Thumb Osteorthritis. Causes, Symptoms and Treatment.

We frequently deal with various pain-related disorders in the wrist, hand or thumb. Due to the enormous importance of our hands in our daily living activities (gestures, such as grasping or pinching objects, depend on the thumb) this segment might suffer from various musculoskeletal conditions such as tendinopathies, osteoarthritis or instabilities.

Thumb Osteoarthrits. Key concepts

The thumb joins the wrist at the level of the joint between two bones of the hand, the trapezium and the first metacarpal. It is at this level (the trapezium-metacarpal joint) that the famous thumb base osteoarthritis usually occurs. 

It consists of a degenerative process at the level of the joint at the base of the thumb. Repetitive use of this joint of the carpus takes its toll, associated with many other systemic factors such as lack of physical activity or overweight. The combination of all these factors may predispose its appearance. Its important to highlight that Osteoarthritis is not a “wear-and-tear” pathology!!

At the joint level, the articular cartilage is the structure that allows the bones to slide correctly and, therefore, the joint to function correctly. Over the years, and associated with many other risk factors, the joints of the hand and wrist can be altered and end up with osteoarthritis.

Could a Joint Control Failure explain Osteoarthritis pain?

One of the issues that can lead to Thumb Osteoarthritis is a poor joint control. Let’s clarify the issue of impaired joint control, as it can be difficult to understand.

Hand Joints move hundreds of times a day for everyday activities and therefore need to be free in mobility and without alterations in its biomechanics.

Let´s think about some thumb movements:

–Opposition; bringing the thumb closer to the rest of the fingers (typical movement for holding pencils, papers, etc.) or called Pinch.

–Abduction: consist of separating the thumb from the rest of the fingers.

It´s easy to assume that Opposition movement will be the strongest one. This is because most of our thumb activities lead to grasping objects, taking it to the Opposition movement to do so. By contrast, abduction does not need that forces.

This excessive tension – the difference in forces between the two muscle groups – can alter the normal position of the bones in the joint by pulling on them. Consequently could begin to load or exert more forces on a particular point in the joint.

This situation, maintained over time, could begin to degenerate at the level of the wrist and carpal bones could end up damaging the same, which can cause Thumb Arthritis.

Exercise as Main treatment of Osteoarthritis

Essentially, the literature speaks of the need to Activate intrinsic and extrinsic muscles of the hand and wrist, highlighting:

– First Dorsal Interosseous: brings the thumb closer to the rest of the fingers with a rotational movement, which may not act correctly and predispose to more pain.

– Abductor Pollicis Longus and Extensor Pollicis Brevis: those may be lack of strength when performing the opposition movement of the Thumb.

Important:

Not every Osteoarthritis degeneration produces pain. Most are normal, physiological processes that doesn´t produce symptoms. Here it is essential to keep active and avoid a sedentary lifestyle.

Yusuf E (2012) published this interesting article, in which he considers it more than plausible that the main factor in osteoarthritis is metabolic and not mechanical, as has always been advocated. It is easy to think that obese people do not walk with their hands, and yet they still suffer from this pathology in their hands. It is essential to control our weight and exercise as we have been saying.

Symptoms of Thumb Base Osteoarthritis

Patients usually refers Pain during their Daily activities with their hands which involves thumb motion. Activities as picking up objects, opening/closing jars or wringing clothes.

Also during joint palpation may appears Pain and discomfort. Deformities may appear in those joints in more advanced cases.

In addition, a progressive loss of strength in the hand will established, causing more pain and activities limitation.

The diagnosis is usually purely clinical, but may be supported by complementary tests such as MRI or X-rays.

Who suffers from Thumb Arthritis?

Recent studies link this patology to older age, female gender, High BMI (Overweight), repetitive thumb use at professional level and family history.

Thumb evidence-based Treatment | ReHand App

First, Osteoarthritis, as we said before, is a normal joint process. Over the years, degenerative changes can occur but patient may not notice any pain.

When discomfort appears, the most effective way to control your symptoms is through individualized Therapeutic Exercise and Physical and Occupational Therapy treatment. It is essential to carry out exercises adapted and individualised to your pathological status and capacities.

Among the various proposals for exercise, the use of applications and touch screens has gained relevance in recent years, due to its direct action on the Central Nervous System, and its consequent early recovery. This is how ReHand, the tool for Prescription, Treatment and Monitoring of injuries of the wrist-hand-finger segment through a Tablet, came about.

Here you can watch an example of Thumb abduction exercise with ReHand:

Your physiotherapist, traumatologist or occupational therapist will be able to prescribe an exercise programme with ReHand adapted to your pathology, such as Thumb Osteoarthritis, and monitor your progress telematically or face-to-face.

Do you treat patients with Thumb Osteoarthritis? Tell us about it and we will help you to choose the right exercises!

Pablo Rodríguez Sánchez-Laulhé

Physiotherapist, Hand Therapist and Health Researcher

References

McQuillan TJ, Kenney D, Crisco JJ, Weiss AP, Ladd AL. Weaker Functional Pinch Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis. Clinical Orthopaedics and Related Research. 2016. 474(2):557-561.

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.

Villafañe JH, Valdes K. Combined thumb abduction and index finger extension strength: comparison of older adults with and without thumb carpometacarpal osteoarthritis. Journal of manipulative and physiological therapeutics (2013). Mayo; 36(4): 238-44.

Yusuf, E. (2012). Metabolic factors in osteoarthritis: Obese people do not walk on their hands. Arthritis Research and Therapy, 14(4). https://doi.org/10.1186/ar3894