Carpometacarpal (CMC) osteoarthritis: thumb pain and the role of physical therapy
Thumb pain has never been a more common problem than it has been now. Computers and smart devices aren’t going away anytime soon, and neither will the incessant demand on our text-punching, mouse-guiding thumbs. Over time, repetitive overuse of thumbs can lead to degenerative changes, such as osteoarthritis of the thumb’s base joint.
The study:
Villafane et al performed a randomized controlled trial consisting of 60 patients diagnosed with 1st carpometacarpal osteoarthritis. These cases were divided into 2 groups:
The experimental group (EG) received a multimodal treatment approach, consisting of exercise and manual therapy (joint and neural mobilizations).
The control group (CG) received a sham intervention, which consisted of pulsed ultrasound at 0 W/cm2 applied on the base of the thumb.
Both groups underwent 12 sessions of treatment over 4 weeks. Outcome measures included reported pain, pinch and grip strength, and pain pressure threshold over 1st CMC, scaphoid and hamate bones.
The results:
The EG reported significant decrease in pain levels from pre-intervention (5.0) to post-intervention (1.9), which continued to decrease at 1-month and 2-month follow-up (1.5), while the CG had smaller decrease from pre-intervention (5.0) to post-intervention (4.9). p<0.001.
There were no statistically significant changes in outcome measure of pinch/grip strength and pain pressure threshold in both EG and CG when comparing pre-intervention to post-intervention.
Limitations in this study: 1.) sample size too small. 2.) the subjects did not complain of grip/pinch weakness pre-intervention, and therefore the prescribed exercises may not have had a strengthening effect. 3.) no measure of function was included as an outcome measure. 4.) no long-term follow-up after 2 months.
What this means:
A multimodal treatment approach including manual therapy and exercise can help significantly improve pain associated with osteoarthritis of the thumb joint. Though this study included only patients with osteoarthritis, it is curious whether similar treatment procedures may be utilized to manage other diagnoses involving the thumb. Further research is needed to help confirm this hypothesis.
The vid below shows some examples of thumb pain treatment used in this article’s experiment.
REFERENCES:
Villafañe JH, Cleland JA, Fernández-de-Las-Peñas C. The effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. J Orthop Sports Phys Ther. 2013 Apr;43(4):204-13. doi: 10.2519/jospt.2013.4524. Epub 2013 Mar 13. PMID: 23485660.