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Joint protection program for the upper limb

Maureen R Gecht-Silver, OTD, MPH, OTR/L
Section Editor
Zacharia Isaac, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Joint protection should be introduced to every patient with a chronic rheumatologic disorder in order to prevent recurrent sprains and strains which can add to inflammation and degeneration [1]. Conservative care includes preventive care, and joint protection is a fundamental way to provide preventive joint care.

Joint protection for the upper limb is reviewed here. An overview of joint protection and the application of the principles of joint protection to the neck and lower limb are presented separately. (See "Overview of joint protection" and "Joint protection program for the neck" and "Joint protection program for the lower limb".)


These principles are derived from the simple, practical application of proper body mechanics, posture, and positioning of joints. Joint protection reduces local joint stress and preserves joint integrity. Joint protection is achieved through patient education, self-management, and problem-solving to promote behavior modification; energy conservation; exercise; and selective use of splints, adaptive devices, and modalities. Guiding patients to perform tasks in a manner that reduces stress on joints is generally preferred to prohibiting the task. (See "Overview of joint protection".)

Principles of joint protection include:

Respect pain.


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Literature review current through: Sep 2016. | This topic last updated: May 31, 2016.
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  1. Sheon RP, Orr PM. Appendix B. A joint protection guide for rheumatic disorders. In: Soft Tissue Rheumatic Pain: Recognition, Management, Prevention, 3rd, Sheon RP, Moskowitz RW, Goldberg VM (Eds), Williams & Wilkins, Baltimore 1996.
  2. Bedi HS, Moon NJ, Bhatia V, et al. Evaluation of Musculoskeletal Disorders in Dentists and Application of DMAIC Technique to Improve the Ergonomics at Dental Clinics and Meta-Analysis of Literature. J Clin Diagn Res 2015; 9:ZC01.
  3. Van Eerd D, Munhall C, Irvin E, et al. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occup Environ Med 2016; 73:62.
  4. Kennedy CA, Amick BC 3rd, Dennerlein JT, et al. Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time. J Occup Rehabil 2010; 20:127.
  5. Stenlund B, Lindbeck L, Karlsson D. Significance of house painters' work techniques on shoulder muscle strain during overhead work. Ergonomics 2002; 45:455.
  6. van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders of the shoulder--a systematic review of the literature. Scand J Work Environ Health 2010; 36:189.
  7. Garg A, Kapellusch JM. Applications of biomechanics for prevention of work-related musculoskeletal disorders. Ergonomics 2009; 52:36.
  8. Bohr PC. Systematic review and analysis of work-related injuries to and conditions of the elbow. Am J Occup Ther 2011; 65:24.
  9. Derebery VJ, Devenport JN, Giang GM, Fogarty WT. The effects of splinting on outcomes for epicondylitis. Arch Phys Med Rehabil 2005; 86:1081.
  10. van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford) 2009; 48:528.
  11. Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systematic reviews. Phys Ther 2007; 87:1697.
  12. Ye L, Kalichman L, Spittle A, et al. Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review. Arthritis Res Ther 2011; 13:R28.
  13. Porter BJ, Brittain A. Splinting and hand exercise for three common hand deformities in rheumatoid arthritis: a clinical perspective. Curr Opin Rheumatol 2012; 24:215.
  14. Williams MA, Williamson EM, Heine PJ, et al. Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation. Health Technol Assess 2015; 19:1.
  15. Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. J Hand Ther 2010; 23:334.
  16. Stenström CH, Minor MA. Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis. Arthritis Rheum 2003; 49:428.
  17. Verhagen AP, Bierma-Zeinstra SM, Burdorf A, et al. Conservative interventions for treating work-related complaints of the arm, neck or shoulder in adults. Cochrane Database Syst Rev 2013; :CD008742.
  18. Beasley J. Osteoarthritis and rheumatoid arthritis: conservative therapeutic management. J Hand Ther 2012; 25:163.
  19. Kong YK, Lowe BD. Optimal cylindrical handle diameter for grip force tasks. Int J Ind Ergon 2005; 35:495.
  20. Sancho-Bru JL, Giurintano DJ, Pérez-González A, Vergara M. Optimum tool handle diameter for a cylinder grip. J Hand Ther 2003; 16:337.
  21. Hallibeck MS, Cochran DJ, Stonecipher BL, et al. Hand-handle orientation and maximum force. Ind Ergon 1910; 5:800.
  22. Kjeken I, Smedslund G, Moe RH, et al. Systematic review of design and effects of splints and exercise programs in hand osteoarthritis. Arthritis Care Res (Hoboken) 2011; 63:834.
  23. Rannou F, Dimet J, Boutron I, et al. Splint for base-of-thumb osteoarthritis: a randomized trial. Ann Intern Med 2009; 150:661.
  24. Gomes Carreira AC, Jones A, Natour J. Assessment of the effectiveness of a functional splint for osteoarthritis of the trapeziometacarpal joint on the dominant hand: a randomized controlled study. J Rehabil Med 2010; 42:469.
  25. Moe RH, Kjeken I, Uhlig T, Hagen KB. There is inadequate evidence to determine the effectiveness of nonpharmacological and nonsurgical interventions for hand osteoarthritis: an overview of high-quality systematic reviews. Phys Ther 2009; 89:1363.
  26. Sillem H, Backman CL, Miller WC, Li LC. Comparison of two carpometacarpal stabilizing splints for individuals with thumb osteoarthritis. J Hand Ther 2011; 24:216.
  27. Boustedt C, Nordenskiöld U, Lundgren Nilsson A. Effects of a hand-joint protection programme with an addition of splinting and exercise: one year follow-up. Clin Rheumatol 2009; 28:793.
  28. Berggren M, Joost-Davidsson A, Lindstrand J, et al. Reduction in the need for operation after conservative treatment of osteoarthritis of the first carpometacarpal joint: a seven year prospective study. Scand J Plast Reconstr Surg Hand Surg 2001; 35:415.
  29. Hammond A, Young A, Kidao R. A randomised controlled trial of occupational therapy for people with early rheumatoid arthritis. Ann Rheum Dis 2004; 63:23.
  30. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford) 2001; 40:1044.
  31. Niedermann K, de Bie RA, Kubli R, et al. Effectiveness of individual resource-oriented joint protection education in people with rheumatoid arthritis. A randomized controlled trial. Patient Educ Couns 2011; 82:42.
  32. Niedermann K, Buchi S, Ciurea A, et al. Six and 12 months' effects of individual joint protection education in people with rheumatoid arthritis: a randomized controlled trial. Scand J Occup Ther 2012; 19:360.
  33. Boocock MG, McNair PJ, Larmer PJ, et al. Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review. Occup Environ Med 2007; 64:291.
  34. Povlsen B. Physical rehabilitation with ergonomic intervention of currently working keyboard operators with nonspecific/type II work-related upper limb disorder: a prospective study. Arch Phys Med Rehabil 2012; 93:78.