Which client education topic should the COTA focus on first for a client with bilateral osteoarthritis of the first carpometacarpal joints (thumbs)?

• A. Hand-strengthening exercises the client can perform independently
• B. Orthotics that may be fabricated to support and protect affected joints
• C. Thermal modalities to reduce pain and stiffness
• D. Joint protection principles

Answer: (D)

Focusing on protecting the joints through education is the most foundational step for someone with bilateral thumb CMC osteoarthritis. Teaching joint protection principles equips the client to perform daily tasks with less stress on the affected joints, minimize painful pinching and repetitive loading, and preserve function over time. This includes strategies like using larger, built-up handles, modifying grips, pacing activities, and maintaining joints in safer positions during tasks. When the client understands how to protect the joints, other interventions—such as orthotics to support the joints, thermal modalities to manage pain and stiffness, or strengthening programs—can be introduced in a way that complements protection rather than conflicts with it.

Strengthening, while important, can place additional load on inflamed joints if protection strategies aren’t in place first. Orthotics and protective devices are helpful, but their effectiveness is maximized once the client has learned how to minimize joint stress during activities. Thermal modalities help with pain and stiffness but do not alter movement patterns or tissue loads, which is why joint protection takes priority.