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Thumb Arthritis. Everything you need to know
Within the carpal joints in the wrist, is worth mentioning the Arthritis of the base joint of the thumb.
It consist of a degenerative process this level, and more specifically between the base of the first metacarpal bone and the Trapezium bone of the wrist. The repetitive use of this joint take its toll, starting with damage at the articular cartilage and continuing with other structures as bone, ligaments or muscles.
The articular cartilage is the structure that allows a proper glide of the bones. This will contribute to a perfecto joint function in our daily living activities.
Over the years, possibly favoured by an imbalance of muscles forces, joint stability start to fail and may produce pain and degeneration.
A Joint Control Failure?
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.
Not every Osteoarthritis degeneration produces pain. Most are normal, physiological processes that doesn´t produce symptoms.
Essentially, the literature speaks of the need to Activate (NOT strengthen) 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.
Click in Link to watch some Thumb Arthritis exercises based on lastest evidence:
Symptoms of Thumb Arthritis
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.
In addition, a progressive loss of strength in the hand will established, causing more pain and activities limitation.
Also, deformities may appear in those joints in more advanced cases.
Usually the diagnosis is purely clinical, but can be supported by complementary tests such as MRIs or X-rays.
Who often 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.
Yusuf E (2012) concluded that it is plausible to assume an obesity-related metabolic factor that conditions the onset of osteoarthritis. The purely mechanical factor is not viable at this level and we should abandon this simplistic vision.
Link to complete article:
Thumb treatment evidence-based
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. Only in extreme cases should we go for surgery.
ReHand App has some exercise programs adapted to the patient, to progressively improve their condition. Based on lastest evidence, our exercises adapts to patients Motion.
Here you can watch an example of Thumb abduction exercise with ReHand:
Pablo Rodríguez Sánchez-Laulhé
Physiotherapist, Hand Therapist and Health Researcher
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