow you to grip a handle instead of pinching the buttons with your fingers.

Technique 3: Use velcro tabs on your garments when possible.

1. Button hooks.
2. Velcro tabs.
3. Cuff and collar button extender.
3. Pulling zippers.
Technique 1: Use clothing with bigger zipper handles that allow for lateral pinch instead of tip to tip pinch.

Technique 2: To avoid pinching with the fingertips, bend the index and middle fingers and pinch the zipper handle in between them.

Technique3: Attach loop tabs on handles of zipper. This will allow you to pull the zipper by slinging your thumb on the loop instead of pinching the zipper with your fingers.

Technique 4: Use clothing with Velcro closures instead of zippers.

1. Zipper rings/loops.
2. Zipper hook handle.
3. Velcro tabs.
Kitchen Tasks:

Turning a stove switch.

 

Technique 1: Use lateral pinch (pinching with thumb pad and side of index finger) instead of fingertip pinch when turning the stove switch. While keeping your wrist straight, turn the switch by rotating the entire forearm. Do not turn the switch by using isolated wrist or finger movements.

Technique 2: To avoid pinching with the fingertips, bend the index and middle fingers and pinch the stove switch in between them. While keeping your wrist straight, rotate the entire forearm to turn the switch on.

Technique 3:  Use an assistive grip device such as the Uniturner, which allows you to turn the stove switch by gripping a handle instead of pinching with your fingers.

 

Uniturner

Household Tasks:

1. Turning a key.

 

Technique 1: Use lateral pinch (pinching with thumb pad and side of index finger) instead of fingertip pinch when holding the key.

Technique 2: While keeping your wrist straight, turn the key by rotating your forearm instead of using isolated wrist or finger movements.

Technique 3: Use a lever key holder which allows you to turn the key by pushing the lever against your palm instead of pinching the key with your fingers.

 

Lever key holders.

2. Turning a lamp switch.

Technique 1: For lamps with rotating switches: Avoid turning the switch using the tips of the thumb and index fingers. Use a lateral pinching pattern by holding the switch with the pad of the thumb and the side of the index finger. While keeping your wrist straight, rotate the switch by moving your entire forearm and elbow.

For lamps with push pin type switches: Do not push the pin switch using the tips of your thumb or index finger. This happens when you position your hand directly in front of the switch. Doing so will hyper-extend a weak joint. Instead try positioning your hand at the side of the switch and while keeping the thumb or index finger joint straight, push the pin switch with the fleshy pad of the thumb or index finger.

Technique 2: Increase the size of a rotating lamp switch by attaching an adaptive lever.

Technique 3: Use a palm switch on most commonly used lamps which allow pressing with the palm, thereby protecting finger joints.

Technique 4: Use lamps with Touch Tronic switches. These lamps can be turned on by simply touching anywhere on its body.

1. Lamp switch extension lever.
2. Touch Tronic lamp converter.
3. Palm-push switch.
4. IKEA slide switch?

3. Opening caps of small bottles or containers.
 
Technique 1: Do not twist the cap by pinching with the tips of the thumb, index and/or middle fingers. Use a lateral pinching pattern by holding the cap with the pad of the thumb and the side of the index finger. Avoid isolated finger or wrist movements when turning the cap. While keeping your wrist straight, turn the cap by using elbow and shoulder movements.

Technique 2: For smaller caps, bend the index and middle fingers and pinch the cap in between them. Turn the cap by using rotating forearm movements.

Technique 3: Avoid over-tightening bottle caps to make it easier to re-open them.

Technique 4: Use containers with flip caps as much as possible.

Technique 5: Use medicine dispensers for frequently used medications.

Medicine dispensers
4. Opening envelopes and other packages.
Technique 1: Do not use the tips of your thumb, index, and middle fingers to pinch and tear open envelopes or packages. Use lateral pinching patterns by holding these items with the pad of the thumb and the side of the index finger. Avoid twisting movements of the wrist and fingers. While keeping your wrist straight, use gross movements of the elbows and shoulders to pull packages open.

Technique 2: Avoid manual tearing if possible to protect finger joints. Cut them open using utility knives or spring loaded scissors.

1. Spring loaded scissors.
2. Utility knife.
5. Writing.

Technique 1: Do not hold the pen by using the tip if the thumb and index finger. Use lateral pinching patterns by placing the pen between the fleshy pad of the thumb and the side of the index finger.

Technique 2: Avoid heavy pinch pressure when writing. Learn how to write "lightly".
 
Technique 3: Use ergonomic pens. They are usually wider and makes use of a roller gel ink that glides easily on paper for light and smooth writing.

Technique 4: Increase the diameter of a regular pen by using cylindrical foam inserts.

Technique 5: Avoid isolated wrist and finger movements when writing. Learn how write using gross movements of the forearm and elbow while minimizing movements on your wrist and fingers.

1. Ergonomic pens.
2. Cylindrical foam inserts.
3. Pen grip assists.

   
  >> Back to Activities List for TABLE 3
  Note: Remember to avoid heavy resistive pinching using your fingertips in order to prevent zigzag deformities of the fingers. This is very important if you already have swelling on your thumb, index, or middle finger joints. Using assistive devices is highly recommended for protection of wrist and finger joints.>>next page
   

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