New insights in treatment of Thumb Arthritis according to Last Evidence

Treatment of Thumb Osteoarthritis and Pain

Hand function can be affected when Osteoarthritis in Carpal-Metacarpal joint (CMC) of the thumb appears. Current evidence support Therapeutic Exercise for managing Thumb Pain as the main treatment. In the National Congress of Hand Therapists of April 2017 that took place in Marbella (Spain), Kristin Valdes (an important Occupational Therapist and researcher) talked about tratment in detail.

Based on some articles from 2013 to 2016, she highlighted three main factors for a symptomatic thumb Osteoarthritis appearance:

1. Compressive forces on the Joint between First Metacarpal and Carpal, known as TrapezioMetacarpal Joint.

2. Ligamentary instability caused by hiperlaxity of some important ligaments. Volar Ligaments are the most affected, caused by lack of nerve endings unlike ligaments on the dorsal side. If those ligaments that stabilise the thumb joint are not functional and do not perform their function properly, this can eventually lead to symptomatic instability associated to osteoarthritis.

3. The proprioceptive system provides information about the position and movement of the thumb, and its impairment may contribute to the development of osteoarthritis. If the afferent information collected at the level of the thumb, its processing at the level of the central nervous system and the muscular efferent response in the thumb does not occur adequately, it can lead to this condition.

Following these factors, thumb osteoarthritis must base its treatment on neuromuscular training to promote dynamic stability of the joint.

Active Treatment of the Thumb improving Stability

According to those factors, Osteoarthritis treatment must include some neuromuscular training techniques for restoring Dynamic Instability in this Joint.

Some exercises proposal are included in our Thumb exercises blog!! Check them out!!

An active management with SensoriMotor Techniques focused on thumb muscles must be the main treatment of this thumb pathology. Also a specific muscle evaluation should be performed. Amongst those thumb muscles, it may highlights:

First Dorsal Interosseous

Abductor Pollicis Longus.

Extensor Pollicis Brevis.

Kristin Valdes also adds that an important goal is to achieve a decrease in tone throughout the adductor and flexor muscles of the thumb, which promote joint deformity, together with elastic bandaging techniques, joint traction and orthoses.

Do you usually treat patients with Thumb Base Osteoarthritis?

ReHand App has evidence-based exercises for the active treatment of this condition! Write to us and we will advise you!

Treatment proposals for Thumb Osteoarthritis

Social media and Newspaper constantly talk about how bad is using smartphones and tablets for your hands and fingers. But that does not have any evidence supporting that fact.

In a study she mentions from 2014 (Algar L & Valdes K 2014) , she argues the opposite of what we have been told so far; and affirms that the use of smartphones can be a great option for thumb osteoarthritis treatment or Distal Radius Fractures. The author proposes its use as a therapeutic tool for patients in their recovery process.

In this study, authors defend the use of new technologies , telerehabilitation systems and Apps for tablets or smartphones for patient’s rehabilitation in order to accelerate and improve the recovery process in hand, wrist or finger disorders.

Kristin highlighted the fact that she usually uses smartphone or tablet Apps within the patient’s recovery process due to its advantages into sensorimotor control work of thumb osteoarthritis.

Those tools are a good way to work Sensorimotor System when is affected.

Why is so important to work Sensorimotor exercises after a Distal Radius Fracture?

However, we need evidence-based Telerehabilitation Systems!!

But there are several problems; those are tools that do not adjust to the patient’s capacities, evolution and pathology, they do not have a systematic increase in difficulty, and they do not allow close monitoring of the health professional in charge. Those apps are usually applications in which health professionals have not collaborated to develop them, so they are not feasible to use.

That´s why the Digital System ReHand App appeared, for solving those problems. ReHand is a combination of New Technologies and latest evidence on Hand Therapy.

ReHand is a digital tool for Prescription, Treatment and Monitoring of injuries of the wrist-hand-finger segment, such as Thumb Osteoarthritis. This Digital tool was developed thanks to a team of Physiotherapists, Hand Therapists and Hand Surgeons, who based all its creation on the latest evidence about Sensorimotor Approach and Therapeutic Exercise.

ReHand allows: 1) Prescribing tailored exercise programmes adapted to the patient’s abilities, pathology and time of recovery, 2) Treatment through a tablet with Therapeutic Exercise, which allows both face-to-face and telematic work; and 3) Monitoring the patient’s evolution and adherence by sending scales and validated questionnaires.

ReHand Exercise in a thumb osteoarthritis patient

Here you can see the case of a patient who, due to an advanced Thumb Osteoathritis that required surgery, worked telematically with the ReHand digital tool. In this case, you can see a proprioceptive exercise of the thumb in different planes of movement:

Do you have patients with osteoarthritis of the thumb? Ask us about the ReHand app exercise programmes for this condition.

References

Bertozzi L, Valdes K, Vanti C, Negrini S, Pillastrini P, Villafañe JH. Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis. Disability and Rehabilitation. 2015; 37(22):2025-43.

Valdes K, Von der Heyde R. An exercise program for carpometacarpal osteoarthritis based on biomechanical principles. Journal of hand therapy. 2012; 25, 251-63.

Algar L, Valdes K. Using smartphone applications as hand therapy interventions. Journal of Hand Therapy. 2014; 27: 254-257.

McGee C, O´Brien V, Van Nortwick S, Adams J, Van Heest A. First dorsal interosseus muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint. Journal of Hand Therapy. 2015; 28, 375-381.

O´Brien VH, Giveans MR. Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: A retrospective study. Journal of hand therapy (2013) 26: 44-52.

Pablo Rodríguez Sánchez-Laulhé

Physiotherapist and Health Researcher