What is it thumb osteoarthritis?

The hand is a wonderful yet complex tool. Each finger is intricately designed and assists us with daily tasks. One of the most versatile and powerful digits is the thumb. The thumb is designed as saddle-shaped structure with flexible ligaments (Jeel & Sheth, 2023). These characteristics enable the thumb to have a large arc of motion. The thumb assists us in grasping, holding, and manipulating various sized objects. However, with such a large range of motion, the thumb is also susceptible to trauma from external forces and general aging (Gillis et al, 2011).

The carpometacarpal (CMC) is the bony prominence found at the base of the thumb. The CMC joint is responsible for stabilizing the thumb with the help of ligaments, including the anterior oblique ligament. This ligament is highly prone to laxity (Gillis et al, 2011). The CMC joint thus is at increased risk of increased stress load, impingement, pain, and cartilage loss (Gillis et al, 2011). These factors make the CMC joint more susceptible to osteoarthritis (OA) (Gillis et al, 2011).

Thumb CMC OA is the second most common degenerative disease of the hand (Gillis et al, 2011). However, there are options to slow the progression of CMC OA. The combination of activity modification, medication, therapy, and surgery can be used based on the stage of CMC OA and patient preference (Gillis et al, 2011). The goal of each intervention is to decrease pain and increase hand function and strength (Jeel & Sheth, 2023). In addition, use of cortisol injections has also been found to decrease pain and discomfort in earlier stages of CMC OA (Gillis et al, 2011). Patients may be eligible for a surgical option to treat CMC OA. Surgery may be recommended by your physician depending on the severity of your arthritis as well as how it impacts your ability to use your hand. There are several types of surgical intervention and should be discussed with your doctor to decide which is best for you.

What can OT/Hand Therapy do to help?

What can Occupational Therapy (OT) do for patients with thumb CMC OA? When a patient is referred to OT for treatment of thumb CMC OA, the focus will be on increasing functional use of the hand, increasing strength of the hand and fingers, and decreasing pain. During OT sessions, patients will participate in an individualized strengthening program. The use of these exercises will help the hand get stronger to prevent further damage and discomfort to the thumb. This program will also focus on teaching patients how to position their hand and thumb to perform their daily tasks with less pain.

Using splints to increase stabilization is also beneficial for long-term management of CMC OA. Your therapist can create a custom splint designed to stabilize the CMC joint in an optimal and safe position while still allowing the patient to use their hand and fingers to grasp and manipulate objects. It has also been found that the use of a custom-made thumb spica splint can reduce pain and allow the ability to tolerate functional pinch activities. The thumb spica splint can be modified and individualized to meet the needs of each patient. This can include use of light weight material, color, size, and fit that is specific to the patients’ needs and lifestyle.

Pain management and patient education is the primary focus in helping the patient manage their symptoms and live life. Pain management can be addressed through activity modifications, splinting, and manual therapy techniques (Cantero-Téllez et al., 2022). A recommendation of modalities, such as ice or heat, used as part of the patient home exercise program can decrease inflammation, stiffness, and pain of the CMC joint.

Centers for Advanced Orthopedics (CAO) has a cohesive team of talented hand surgeons and OT/CHTs (Certified Hand Therapists) that specialize in treating all conditions of the hand. The surgeon and hand therapist work very closely together allowing constant communication regarding the patient’s care. This will maximize the outcome and help ensure the patients have the best care. At CAO a team approach is a priority.

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Citation

1. Cantero-Téllez, R., Algar, L. A., Valdes, K. A., & Naughton, N. (2022). Clinical effects of proprioceptive thumb exercise for individuals with carpometacarpal joint osteoarthritis: A randomized controlled trial. Journal of Hand Therapy, 35(3), 358–366. doi:10.1016/j.jht.2022.06.009
2. Gillis, J., Calder, K., & Williams, J. (2011). Review of thumb carpometacarpal arthritis classification, treatment and outcomes. Can J Plast Surg, 19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249665/pdf/cjps19134.pdf
3. Jeel Mahendrabhai Jeevrajani, & Sheth, M. (2023). Physiotherapeutic Approaches in Thumb Carpometacarpal Joint Arthritis for Pain, Function, and Grip Strength. Journal of Integrated Health Sciences, 11(2), 89–91. doi:10.4103/jihs.jihs_38_23