An exercise program for carpometacarpal osteoarthritis based on biomechanical principles

Distribution of strength potential of the thumb muscles and their relationship to trapeziometacarpal osteoarthritis: An exploratory cadaveric study

BACKGROUND

The ten muscles of the thumb allow for a variety of movement combinations yielding similar functional outcomes yet using different load transmission with different biomechanical stresses resulting in heterogenous trapeziometacarpal wear patterns. Our exploratory study investigates the correlation between the severity and location of trapeziometacarpal joint osteoarthritis and estimated individual thumb muscles maximal force.

METHOD

Normalized muscle mass to body mass and physiological cross-sectional area ratio were calculated following systematic muscular dissection of 19 cadaveric hands, 60 % males, average age 79.2, SD = 7.1. Correlations were analyzed with 3 different measures of articular degenerations.

FINDINGS

Moderate negative correlation was found between Eaton-Glickel osteoarthritis grade and normalized muscle mass of opponens pollicis (rₛ = -0.59, p < .01) and abductor pollicis longus (rₛ = -0.60, p < .01). Moderate negative correlation was also found between trapeziometacarpal index and normalized opponens pollicis and abductor pollicis longus muscle mass (rₛ = -0.63, p < .01) and (rₛ = -0.51, p < .05), respectively. No correlation was identified between physiological cross-sectional area ratios and the above degeneration metrics.

INTERPRETATION

Our current findings identified moderate negative correlations between the normalized mass to body mass of abductor pollicis longus and opponens pollicis for both Eaton-Glickel osteoarthritis grade and trapeziometacarpal index, which would support the current hand therapy exercise recommendations for the arthritic trapeziometacarpal population. Caution must be taken in the interpretation of correlations with articular zones degradation as our analytical power was reduced by the complete eburnation of few articular surfaces.

Trapeziometacarpal total joint arthroplasty, with or without supervised hand rehabilitation: A quasi-experimental trial

Introduction

Aim of this study was to determine whether postoperative supervised rehabilitation improves functional outcomes after trapeziometacarpal (TMC) total joint arthroplasty (TJA), compared to education alone.

Method

A quasi-experimental before-after trial included 31 women (≥40 years) per group diagnosed with trapeziometacarpal osteoarthritis who underwent TJA. A cohort (n = 31) who was given education alone was compared to a cohort (n = 31) who were subjected to supervised rehabilitation. Primary outcome was the difference in hand function 3 months postoperatively, measured by the Michigan Hand Outcomes Questionnaire (MHOQ). Other outcomes were the MHOQ subscale scores, the active range of motion, strength, time to return to work, satisfaction and complications.

Results

Patients in the education group had a significantly higher median delta MHOQ score when compared to the rehabilitation group at 3 months; 28.5 (20.5-31.3) versus 15.8 (1.9-21.1), (p = <0.01) and at 12 months 36.6 (26.8 - 47.2) versus 27.4 (14.5 - 33.0), (p = 0.01). Only the secondary outcomes the MHOQ subscales hand function, ADL and satisfaction revealed significant differences in favor of the education group. The education method reduced the median number of hand therapy sessions with eight visits.

Conclusion

The present study does not show a significant or clinically relevant benefit from supervised rehabilitation in terms of functional outcomes following TJA compared to education alone. Based on this, it seems safe to leave patients unsupervised in their recovery following TJA and to suffice with just education, however further exploration of effectiveness and safety of this intervention is recommend in larger trials.

Comparative electromyographic study of the stabilizing muscles of the trapeziometacarpal joint during different rehabilitation exercises

BACKGROUND

The first dorsal interosseous (FDI) and opponens pollicis (OP) muscles are the main stabilizers of the trapeziometacarpal joint. Optimal exercise selection based on surface electromyography (sEMG) activity may help to optimize rehabilitation programs in hand therapy.

PURPOSE

To compare the sEMG activity of FDI and OP during seven typical rehabilitation exercises.

STUDY DESIGN

Cross-sectional.

METHODS

Twelve healthy participants (age: 25.92 ± 5.79, female/male: 6/6) were included. The sEMG activity of the FDI and OP was measured during seven therapeutic exercises; thumb-to-little fingertip pinch, tri-digit tip pinch, intrinsic plus fist with ball, key pinch, four- and five-finger separation with elastic resistance, and thumb-index tip pinch. Root mean square was used and adjusted to the maximum voluntary contraction (MVC) of each muscle. Friedman's test with Dunn's post-hoc was used to compare amplitude signals between exercises.

RESULTS

Intrinsic plus fist with ball showed the highest electromyographic amplitude for FDI and OP. Post-hoc analysis revealed a statistical difference between intrinsic plus fist with ball (45.67% of MVC) and four-finger separation (8.70% MVC, p < 0.0001) for the OP. While for FDI, post-hoc analysis showed statistical differences between intrinsic plus fist with ball (49.70% MVC) and four hand exercises (thumb-to-little fingertip pinch = 12.13% MVC, p < 0.0001; tri-digit tip pinch = 13.21% MVC, p < 0.0001; four-finger separation = 18.51% MVC, p = 0.004; thumb-index tip pinch = 17.66% MVC, p = 0.0028).

DISCUSSION/CONCLUSION

Intrinsic plus fist with ball exercise showed the highest sEMG activation. These findings could guide hand therapists in the optimal selection of exercises, taking into account the level of muscle activity in routine rehabilitation exercises.

Extracorporeal Shock Wave Therapy (ESWT) vs. Exercise in Thumb Osteoarthritis (SWEX-TO): Prospective Clinical Trial at 6 Months

Rhizarthrosis is the most frequent form of osteoarthritis and is responsible for pain, disability and reduced functionality. The aim of the study is to investigate the clinical effects of shock wave treatment in patients suffering from arthritis of the first finger. A prospective clinical study was designed, in which 72 patients affected by rhizarthrosis were randomized to treatment with shock waves or exercises; in both groups an immobilization brace was used on the first finger. At recruitment and at 1, 3 and 6 months, patients received assessments of pain (VAS), functionality (FIHOA) and disability (DASH); furthermore, the perception of improvement was monitored during follow-ups (Roles and Maudsley Score). In both groups there was a significant improvement in all scores in the comparison between recruitment and 6 months. The perception of improvement was statistically better in the shock wave group than in the exercise group at 1, 3 and 6 months. The regression analysis showed that the reduction of VAS and DASH were statistically influenced by shock wave treatment (p < 0.001). Both therapies are effective in managing patients suffering from arthritis of the first finger, but the shock wave treatment could ensure greater persistence of improvements.

Rhizarthrosis Part I: A Literature Review

Rhizarthrosis (RA), or trapeziometacarpal osteoarthritis, is an arthritic degenerative process that affects the first joint of the thumb. The objective of this work is to provide therapists with an overview of the fundamental issues related to the therapeutic management of trapeziometacarpal joint instability. Prevalent in females, especially post-menopause, and linked to age, RA involves ligament and muscle structures, with causes ranging from hormonal influences to mechanical factors. Understanding the biomechanics, stability, and factors contributing to RA is crucial for effective intervention. This study explores the role of ligaments, muscles, and anatomical variants in thumb joint degeneration, emphasizing the importance of stability and congruence. RA manifests as pain at the base of the thumb, limiting grip strength and hindering everyday tasks. Pain initially occurs during specific movements but can progress to constant discomfort, affecting sleep. Chronic RA leads to joint stiffness, deformities like the "Z thumb," and muscle atrophy, impacting daily functions. Clinical evaluation involves pain assessment, joint mobility examination, and palpation. Diagnostic tests like the grind test and lever test aid in confirming RA. Radiographic examination reveals joint space degeneration and osteophytes and helps classify RA stages using the Eaton-Littler classification. Conservative treatment aims to alleviate pain, reduce joint stress, and enhance function. Orthoses help stabilize the joint. Therapeutic exercises, emphasizing muscle strength and dynamic stability, prove beneficial. Manual therapies like neurodynamic, Kaltenborn, Mulligan, and Maitland techniques target pain reduction and improve joint mechanics. The studies on conservative approaches provide evidence that a multimodal intervention consisting of joint mobilization, neural mobilization, and exercise is beneficial in reducing pain in patients with RA. When conservative therapy fails, surgical intervention is indicated.

Complex motions embedded in a hand exercise regimen - effects on thumb function in participants with carpometacarpal osteoarthritis: A pilot study

Objective

The goal of this pilot study was to identify changes associated with completion of a unique six-week hand exercise program in persons with carpometacarpal osteoarthritis.

Methods

Twenty-four individuals, aged 55-80, with doctor-diagnosed carpometacarpal osteoarthritis participated in the study. Movement data from standard clinical motions and complex multi-planar motions were obtained using a motion capture system at three-time points: an initial visit, after two weeks of hand exercises, and after completion of the six-week exercise program.

Results

This exercise program produced trends of improvement in complex multi-planar motions. Specifically, joint angle changes were seen during opposition and the formation of an "okay sign" that was included as part of the exercise program.

Conclusion

Through the use of motion capture, changes were identified in thumb joint function after exercise. Specifically, motions associated with the more complex multi-planar tasks showed changes in individual joint contributions following the six-week exercise intervention. The results suggest that further exploration of this exercise program, particularly the inclusion of complex multi-planar tasks during osteoarthritis treatment and associated evaluations, should be considered in future clinical studies.

Effect of a stabilization exercise program versus standard treatment for thumb carpometacarpal osteoarthritis: A randomized trial

STUDY DESIGN

Randomized, interventional trial with 1 year follow-up.

INTRODUCTION

Though recommended, evidence is lacking to support specific exercises to stabilize and strengthen the first carpometacarpal (CMC) joint for cases of osteoarthritis (OA).

PURPOSE OF THE STUDY

To determine in a naturalistic setting, whether standard treatment plus a home exercise program (ST+HEP) is more effective than standard treatment (ST) alone in improving Quick Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other patient-centered (pain, function) and clinical outcomes (range of motion, strength).

METHODS

A total of 190 patients from a hand therapy practice in northwestern PA were enrolled by informed consent and randomized into ST or ST+HEP groups. Average age was 60 years, most were female (78%) with sedentary occupations most common (36%). ST group received orthotic interventions, modalities, joint protection education and adaptive equipment recommendations, while the ST+HEP group received a home exercise program in addition to ST for 6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included grip strength, pinch strength, range of motion (ROM), qDASH, Patient Specific Functional Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could change groups if desired. Efficacy data analysis included both parametric and non-parametric tests. The threshold for statistical significance was 0.05 and adjusted for multiple comparisons.

RESULTS

Repeated measures ANOVA failed to show a statistically significant difference in strength and ROM assessments between treatment groups over the 12 month follow-up (P ≥ .398). Differences between groups did not exceed 13%. Both the ST and ST+HEP groups evidenced improvement over time in most patient-focused assessments (P ≤ .011), including improvements exceeding reported clinically important differences in pain with activity and PSFS scores. Scores for these measures were similar at each follow-up period (P ≥ .080) in each group. The presence of CTS exerted no effect on outcomes; longer treatment time was weakly related to poorer qDASH and PSFS scores initially. Of those enrolled, 48% of subjects completed the study.

CONCLUSIONS

The addition of a high-frequency home exercise program did not improve clinical or patient-centered outcomes more so than standard care in our sample however, study limitations are numerous. Both groups had decreased pain with activity and improved PSFS scores, meeting the established minimally clinically important difference (MCID) of each at 6 and 12 months. Adherence with the home program was poor and/or unknown.

Dynamic stabilization home exercise program for treatment of thumb carpometacarpal osteoarthritis: A prospective randomized control trial

STUDY DESIGN

Randomized control trial.

INTRODUCTION

Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common cause of hand pain and disability. Standard conservative therapy (SCT) for thumb CMC OA includes an orthosis and instruction in joint protection, adaptive equipment, and pain relieving modalities. The dynamic stability home exercise (HE) program is complementary conservative therapy designed to strengthen the stabilizing muscles of the thumb CMC.

PURPOSE OF THE STUDY

To investigate whether the addition of HE to SCT (SCT+HE) was more effective at reducing pain and disability in thumb CMC OA compared to SCT alone.

METHODS

The study compared 2 groups: SCT and SCT+HE. The SCT group received SCT with in-home pain management instructions, joint protection strategies with adaptive equipment, and a hand-based thumb-spica orthosis. The SCT+HE group received HE program instructions for adductor stretching and opponens and first dorsal interosseous strengthening in addition to SCT. Our primary outcome measure was the numerical rating scale (NRS) with secondary outcome measures of QuickDASH (shortened Disabilities of the Arm, Shoulder and Hand questionnaire), range of motion, grip strength, and pinch strength. Outcome measurements were assessed at first visit, 6 weeks, and 6 months.

RESULTS

There was no statistical difference between the 2 groups for NRS and QuickDASH at 6 weeks (P = .28 and P = .36, respectively) or 6 months (P = .52 and P = .97, respectively). However, there was a statistically significant decrease in NRS and QuickDASH scores at 6 weeks and 6 months within both groups.

CONCLUSIONS

Both SCT and SCT+HE are effective at reducing pain and disability in OA of the thumb CMC joint. Neither therapy program was superior to the other at improving NRS or QuickDASH scores at 6-week or 6-month follow-up.

Characterizing response to a dynamic stability modeled approach for thumb carpometacarpal joint pain: A retrospective study

STUDY DESIGN

Retrospective case series.

INTRODUCTION

Literature trends indicate that thumb dynamic stabilization may benefit clients with thumb carpometacarpal (CMC) joint pain and arthritis. There is minimal research investigating whether client characteristics predict responsiveness to hand therapy for thumb dynamic stabilization.

PURPOSE OF THE STUDY

1) To investigate how adults with thumb CMC joint pain responded to a hand therapy dynamic stabilization modeled intervention. 2) To determine if various client factors influenced responsiveness and to what extent.

METHODS

An electronic medical record search identified adults treated from August 2009 through December 2015 for thumb CMC joint pain. Radiographs were retrospectively staged. Outcome measures were 1) Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) total disability score and 2) Numerical Pain Rating Scale (NPRS). Paired t-tests were performed to compare pre and post treatment measures. Multivariate analyses were used to investigate predictive factors.

RESULTS

A total of 249 charts were analyzed. Large overall significant effects were noted for disability score (QuickDASH P <.001, X = 12.1, Cohen's d = 0.9). The average improvement of 2.1 (SD = 2.6) points exceeded the minimal clinically important difference (MCID) of 1.7 points on the NPRS pain scale. Significant predictors of QuickDASH Scores were radiographic staging, bilateral hand involvement and initial pain ratings. Significant predictors for change in pain scores (meeting or exceeding the minimal clinically important difference for the NPRS) were bilateral thumb involvement and initial "pain at worst" rating.

CONCLUSION

After completing hand therapy with a dynamic stabilization approach, clients had less pain and disability. Those who had unilateral thumb pain, or those who started with higher pain levels were most likely to have clinically meaningful improvements in pain. Clients in early CMC osteoarthritis (OA) stages responded better than those in later stages, indicating that early referral to therapy is important.

The biomechanics of osteoarthritis in the hand: Implications and prospects for hand therapy

BACKGROUND

The unique anatomy of the human hand makes it possible to carefully manipulate tools, powerfully grasp objects, and even throw items with precision. These apparent contradictory functions of the hand, high mobility for manual dexterity vs high stability during forceful grasping, imply that daily activities impose a high strain on a relatively instable joint. This makes the hand susceptible to joint disorders such as osteoarthritis. Both systemic (eg, genetics, hormones) and mechanical factors (eg, joint loading) are important in the development of osteoarthritis, but the precise pathomechanism remains largely unknown. This paper focuses on the biomechanical factors in the disease process and how hand therapists can use this knowledge to improve treatment and research.

CONCLUSION

Multiple factors are involved in the onset and development of osteoarthritis in the hand. Comprehension of the biomechanics helps clinicians establish best practices for orthotics intervention, exercise, and joint protection programs even in de absence of clear evidence-based guidelines. The effect and reach of hand therapy for OA patients can be expanded substantially when intervention parameters are optimized and barriers to early referrals, access reimbursement, and adherence are addressed. Close and early collaboration between hand therapists and primary care, women's health, rheumatology, and hand surgery providers upon diagnosis, and with hand surgeons pre and postoperatively, combined with advances in the supporting science and strategies to enhance adherence, appear to be a promising way forward.

Dynamic stabilization of the painful thumb: A historical and evidence-informed synthesis

STUDY DESIGN

Expert opinion INTRODUCTION: Thumb carpometacarpal joint (CMC) osteoarthritis is a common condition seen in the hand therapy clinic. Prevalence is generally higher in females, and the percentage rises for post-menopausal females. Patients typically present with pain and functional difficulties. Conservative management is recommended before a surgical consult. Evidence is mounting that a dynamic stability modeled approach has a significant effect on pain and improving function.

PURPOSE

The purpose of this paper is two-fold: first, to present the history and development of a dynamic stabilization model for treatment of the patient with thumb CMC osteoarthritis (OA), and second, to provide expert clinical commentary and recommendations for the treatment of thumb CMC OA in light of the best available evidence.

METHODS

Expert clinical commentary is based on an extensive review of relevant literature.

RESULTS

The current literature and expert opinion supports an evidence-informed multimodal intervention: modalities, pain relief techniques, manual release, joint mobilizations as deemed necessary, neuromuscular re-education through proprioceptive exercises, and education in joint protection principles.

CONCLUSION

A rationale for a dynamic stabilization approach is presented. The unique anatomy of the thumb deserves finely tuned care based on high quality research. To advance our knowledge and clinical skills we must not become stagnant, but continue to generate high level evidence. The standard for future thumb CMC OA studies should be well-defined intervention parameters, consistent documentation, and the use of appropriate patient-rated outcome measures.

Effect of first dorsal interosseous strengthening on clinical outcomes in patients with thumb osteoarthritis: a study protocol for a randomized controlled clinical trial

BACKGROUND

Thumb carpometacarpal osteoarthritis (CMC OA) is characterized by chronic progressive degeneration of the joint cartilage, with high prevalence. Patients present with pain at the base of the thumb, morning stiffness, and muscle weakness, symptoms that affect hand function and therefore interfere in activities and social participation. Movements that involve grip or lateral pinch are the most affected and directly impact independence, self-care, and leisure activities. In the literature consulted, several protocols with exercises for these patients were found. However, most do not compare the same intervention modality and only provide basic methodological information, with no consistent information on training load and load progression. In addition, most protocols only address the strengthening of the abductor and extensor thumb muscles and pinching or grasping exercises. However, some biomechanical and electromyographic studies have demonstrated the important role of the first dorsal interosseous muscles as stabilizers of the thumb carpometacarpal joint.

METHODS

This is a randomized, controlled, double-blind, and parallel clinical trial that will include 56 participants, over 40 years old, with radiographic evidence of thumb base osteoarthritis. Participants will be randomly allocated into two groups: control and intervention. The following evaluations will be conducted: the Australian/Canadian Hand Osteoarthritis Index, Canadian Occupational Performance Measure, Nine-Hole Peg Test, grip and pinch strength associated with muscle activation assessment, and Bilateral Upper Limb Function Test at four different times: baseline, session 13, session 18, and follow-up. Treatment will take place over 6 weeks, with reassessments in the fourth and sixth weeks and 3 months after the end of the intervention (follow-up). Qualitative variables will be expressed as frequency and percentage, and quantitative variables as mean and standard deviation. Intergroup comparison of the intervention will be performed by repeated measures ANOVA, considering the effect of the two groups and four assessments, and interactions between them.

DISCUSSION

This study will demonstrate whether the specific strengthening of the first dorsal interosseous muscle has a superior and positive effect on the clinical picture of patients with CMC OA. Additionally, if specific strengthening of the muscle is not superior to the traditional protocol in the literature, it will also be determined whether the two protocols are equivalent in terms of the best clinical picture.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials (ReBEC) RBR-8kgqk4 . Prospectively registered on 15 January 2020.

Impairments in grip and pinch force accuracy and steadiness in people with osteoarthritis of the hand: A case-control comparison

BACKGROUND

Symptomatic hand osteoarthritis (OA) is severely disabling condition. Limited evidence has focused on force control measures in this population.

OBJECTIVES

It was the aim of the present study to determine whether force matching accuracy and steadiness are impaired in people with hand OA. In addition, the relationship between force control measures (accuracy and steadiness) and measures of hand function and pain in people with symptomatic hand OA was explored.

DESIGN

Case-control study.

METHOD

Sixty-two participants with symptomatic hand OA and 26 healthy pain-free controls undertook an isometric grip and pinch force matching task at 50 % of their maximum voluntary contraction. Average pain hand pain was recorded. In addition, the Disability of the Arm Shoulder and Hand Questionnaire (DASH), and the Functional Index of Hand Osteoarthritis were collected.

RESULTS

Grip force-matching accuracy and steadiness were significantly impaired in the hand OA group compared to controls (P < 0.05). Pinch force-matching error was greater in people with hand OA (P < 0.05), however, pinch force steadiness was not different between groups. There was a learning effect in people with hand OA, with resolution of force matching impairments with task repetition. A small positive correlation was identified between grip force control and the DASH. No association was found between other measures of force control and self-reported measures of function or pain.

CONCLUSIONS

People with hand OA presented with greater impairments in measures of submaximal force control. These were correlated with self-reported hand function but not pain. Future studies may wish to examine whether objective measures of functional performance are related to force-matching error and steadiness.

Flexion-extension strength of the index-thumb system in Italian population. A cross-sectional study to gather normative data

STUDY DESIGN

Cross-sectional study.

INTRODUCTION

Flexion (Palmar Pinch, PP-MVC and Tip Pinch, TP-MVC) and extension (E-MVC) maximal voluntary contraction (MVC) of the index-thumb system offers a quick way to estimate the level of hands' impairment in several musculoskeletal and neurologic conditions.

PURPOSE OF THE STUDY

This study established normative data of PP-MVC, TP-MVC, E-MVC in the Italian population and evaluated their correlation with hand dominance, anthropometric factors, dexterity and workload level.

METHODS

In our study, 303 healthy people (150F, 153M) were recruited. Participants performed PP-MVC, TP-MVC and E-MVC tests per hand, conducted by using a pinch-gauge. T-test was used to analyze MVC means between sexes and between hands. One-way ANOVA was conducted to compare MVC means in male and female samples stratified by age (18-29, 30-44, 45-59, 60-74, +75). Spearman's correlation analysis was performed to determine anthropometric variables, dexterity and workload level effects on MVCs.

RESULTS

Medium-to-large effect sizes of age were shown in the majority of tasks. The 30 to 44 years and then +75 years age groups showed the highest and the lowest values, respectively, for both sex and both hands. Men were meanly 50% stronger, and the dominant hand showed higher values (6-10%). MVC-tests correlated moderately with weight and height weakly with dexterity and workload level.

CONCLUSIONS

After 30 to 44 years, hand strength declines in line with the normal process of aging that also entails muscle fibers and the reduction of daily activities in older adults. In relative terms, E-MVC showed the highest strength loss in the over 75 seconds. The difference between sexes was higher in E-MVC than in flexion MVCs. E-MVC seems to depend more on musculoskeletal architecture that differs from women to men, according to the highest correlation between E-MVC and anthropometric variables. Only high workload levels impacted hand strength. In heaviest occupations, no PP-MVCs differences were observed between hands.

Pressure algometry and palpation of the upper limb peripheral nervous system in subjects with hand osteoarthritis are repeatable and suggest central changes

STUDY DESIGN

Case-control study.

INTRODUCTION

A subset of patients with hand osteoarthritis (OA) shows evidence of central pain phenotypes.

PURPOSE OF THE STUDY

To examine whether differences exist in experimental pain responses in the affected and nonaffected sides of patients with unilateral hand OA. To investigate the test-retest reliability of pressure algometry and manual digital palpation in patients with unilateral hand OA.

METHODS

The hand OA group consisted of 20 patients, and the control group consisted of 20 healthy subjects. Pressure pain threshold (PPT) measurements were made 2 times, consisting of 3 repeat trials, each using computerized algometry and manual digital palpation. Grip and key strength (dynamometer), pain (visual analog scale), and function (Disabilities of the Arm, Shoulder and Hand [short version]) were also measured. The 2-way analysis of variance was conducted to determine the differences between sides and groups. Intraclass correlation coefficient (ICC) and standard error of measurement were calculated.

RESULTS

Patients with hand OA had decreased PPTs over the thumb carpometacarpal joint as well as radial and median nerves compared with controls (all P < .01). No significant group effect by side interaction was detected for any measure. The minimal detectable change values needed to detect change in subjects with hand OA were C5-C6 joint (0.3-0.5 kg/cm²), carpometacarpal joint (0.3-0.5 kg/cm²), hamate bone (0.2-0.4 kg/cm²), radial nerve (0.2-0.8 kg/cm²), median nerve (0.3-0.6 kg/cm²), and ulnar nerve (0.2-0.4 kg/cm²) for PPT. Test-retest reliability was calculated for both hands of participants with OA (ICC, 0.98-0.99) and healthy participants (ICC, 0.74-0.99).

DISCUSSION

Although pressure algometry and manual digital palpation are techniques already used in previous studies and have been shown to be reproducible and moderately reliable for joint palpation, this current study suggests that pressure algometry and manual digital palpation could also be reliable methods of determining nerve sensitivity of the radial, ulnar and median nerves in subjects with hand OA.

CONCLUSIONS

Hyperalgesia in patients with hand OA might be associated with clinical measures, and bilateral signs in unilateral OA could suggest central changes.

Metacarpal Abduction Orthosis for Patients With the Thumb Carpometacarpal Osteoarthritis

Purpose

A specific orthosis to increase radial abduction of the metacarpal of the thumb rather than immobilize it was designed for patients with carpometacarpal (CMC) joint osteoarthritis. This orthosis was designed especially for musicians, who need a large abduction angle of the thumb CMC joint to maintain their hand span to perform music.

Methods

The thumb abduction orthosis was custom-made of flexible polypropylene, leaving the thumb metacarpophalangeal and wrist joints unrestricted and compressing the ulnar side of the thenar muscle to increase the radial abduction angle of the thumb metacarpal. Hand span and grip strength were measured, and clinical symptoms were assessed with the visual analog scale and Quick–Disabilities of the Arm, Shoulder, and Hand score. The Tubiana and Chamagne score was used to assess musical performance.

Results

A total of 23 thumbs of 19 professional musicians with CMC joint osteoarthritis were placed in an orthosis. The radial abduction angle of the thumb CMC joint, grip strength, and hand span were significantly increased or enlarged after bracing. Clinical symptoms evaluated by visual analog score, Quick–Disabilities of the Arm, Shoulder, and Hand score, and Tubiana and Chamagne score also improved.

Conclusions

Placement of a metacarpal abduction orthosis improved the hand span and improved patient-reported outcomes.

Type of study/level of evidence

Therapeutic IV.

Patients With Thumb-base Osteoarthritis Scheduled for Surgery Have More Symptoms, Worse Psychological Profile, and Higher Expectations Than Nonsurgical Counterparts: A Large Cohort Analysis

BACKGROUND

Psychological characteristics, such as depression, anxiety or negative illness perception are highly prevalent in patients with several types of OA. It is unclear whether there are differences in the clinical and psychological characteristics of patients with thumb carpometacarpal (CMC-1) osteoarthritis (OA) scheduled for nonsurgical treatment and those with surgical treatment.

QUESTIONS/PURPOSES

(1) What are the differences in baseline sociodemographic characteristics and clinical characteristics (including pain, hand function, and health-related quality of life) between patients with thumb CMC-1 OA scheduled for surgery and those treated nonoperatively? (2) What are the differences in psychological characteristics between patients scheduled for surgery and those treated nonsurgically, for treatment credibility, expectations, illness perception, pain catastrophizing, and anxiety and depression? (3) What is the relative contribution of baseline sociodemographic, clinical, and psychological characteristics to the probability of being scheduled for surgery?

METHODS

This was a cross-sectional study using observational data. Patients with CMC-1 OA completed outcome measures before undergoing either nonsurgical or surgical treatment. Between September 2017 and June 2018, 1273 patients were screened for eligibility. In total, 584 participants were included: 208 in the surgery group and 376 in the nonsurgery group. Baseline sociodemographic, clinical, and psychological characteristics were compared between groups, and a hierarchical logistic regression analysis was used to investigate the relative contribution of psychological characteristics to being scheduled for surgery, over and above clinical and sociodemographic variables. Baseline measures included pain, hand function, satisfaction with the patient's hand, health-related quality of life, treatment credibility and expectations, illness perception, pain catastrophizing, and anxiety and depression.

RESULTS

Patients in the surgery group had longer symptom duration, more often a second opinion, higher pain, treatment credibility and expectations and worse hand function, satisfaction, HRQoL, illness perception and pain catastrophizing compared with the non-surgery group (effect sizes ranged from 0.20 to 1.20; p values ranged from < 0.001 to 0.044). After adjusting for sociodemographic, clinical, and psychological factors, we found that the following increased the probability of being scheduled for surgery: longer symptom duration (standardized odds ratio [SOR], 1.86; p = 0.004), second-opinion visit (SOR, 3.81; p = 0.027), lower satisfaction with the hand (SOR, 0.65; p = 0.004), higher treatment expectations (SOR, 5.04; p < 0.001), shorter perceived timeline (SOR, 0.70; p = 0.011), worse personal control (SOR, 0.57; p < 0.001) and emotional response (SOR, 1.40; p = 0.040). The hierarchical logistic regression analysis including sociodemographic, clinical, and psychological factors provided the highest area under the curve (sociodemographics alone: 0.663 [95% confidence interval 0.618 to 0.709]; sociodemographics and clinical: 0.750 [95% CI 0.708 to 0.791]; sociodemographics, clinical and psychological: 0.900 [95% CI 0.875 to 0.925]).

CONCLUSIONS

Patients scheduled to undergo surgery for CMC-1 OA have a worse psychological profile than those scheduled for nonsurgical treatment. Our findings suggest that psychological characteristics should be considered during shared decision-making, and they might indicate if psychological interventions, training in coping strategies, and patient education are needed. Future studies should prospectively investigate the influence of psychological characteristics on the outcomes of patients with CMC-1 OA.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Thumb carpometacarpal osteoarthritis: A musculoskeletal physiotherapy perspective

PROPOSAL

To perform a literature review to provide the practitioner with a description of the information and techniques to enhance the provision of conservative interventions in clinical practice.

METHODS

Studies were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to December 2017. Authors independently selected studies, conducted quality assessment, and extracted results.

RESULTS

There is evidence to support a multimodal approach to the therapeutic management of the patient with CMC OA. This distinct approach includes: patient education, manual therapy, therapeutic exercise programs, and orthotic provision.

CONCLUSION

There is evidence to support some of the commonly performed conservative interventions to improve hand function and decrease hand pain.

Effects of the applied ancient boxing exercise on leg strength and quality of life in patients with osteoarthritis

This study aimed to investigate the effect of ancient boxing exercise on the strength of leg muscles and quality of life in patients with osteoarthritis. The subjects were divided into 2 groups, control group (CG) and experimental group (EG). The average aged of control and experimental group were 60.3±6.8 and 59.0±7.8 years, respectively. All volunteers were interviewed for basic information, evaluation of the criteria of research and sign consent to participate in the research. The outcome measurement consisted of five time sit to stand test, 6-min walk test, flexibility by sit and reach test, Berg Balance Scale, Timed Up and Go Test, knee injury and osteoarthritis outcomes score (KOOS) and quality of life of World Health Organization Thai brief version (WHOQOL-BERF-THAI). Prior and posttest measurements were performed at 0, 4, 8, and 12 weeks, and those who received ancient boxing exercise were given 60 min 3 times per week for 12 weeks. The results of the study showed that postexercise leg muscle strength, physical performances, quality of life and KOOS increased significantly after exercise. In conclusion, the ancient boxing exercise could increase the strength of leg muscles physical performances, quality of life in people with knee osteoarthritis. This exercise can be used as a long lasting exercise in the future.

Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study

OBJECTIVE

To compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics.

DESIGN

Prospective cohort study with propensity score matching.

SETTING

Data collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands.

PARTICIPANTS

A consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes.

INTERVENTIONS

Exercises and orthotics versus orthotics alone.

MAIN OUTCOME MEASURES

Primary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100).

RESULTS

A larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131).

CONCLUSIONS

Non-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.

Is a joint-specific home exercise program effective for patients with first carpometacarpal joint osteoarthritis? A critical review

Introduction

First carpometacarpal joint osteoarthritis is a common degenerative condition. The thumb has been reported to account for up to 50% of hand function and is functionally and biomechanically unique in the hand. To this end, it would seem appropriate that exercise programs for first carpometacarpal joint osteoarthritis would be specifically tailored to the thumb. However, this is not widely reflected in the literature. This review aimed to critically evaluate studies presenting primary evidence to determine whether a joint-specific exercise program is effective for patients with osteoarthritis in the first carpometacarpal joint.

Methods

Six electronic databases were searched for papers presenting primary data relating to home exercise programs that were specific to osteoarthritis in the first carpometacarpal joint. Methodological quality of included papers was evaluated using the Structured Effectiveness for Evaluation of Studies tool and levels of evidence were established based on National Health and Medical Research Council (NHMRC) guidelines. Qualitative analysis of the combined body of literature was performed and a recommendation generated and then graded according to NHMRC guidelines.

Results

Searching identified three relevant papers. Overall, methodological quality was moderate, with limitations primarily related to lack of power. Findings from the body of literature demonstrated considerable variation, but evidence to support specific thumb strengthening exercises was found. This provided an NHMRC Grade D level of recommendation.

Conclusions

It is recommended that future studies consider optimal frequency of strengthening exercises and the potential role of adductor pollicis release and passive carpometacarpal joint mobilization in home exercise programs for first carpometacarpal osteoarthritis.

Class IV laser therapy for trapeziometacarpal joint osteoarthritis: Study protocol for a randomized placebo-controlled trial

OBJECTIVE

Osteoarthritis (OA) is a chronic and prevalent joint disorder with great impact on quality of life and high economic burden. Although a number of conservative therapies have proven to be effective for the management of hand OA, only modest treatment effects were reported for most individual interventions. The aim of the proposed study is to assess the effect of Class IV laser therapy (LT) on pain and pinch strength in patients with thumb carpometacarpal (TCMC) OA.

METHODS

A randomized, controlled, single-centre, double-blind, clinical trial, with 1:1 allocation ratio, will be carried out involving patients presenting TCMC-OA Grades 1-2 (aged >18 years). Both assessor and statistician will remain blinded. Patients with TCMC-OA will be randomly assigned to the experimental group (will receive LT) and control group (will receive a placebo treatment). Outcome measures will be pain scores at the base of the thumb measured with visual analogue scale (0-10: 0, no pain and 10, worst pain) and changes in pinch strength, both collected at baseline, 4, and 12 weeks. Statistical analyses will be based on an intention-to-treat analysis using the last value forward method. A two-tailed independent Student's t test for the continuous variable of age and baseline scores will be used for comparison of baseline characteristics and outcome variables. Paired Student's t tests will be used to determine the level of significance of the differences between the pretreatment and posttreatment measurements of the individual groups. Repeated measures analysis of variance will be used to determine the differences in time as the within-subjects factor and group as the between-subjects factor.

DISCUSSION

To our knowledge, the results of this study will provide the first double-blinded evidence for Class IV LT in patients with TCMC-OA.

Trapeziometacarpal joint contact varies between men and women during three isometric functional tasks

Trapeziometacarpal (TMC) joint osteoarthritis (OA) affects women two to six times more than men, and is influenced by stresses and strains in the cartilage. The purpose of this study was to characterise sex and age differences in contact area and peak stress location of the healthy TMC joint during three isometric tasks including pinch, grasp and jar twist. CT images of the hand from 50 healthy adult men and women were used to create a statistical shape model that was used to create finite element models for each subject and task. Force-driven simulations were performed to evaluate cartilage contact area and peak stress location. We tested for sex and age differences using Principal Component Analysis, linear regression, and Linear Discriminant Analysis. We observed sex differences in peak stress location during pinch (p = .0206), grasp (p = .0264), and jar twist (p = .0484). The greatest sex differences were observed during jar twist, where 94% of peak stresses in men were located in the centre compared with 50% in the central-volar region in women. These findings show that peak stress locations are more variable in women during grasp and jar twist than men, and suggest that women may employ different strategies to perform these tasks.

The effects of resistance training on muscle strength, joint pain, and hand function in individuals with hand osteoarthritis: a systematic review and meta-analysis

Background

Hand osteoarthritis is a common condition characterised by joint pain and muscle weakness. These factors are thought to contribute to ongoing disability. Some evidence exists that resistance training decreases pain, improves muscle strength, and enhances function in people with knee and hip osteoarthritis. However, there is currently a lack of consensus regarding its effectiveness in people with hand osteoarthritis. Therefore, the aim of this systematic review and meta-analysis was to establish whether resistance training in people with hand osteoarthritis increases grip strength, decreases joint pain, and improves hand function.

Methods

Seven databases were searched from 1975 until July 1, 2016. Randomised controlled trials were included. The Cochrane Risk of Bias Tool was used to assess studies’ methodological quality. The Grade of Recommendations Assessment, Development, and Evaluation system was adopted to rate overall quality of evidence. Suitable studies were pooled using a random-effects meta-analysis.

Results

Five studies were included with a total of 350 participants. The majority of the training programs did not meet recommended intensity, frequency, or progression criteria for muscle strengthening. There was moderate-quality evidence that resistance training does not improve grip strength (mean difference = 1.35; 95% confidence interval (CI) = –0.84, 3.54; I² = 50%; p = 0.23 ). Low-quality evidence showed significant improvements in joint pain (standardised mean difference (SMD) = –0.23; 95% CI = –0.42, –0.04; I² = 0%; p = 0.02) which were not clinically relevant. Low-quality evidence demonstrated no improvements in hand function following resistance training (SMD = –0.1; 95% CI = –0.33, 0.13; I² = 28%; p = 0.39).

Conclusion

There is no evidence that resistance training has a significant effect on grip strength or hand function in people with hand osteoarthritis. Low-quality evidence suggests it has a small, clinically unimportant pain-relieving effect. Future studies should investigate resistance training regimes with adequate intensity, frequency, and progressions to achieve gains in muscle strength.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-017-1348-3) contains supplementary material, which is available to authorized users.

Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial

BACKGROUND

In the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted. This multicentre randomized controlled trial aims to address the following questions: Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA? What are patients' motivation and reasons for wanting CMC1-surgery? Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery? Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA? Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function? Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery? Is OT more cost-effective than surgery in the management of CMC1-OA?

METHODS/DESIGN

All persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate. Those who agree attend a clinical assessment and report their symptoms, function and motivation for surgery in validated outcome measures, before they are randomly selected to receive OT in the period before surgical consultation (estimated n = 180). The primary outcome will be the number of participants in each group who have received surgical treatment after 2 years. Secondary and tertiary outcomes are pain, function and satisfaction with care over the 2-year trial period. Outcomes will be collected at baseline, 4, 18 and 24 months. The main analysis will be on an intention-to-treat basis, using logistic regression, comparing the number of participants in each group who have received surgical treatment after 2 years.

DISCUSSION

The findings will improve the evidence-based management of HOA.

TRIAL REGISTRATION IDENTIFIER

NCT01794754 . First registrated February 15^th 2013.

Mobilization with movement and elastic tape application for the conservative management of carpometacarpal joint osteoarthritis

Carpometacarpal osteoarthritis can limit a person's ability to engage in desired activities. Many therapists utilize conservative approaches to assist these patients. These authors describe utilizing a combination of mobilization with movement and the use of elastic tape for patients with this arthritis. - Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor.

Efficacy of treatments and pain management for trapeziometacarpal (thumb base) osteoarthritis: protocol for a systematic review

INTRODUCTION

The thumb is essential for daily activities. Unfortunately, this digit is commonly affected by trapeziometacarpal osteoarthritis (TMO), handicapping a large number of individuals. TMO constitutes an increasing human and economic burden for our society whose population is ageing. Limited access to adequate treatment is among the most important obstacles to optimal TMO management. Poor understanding of TMO characteristics, lack of knowledge about evidence-based treatments, simplistic pain management plans based solely on the patient's physical condition, absence of interprofessional communication and lack of multidisciplinary treatment guidelines contribute to inadequate TMO management. On the long term, our research project aims at improving the quality of care and services offered to patients with TMO by developing a patient-centred, evidence-based multidisciplinary management clinical pathway coordinated across the healthcare system. This proposed systematic review is a prerequisite to ensuring evidence-based practices and aims to document the efficacy of all the existing modalities for TMO management.

METHODS AND ANALYSIS

The protocol of the systematic review is registered with PROSPERO and will be conducted using the guidelines Cochrane Handbook for Systematic Reviews of Interventions. We will identify studies in English and French concerning TMO treatments through searches in Cochrane Central, EMBASE, MEDLINE, PsychINFO, CINHAL, PubMed, OT Seekers, PEDRO and the grey literature. 2 reviewers will independently screen study eligibility, extract data and appraise studies using published assessment tools. Meta-analyses will be undertaken where feasible; otherwise, narrative syntheses will be carried out. The robustness of evidence will be assessed using the GRADE system.

ETHICS AND DISSEMINATION

Ethics approval is not required for this study. A comprehensive knowledge exchange and transfer plan incorporating effective strategies will be used to disseminate the findings of this review and utilise them to optimise TMO management.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42015015623.

Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial

BACKGROUND

Hand exercises are recommended for patients with hand osteoarthritis (HOA), though evidence for their effect is conflicting.

OBJECTIVE

To evaluate, in a randomised controlled trial, the effect of HOA information plus home-based hand exercises (exercise group) compared with information only (control group) in women with HOA.

METHODS

Interventions were delivered by two occupational therapists. Exercise group participants received eight follow-up calls over the 3-month study and recorded adherence, pain after exercises and adverse events in a diary. Primary outcome was activity performance measured after 3 months by the Patient-Specific Functional Scale (PSFS), with a range of 0-10. Secondary outcomes were measurements of hand function, disease activity, symptoms and number of responders to treatment according to the OMERACT-OARSI criteria.

RESULTS

Of 80 women randomised (40 : 40) (mean age (SD) 60.8 years (7.0)), follow-up was 89% (n=71). An intention-to-treat analysis was performed. The adjusted mean difference for the exercise versus control group was 1.4 points (95% CI 0.6 to 2.2, effect size 1.0) for the PSFS score. Thirteen patients in the exercise group versus three participants in the control group reached a positive minimal clinical important difference of 2.2 points in the PSFS total score, while none versus two, respectively, had a negative change (p=0.007). For secondary outcomes, significant mean differences were found in grip strength and thumb web space, in fatigue, joint pain and the Functional Index for HOA activity performance scores. Sixteen exercise-group participants fulfilled the OMERACT-OARSI response criteria versus two control-group participants (p<0.001).

CONCLUSIONS

Hand exercises were well tolerated and significantly improved activity performance, grip strength, pain and fatigue in women with HOA.

TRIAL REGISTRATION NUMBER

ISRTCN79019063.

Men and women have similarly shaped carpometacarpal joint bones

Characterizing the morphology of the carpometacarpal (CMC) joint bones and how they vary across the population is important for understanding the functional anatomy and pathology of the thumb. The purpose of this paper was to develop a statistical shape model of the trapezium and first metacarpal bones to characterize the size and shape of the whole bones across a cohort of 50. We used this shape model to investigate the effects of sex and age on the size and shape of the CMC joint bones and the articulating surface area of the CMC joint. We hypothesized that women have similar shape trapezium and first metacarpal bones compared to men, following scaling for overall size. We also hypothesized that age would be a significant predictor variable for CMC joint bone changes. CT image data and segmented point clouds of 50 CMC bones from healthy adult men and women were obtained from an ongoing study and used to generate two statistical shape models. Statistical analysis of the principal component weights of both models was performed to investigate morphological sex and age differences. We observed sex differences, but were unable to detect any age differences. Between men and women the only difference in morphology of the trapezia and first metacarpal bones was size. These findings confirm our first hypothesis, and suggest that the women have similarly shaped trapezium and first metacarpal bones compared to men. Furthermore, our results reject our second hypothesis, indicating that age is a poor predictor of CMC joint morphology.

Conservative treatment of thumb base osteoarthritis: a systematic review

PURPOSE

To provide a systematic review of randomized controlled trials regarding the conservative treatment of thumb base osteoarthritis (OA).

METHODS

A systematic literature search was conducted in the electronic bibliographic databases Medline (Pubmed) and Embase (both starting year to May 2014) using predetermined criteria for studies on nonoperative treatment of thumb base OA.

RESULTS

Twenty-three articles fulfilled our inclusion criteria. Systematic evaluation demonstrated the following: (1) Hand therapy can possibly reduce pain. However, owing to the lack of good-quality (randomized controlled) trials with sufficient follow-up time, no proper conclusions can be drawn. (2) Although both steroid and hyaluronate intra-articular injections can provide pain relief, most authors conclude that injection of hyaluronate is more effective. Follow-up is rather short with a maximum of 12 months in 1 study. Furthermore, study comparison is hampered by heterogeneity of study design and outcome parameters. (3) The use of orthoses reduces pain without effect on function, strength, or dexterity. Included studies used various types of orthoses. Follow-up times varied (2 wk-7 y). (4) There is no justification for the use of transdermal steroid delivery. (5) There is insufficient evidence justifying the use of leech therapy. (6) There are no high-level evidence studies specifically evaluating the effect of analgesics and patient education in joint protection in patients with thumb base OA.

CONCLUSIONS

There are only a few high-quality studies addressing the conservative treatment of trapeziometacarpal OA. Available evidence suggests only some effect of orthoses and intra-articular hyaluronate or steroid injections.

Current practice patterns in conservative thumb CMC joint care: survey results

STUDY DESIGN

Cross-sectional descriptive survey

INTRODUCTION

Best practice for conservative clinical care pathways is not well outlined in the literature for patients with thumb carpometacarpal joint (CMCJ) pain. This self-report survey investigated the current practice patterns of assessments and conservative interventions for the painful thumb CMCJ among hand therapists.

METHODS

An online survey was distributed to members of the American Society of Hand Therapists (ASHT). Questions were included about evaluation measures and intervention techniques used for this population. A descriptive analysis was completed of the results.

RESULTS

A total of 23.5% of the ASHT membership responded to the survey. Results were categorized using the International Classification of Functioning and Disability domains as a framework. The survey results report varying use of evaluation measures, therapeutic interventions, including orthotic fabrication, joint protection and patient education all therapeutic interventional techniques, and modalities.

CONCLUSION

Therapists use a comprehensive array of evaluation measures and interventions for body functions and structures in the care of thumb CMC pain. In contrast, more consistent use is needed of psychometrically-sound functional outcome measures that show change in activities and participation. This survey highlights areas to employ current evidence, as well as, future research should address environmental factors and personal factors for this population

LEVEL OF EVIDENCE

Not applicable.

Reliability of pinch strength testing in elderly subjects with unilateral thumb carpometacarpal osteoarthritis

[Purpose] The aim of this study was to examine the test-retest reliability of pinch strength testing in elderly subjects with thumb CMC OA. [Subjects and Methods] A total of 27 patients with unilateral right-thumb CMC OA (mean ± SD age: 81.3 ± 4.7 years) were recruited. Each patient performed three pain-free maximal isometric contractions on each hand on two occasions, one week apart. Three different measurements were taken: tip, tripod, and key pinch strength. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95% limits of agreement (LOA) calculations were performed. [Results] Test-retest reliability of measurements of tip, tripod, and key pinch strength was excellent for the affected side (ICC=0.93, 0.96, and 0.99) and the contralateral thumb (ICC=0.91, 0.92, and 0.94). [Conclusions] The present results indicate that maximum pinch strength can be measured reliably using the Pinch Gauge Dynamometer, in patients with thumb CMC OA, which enables its use in research and in the clinic to determine the effect of interventions on improving pinch strength.

Reliability of pinch strength testing in elderly subjects with unilateral thumb carpometacarpal osteoarthritis

[Purpose] The aim of this study was to examine the test-retest reliability of pinch strength testing in elderly subjects with thumb CMC OA. [Subjects and Methods] A total of 27 patients with unilateral right-thumb CMC OA (mean ± SD age: 81.3 ± 4.7 years) were recruited. Each patient performed three pain-free maximal isometric contractions on each hand on two occasions, one week apart. Three different measurements were taken: tip, tripod, and key pinch strength. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95% limits of agreement (LOA) calculations were performed. [Results] Test-retest reliability of measurements of tip, tripod, and key pinch strength was excellent for the affected side (ICC=0.93, 0.96, and 0.99) and the contralateral thumb (ICC=0.91, 0.92, and 0.94). [Conclusions] The present results indicate that maximum pinch strength can be measured reliably using the Pinch Gauge Dynamometer, in patients with thumb CMC OA, which enables its use in research and in the clinic to determine the effect of interventions on improving pinch strength.

Magnetotherapy in hand osteoarthritis: a pilot trial

OBJECTIVE

To evaluate the effectiveness of magnetotherapy in the treatment of hand osteoarthritis (HO).

METHODS

In this randomized controlled single-blind follow-up study, patients with HO were randomly assigned into 2 groups (G1 and G2). The subjects in G1 (n=25) received 25Hz, 450 pulse/s, 5-80G, magnetotherapy of totally 10 days and 20 min/day combined with active range of motion/strengthening exercises for the hand. G2 (n=25) received sham-magnetotherapy for 20 min/day for the same duration combined with the same hand exercises. Outcome measures were pain and joint stiffness evaluation, handgrip and pinchgrip strength (HPS), Duruöz and Auscan Hand Osteoarthritis Indexes (DAOI) and Short Form-36 Health Questionnaire (SF-36) administered at baseline, immediately after treatment and at the follow up.

RESULTS

When the groups were compared with each other, improvement observed in SF-36 Pain (p<0.001), SF-36 Social Function (p=0.030), SF-36 Vitality (p=0.002), SF-36 General Health (p=0.001), Pain at rest (p<0.001), Pain at motion (p<0.001), Joint stiffness (p<0.001), DAOI (p<0.001) were in favor of G1.

CONCLUSIONS

Changes in pain, function and quality of life scores showed significant advantage in favor of the applied electromagnetic intervention in patients with HO.

The effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial

STUDY DESIGN

Double-blind, randomized controlled trial.

OBJECTIVE

To examine the effectiveness of a manual therapy and exercise approach relative to a placebo intervention in individuals with carpometacarpal (CMC) joint osteoarthritis (OA).

BACKGROUND

Recent studies have reported the outcomes of exercise, joint mobilization, and neural mobilization interventions used in isolation in patients with CMC joint OA. However, it is not known if using a combination of these interventions as a multimodal approach to treatment would further improve outcomes in this patient population.

METHODS

Sixty patients, 90% female (mean ± SD age, 82 ± 6 years), with CMC joint OA were randomly assigned to receive a multimodal manual treatment approach that included joint mobilization, neural mobilization, and exercise, or a sham intervention, for 12 sessions over 4 weeks. The primary outcome measure was pain. Secondary outcome measures included pressure pain threshold over the first CMC joint, scaphoid, and hamate, as well as pinch and strength measurements. All outcome measures were collected at baseline, immediately following the intervention, and at 1 and 2 months following the end of the intervention. Mixed-model analyses of variance were used to examine the effects of the interventions on each outcome, with group as the between-subject variable and time as the within-subject variable.

RESULTS

The mixed-model analysis of variance revealed a group-by-time interaction (F = 47.58, P<.001) for pain intensity, with the patients receiving the multimodal intervention experiencing a greater reduction in pain compared to those receiving the placebo intervention at the end of the intervention, as well as at 1 and 2 months after the intervention (P<.001; all group differences greater than 3.0 cm, which is greater than the minimal clinically important difference of 2.0 cm). A significant group-by-time interaction (F = 3.19, P = .025) was found for pressure pain threshold over the hamate bone immediately after the intervention; however, the interaction was no longer significant at 1 and 2 months postintervention.

CONCLUSION

This clinical trial provides evidence that a combination of joint mobilization, neural mobilization, and exercise is more beneficial in treating pain than a sham intervention in patients with CMC joint OA. However, the treatment approach has limited value in improving pressure pain thresholds, as well as pinch and grip strength. Future studies should include several therapists, a measure of function, and long-term outcomes.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN37143779.

LEVEL OF EVIDENCE

Therapy, level 1b.

Functional patterns of thumb key pinch and their influence on thumb strength and stability

Introduction

Trapeziometacarpal osteoarthritis (TMC OA) is a common condition frequently related to instability and hypermobility. Many factors are involved in the development of this degenerative process. Recent research suggests that the position of the metacarpophalangeal (MCP) joint may influence TMC joint contact wear patterns and subsequent development of OA. The aim of this study is to explore the alignment of the MCP joint of the thumb during lateral pinch in order to describe the naturally occurring alignment in a group of healthy volunteers without symptoms.

Methods

One hundred and nine participants were asked to apply a lateral pinch manoeuvre to a pinchmeter, while their thumbs were assessed. Passive hypermobility of the thumb MCP (MCP) joint was assessed, key pinch strength was measured, key pinch position was photographed and the angle of the joints during the assessment was measured.

Results

Four different functional pinch patterns were identified. The most frequent pattern seems to be MCP hyperextension described by Moulton as harmful for the TMC joint. The level of strength obtained did not correspond to the pinch pattern used, and hypermobility of the thumb MCP joint did not determine the position of the thumb during key pinch.

Conclusion

Four different thumb postures were identified during lateral pinch; however, these postures were not associated with any difference in pinch strength. We conclude that the more unstable and mechanically inefficient postures are compensated by functional capacity.