Full Length Article| Volume 35, ISSUE 3, P454-460, July 2022

Thumb carpometacarpal palmar and radial abduction in adults with thumb carpometacarpal joint pain: Inter-rater reliability and precision of the inter-metacarpal distance method

Published:March 05, 2021DOI:


      • The precision and inter-rater reliability of the intermetacarpal distance measurement method for palmar and radial abduction have been established for persons with medical diagnosis of or clinical exam consistent with thumb CMC osteoarthritis.
      • Interrater reliability was excellent for radial and palmar abduction and precision was acceptable to excellent for these measurements.
      • The findings suggest that this method to assessing thumb CMC abduction are more reliable and precise than other methods for this population. Hand therapists should use this assessment over others.


      Study Design

      Psychometric study of inter-rater reliability.


      Functional use of the thumb can be limited in individuals with thumb carpometacarpal (CMC) osteoarthritis(OA), especially in the presence of a thumb adduction contracture. Goniometry is a common method of assessing palmar and radial abduction of the thumb base and can be used as a method of determining effectiveness of an intervention for adduction contracture. However, goniometry for the assessment of these motions has been shown to have low to moderate reliability. The intermetacarpal distance (IMD) measurement method has been shown to be the most reliable for measuring CMC palmar abduction in individuals with healthy hands but has not been studied in persons with thumb CMC OA.


      The purpose of this study was to determine the inter-rater reliability and precision of the inter-metacarpal distance method for measuring palmar and radial abduction in persons with symptoms of thumb CMC OA.


      Two trained hand therapists utilized the IMD method to measure palmar and radial abduction in the affected hands of 22 subjects (28 thumbs) with a physician-confirmed diagnosis or positive provocative test consistent with a diagnosis of thumb CMC OA. The intraclass correlation coefficient (ICC2,2) was used to assess inter-rater reliability of the IMD method. To determine the precision of the measurements, the standard error of measurement (SEM), minimal detectable change (MDC), and MDC percent were calculated. Findings were supplemented with descriptive data on the IMD values as well as descriptive data on the sample.


      Intraclass correlation coefficients for both radial and palmar abduction were found to be >.75, indicating excellent reliability. The precision of the IMD measurements were acceptable-to-excellent as evidenced by MDC% values of <30% and <10% for radial and palmar abduction respectively.


      We present a new method for measuring thumb radial abduction. The inter-metacarpal distance method has excellent inter-rater reliability and acceptable-to-excellent precision when measuring palmar and radial abduction in individuals with or suspected to have thumb CMC OA. Currently, it is the most reliable tool for measuring thumb abduction.
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        • Bellamy N
        • Campbell J
        • Haraoui B
        • et al.
        Dimensionality and clinical importance of pain and disability in hand osteoarthritis: Development of the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index.
        Osteoarthr Cart. 2002; 10: 855-862
        • Haara MM
        • Heliövaara M
        • Kröger H
        • et al.
        Osteoarthritis in the carpometacarpal joint of the thumb: Prevalence and associations with disability and mortality.
        J Bone Jt Surg - Ser A. 2004; 86: 1452-1457
        • Batra S
        • Kanvinde R.
        Osteoarthritis of the thumb trapeziometacarpal joint.
        Curr Orthop. 2007; 21: 135-144
        • Li YK
        • White CP.
        Five things to know about...carpometacarpal osteoarthritis of the thumb.
        CMAJ. 2013; 185: 149
        • Swigart CR.
        Arthritis of the base of the thumb.
        Curr Rev Musculoskelet Med. 2008; 1: 142-146
        • Murugkar PM
        • Brandsma JW
        • Anderson AM
        • Gurung K
        • Pun Y.
        Reliability of thumb web measurements.
        J Hand Ther. 2004; 17: 58-63
        • Zhang W
        • Doherty M
        • Leeb BF
        • et al.
        EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).
        Ann Rheum Dis. 2021; 66: 377-388
        • Pellegrini VD.
        The ABJS 2005 Nicolas Andry Award: Osteoarthritis and injury at the base of the human thumb - survival of the fittest?.
        Clin Orthop Relat Res. 2005; 438: 266-276
        • Kloppenburg M
        • Kroon FPB
        • Blanco FJ
        • et al.
        2018 update of the EULAR recommendations for the management of hand osteoarthritis.
        Ann Rheum Dis. 2019; 78: 16-24
        • Kjeken I
        • Dagfinrud H
        • Slatkowsky-Christensen B
        • et al.
        Activity limitations and participation restrictions in women with hand osteoarthritis: patients’ descriptions and associations between dimensions of functioning.
        Ann Rheum Dis. 2005; 64: 1633-1638
        • Gravås EMH
        • Østerås N
        • Nossum R
        • et al.
        Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial.
        RMD Open. 2019; 5e001046
        • Tveter A
        • Nossum R
        • Eide R
        • et al.
        Short-term effect of occupational therapy intervention on hand function and pain in patients with thumb base osteoarthritis - Secondary analyses of a randomized controlled trial.
        Osteoarthr Cartil. 2019; 27: S85
        • Poole JU
        • Pellegrini VD.
        Arthritis of the thumb basal joint complex.
        J Hand Ther. 2000; 13: 91-107
        • O'Brien VH
        • Giveans MR.
        Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: a retrospective study.
        J hand Ther Off J Am Soc Hand Ther. 2021; 26 (quiz 52): 44-51
        • Valdes K
        • Algar L
        • McGee C.
        Therapist's management of the thumb carpometacarpal joint.
        in: Skirven TM Osterman AL Fedorczyk JM Amadio P Feldscher SB Shin EK Rehabilitation of the Hand and Upper Extremity. 7th ed. Elsevier, Philadelphia2020: 1261-1277
        • De Tulio L
        • Wolfe D
        • Strohl A.
        Clinical examination of the hand.
        in: Skirven T Osterman AL Fedorczyk J Amadio P Feldscher S Shin EK Rehabilitation of the Hand and Upper Extremity. 7th ed. Elsevier, Philadelphia2020: 46-61
        • Jha B
        • Ross M
        • Reeves SWSL
        • Couzens GB
        • Peters SE.
        Measuring thumb range of motion in first carpometacarpal joint arthritis: the inter-rater reliability of the Kapandji Index versus goniometry.
        Hand Ther. 2016; 21: 45-53
        • de Kraker M
        • Selles RW
        • Schreuders TAR
        • Hovius SER
        • Stam HJ.
        The Pollexograph®: A New Device for Palmar Abduction Measurements of the Thumb.
        J Hand Ther. 2009; 22: 271-276
        • de Kraker M
        • Selles RW
        • Schreuders TAR
        • Stam HJ
        • Hovius SER.
        Palmar abduction: reliability of 6 measurement methods in healthy adults.
        J Hand Surg Am. 2009; 34: 523-530
        • Dunn G
        • Everitt BS.
        Clinical Biostatistics : An Introduction to Evidence-Based Medicine.
        E. Arnold, New York, NY1995 (doi:9780470249901)
        • Kottner J
        • Audige L
        • Brorson S
        • et al.
        Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed.
        Int J Nurs Stud. 2011; 48: 661-671
        • Model Z
        • Liu AY
        • Kang L
        • Wolfe SW
        • Burket JC
        • Lee SK.
        Evaluation of physical examination tests for thumb basal joint osteoarthritis.
        Hand. 2016; 11: 108-112
        • Gelberman RH
        • Boone S
        • Osei DA
        • Cherney S
        • Calfee RP.
        Trapeziometacarpal arthritis: a prospective clinical evaluation of the thumb adduction and extension provocative tests.
        J Hand Surg Am. 2015; 40: 1285-1291
        • Hanley JA
        • McNeil BJ.
        The meaning and use of the area under a receiver operating characteristic (ROC) curve.
        Radiology. 1982; 143: 29-36
        • Walter SD
        • Eliasziw M
        • Donner A.
        Sample size and optimal designs for reliability studies.
        Stat Med. 2021; 17 (1<101::aid-sim727>;2-e): 101-110
      1. Tool N. Ironton 6in. Composite Digital Fractional Caliper. Published 2020.

        • Ferreira-Valente MA
        • Pais-Ribeiro JL
        • Jensen MP.
        Validity of four pain intensity rating scales.
        Pain. 2011; 152: 2399-2404
        • P S
        • J B
        • D S
        Development and initial validation of the upper extremity functional index.
        Physiother Canada. 2001; 52: 259-267
        • Chesworth BM
        • Hamilton CB
        • Walton DM
        • et al.
        Reliability and validity of two versions of the upper extremity functional index.
        Physiother Canada. 2014; 66: 243-253
        • Gabel CP
        • Michener LA
        • Burkett B
        • Neller A.
        The upper limb functional index: development and determination of reliability, validity, and responsiveness.
        J Hand Ther. 2006; 19: 328-348
        • Koo TK
        • Li MY.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Hallgren KA.
        Computing inter-rater reliability for observational data: an overview and tutorial.
        Tutor Quant Methods Psychol. 2012; 8: 23-34
        • Haley SM
        • Fragala-Pinkham MA.
        Interpreting change scores of tests and measures used in physical therapy.
        Phys Ther. 2006; 86: 735-743
        • Wright A
        • Hannon J
        • Hegedus EJ
        • Kavchak AE.
        Clinimetrics corner: a closer look at the minimal clinically important difference (MCID).
        J Man Manip Ther. 2012; 20: 160-166
        • Smidt N
        • Van der Windt DA
        • Assendelft WJ
        • et al.
        Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis.
        Arch Phys Med Rehabil. 2002; 83: 1145-1150
        • Fleiss JL.
        Reliability of measurement.
        in: Fleiss JL The Design and Analysis of Clinical Experiments. Wiley, New York1986 (1e32)
        • Beaton DE
        • Bombardier C
        • Katz JN
        • Wright JG.
        A taxonomy for responsiveness.
        J Clin Epidemiol. 2001; 54: 1204-1217

      JHT Read for Credit

      Quiz: # 874

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        Goniometry of thumb abduction has been shown to be
        • a.
          highly reliable
        • b.
          virtually unreliable
        • c.
          only moderately reliable
        • d.
          one of the most accurate measures known to hand therapy
      • # 2.
        Inter-rater reliability was determined by
        • a.
          an ICC
        • b.
          the Pearson Correlation Coefficient
        • c.
          an ANOVA
        • d.
          a Kappa
      • # 3.
        Precision of the measures was analyzed by
        • a.
          a team of university statisticians
        • b.
          digital scanning
        • c.
        • d.
          MDC and SEM
      • # 4.
        Radial abduction was measured with
        • a.
          X-ray analysis
        • b.
          a plastic goniometer
        • c.
          a caliper placed on the thumb MPJ and the index MPJ
        • d.
          a straightedge placed between the index MPJ and the thumb MPJ
      • # 5.
        The IMD method was shown to be reliable
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.