Research Article|Articles in Press

Effect of a stabilization exercise program versus standard treatment for thumb carpometacarpal osteoarthritis: A randomized trial


      • Standard therapy for CMC osteoarthritis with and without a stabilization home exercise program decreases pain and improves function over the course of a year.
      • Individuals with CMC osteoarthritis may benefit from individualized stabilization, stretching and strengthening exercises.
      • The role of exercise including optimal exercise selection and dosage is still under investigation.


      Study Design

      Randomized, interventional trial with 1 year follow-up.


      Though recommended, evidence is lacking to support specific exercises to stabilize and strengthen the first carpometacarpal (CMC) joint for cases of osteoarthritis (OA).

      Purpose of the Study

      To determine in a naturalistic setting, whether standard treatment plus a home exercise program (ST+HEP) is more effective than standard treatment (ST) alone in improving Quick Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other patient-centered (pain, function) and clinical outcomes (range of motion, strength).


      A total of 190 patients from a hand therapy practice in northwestern PA were enrolled by informed consent and randomized into ST or ST+HEP groups. Average age was 60 years, most were female (78%) with sedentary occupations most common (36%). ST group received orthotic interventions, modalities, joint protection education and adaptive equipment recommendations, while the ST+HEP group received a home exercise program in addition to ST for 6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included grip strength, pinch strength, range of motion (ROM), qDASH, Patient Specific Functional Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could change groups if desired. Efficacy data analysis included both parametric and non-parametric tests. The threshold for statistical significance was 0.05 and adjusted for multiple comparisons.


      Repeated measures ANOVA failed to show a statistically significant difference in strength and ROM assessments between treatment groups over the 12 month follow-up (P ≥ .398). Differences between groups did not exceed 13%. Both the ST and ST+HEP groups evidenced improvement over time in most patient-focused assessments (P ≤ .011), including improvements exceeding reported clinically important differences in pain with activity and PSFS scores. Scores for these measures were similar at each follow-up period (P ≥ .080) in each group. The presence of CTS exerted no effect on outcomes; longer treatment time was weakly related to poorer qDASH and PSFS scores initially. Of those enrolled, 48% of subjects completed the study.


      The addition of a high-frequency home exercise program did not improve clinical or patient-centered outcomes more so than standard care in our sample however, study limitations are numerous. Both groups had decreased pain with activity and improved PSFS scores, meeting the established minimally clinically important difference (MCID) of each at 6 and 12 months. Adherence with the home program was poor and/or unknown.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Therapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Armstrong AL
        • Hunter JB
        • Davis TR.
        The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women.
        J Hand Surg Br. 1994; 19: 340-341
        • McQuillan TJ
        • Kenney D
        • Crisco JJ
        • Weiss AP
        • Ladd AL.
        Weaker functional pinch strength is associated with early thumb carpometacarpal osteoarthritis.
        Clin Orthop Relat Res. 2016; 474: 557-561
        • Rogers MW
        • Wilder FV.
        Exercise and hand osteoarthritis symptomatology: a controlled crossover trial.
        J Hand Ther. 2009; 22 (discussion 19-20; quiz 18): 10-17
        • Poole JU
        • Pellegrini VD
        Arthritis of the thumb basal joint complex.
        J Hand Ther. 2000; 13: 91-107
        • Bobos P
        • Nazari G
        • Szekeres M
        • Lalone EA
        • Ferreira L
        • MacDermid JC.
        The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: A systematic review and meta-analysis.
        J Hand Ther. 2019; 32: 194-211
        • Buhler M
        • Chapple CM
        • Stebbings S
        • Sangelaji B
        • Baxter GD.
        Effectiveness of splinting for pain and function in people with thumb carpometacarpal osteoarthritis: a systematic review with meta-analysis.
        Osteoarthritis Cartilage. 2019; 27: 547-559
        • Rannou F
        • Dimet J
        • Boutron I
        • et al.
        Splint for base-of-thumb osteoarthritis: a randomized trial.
        Ann Intern Med. 2009; 150: 661-669
        • Mobargha N
        • Esplugas M
        • Garcia-Elias M
        • Lluch A
        • Megerle K
        • Hagert E.
        The effect of individual isometric muscle loading on the alignment of the base of the thumb metacarpal: a cadaveric study.
        J Hand Surg Eur. 2016; 41: 374-379
        • Valdes K
        • von der Heyde R.
        An exercise program for carpometacarpal osteoarthritis based on biomechanical principles.
        J Hand Ther. 2012; 25 (quiz 263): 251-262
        • Mobargha N
        • Ludwig C
        • Ladd AL
        • Hagert E.
        Ultrastructure and innervation of thumb carpometacarpal ligaments in surgical patients with osteoarthritis.
        Clin Orthop Relat Res. 2014; 472: 1146-1154
        • Ladd AL
        • Lee J
        • Hagert E.
        Macroscopic and microscopic analysis of the thumb carpometacarpal ligaments: a cadaveric study of ligament anatomy and histology.
        J Bone Joint Surg Am. 2012; 94: 1468-1477
        • McGee C
        • O'Brien V
        • Van Nortwick S
        • Adams J
        • Van Heest A
        First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint.
        J Hand Ther. 2015; 28 (quiz 381): 375-380
        • 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. 2013; 26 (quiz 52): 44-51
        • Adams JE
        • O'Brien V
        • Magnusson E
        • Rosenstein B
        • Nuckley DJ.
        Radiographic analysis of simulated first dorsal interosseous and opponens pollicis loading upon thumb CMC joint subluxation: a cadaver study.
        Hand. 2018; 13: 40-44
        • Neumann DA
        • Bielefeld T.
        The carpometacarpal joint of the thumb: stability, deformity, and therapeutic intervention.
        J Orthop Sports Phys Ther. 2003; 33: 386-399
        • O'Brien VH
        • McGaha JL.
        Current practice patterns in conservative thumb CMC joint care: survey results.
        J Hand Ther. 2014; 27: 14-22
        • Valdes K
        • Marik T.
        A systematic review of conservative interventions for osteoarthritis of the hand.
        J Hand Ther. 2010; 23 (quiz 351): 334-350
        • Wajon A
        • Ada L.
        No difference between two splint and exercise regimens for people with osteoarthritis of the thumb: a randomised controlled trial.
        Aust J Physiother. 2005; 51: 245-249
        • 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; 43: 204-213
        • Kus G
        • Yeldan I.
        Strengthening the quadriceps femoris muscle versus other knee training programs for the treatment of knee osteoarthritis.
        Rheumatol Int. 2019; 39: 203-218
        • Albrect J.
        Caring for the Painful Thumb: More Than a Splint.
        Corporate Graphics, North Mankato, MN2008
        • Pellegrini VD
        Osteoarthritis at the base of the thumb.
        Orthop Clin North Am. 1992; 23: 83-102
        • Moulton MJ
        • Parentis MA
        • Kelly MJ
        • Jacobs C
        • Naidu SH
        • Pellegrini VD
        Influence of metacarpophalangeal joint position on basal joint-loading in the thumb.
        J Bone Joint Surg Am. 2001; 83: 709-716
        • Hawker GA
        • Mian S
        • Kendzerska T
        • French M.
        Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).
        Arthritis Care Res. 2011; 63: S240-S252
        • Gummesson C
        • Ward MM
        • Atroshi I.
        The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.
        BMC Musculoskelet Disord. 2006; 7: 44
        • Wright HH
        • O'Brien V
        • Valdes K
        • et al.
        Relationship of the patient-specific functional scale to commonly used clinical measures in hand osteoarthritis.
        J Hand Ther. 2017; 30: 538-545
        • Heidari S
        • Babor TF
        • De Castro P
        • Tort S
        • Curno M.
        Sex and gender equity in research: rationale for the SAGER guidelines and recommended use.
        Res Integr Peer Rev. 2016; 1
        • Farrar JT
        • Young JP
        • LaMoreaux L
        • Werth JL
        • Poole RM.
        Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.
        Pain. 2001; 94: 149-158
        • Franchignoni F
        • Vercelli S
        • Giordano A
        • Sartorio F
        • Bravini E
        • Ferriero G.
        Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH).
        J Orthop Sports Phys Ther. 2014; 44: 30-39
        • Polson K
        • Reid D
        • McNair PJ
        • Larmer P.
        Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire.
        Man Ther. 2010; 15: 404-407
        • Hefford C
        • Abbott JH
        • Arnold R
        • Baxter GD.
        The patient-specific functional scale: validity, reliability, and responsiveness in patients with upper extremity musculoskeletal problems.
        J Orthop Sports Phys Ther. 2012; 42: 56-65
        • Stamm TA
        • Machold KP
        • Smolen JS
        • et al.
        Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial.
        Arthritis Rheum. 2002; 47: 44-49
        • Lambert TE
        • Harvey LA
        • Avdalis C
        • et al.
        An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial.
        J Physiother. 2017; 63: 161-167
        • Groth GN
        • Wulf MB.
        Compliance with hand rehabilitation: health beliefs and strategies.
        J Hand Ther. 1995; 8: 18-22
        • Duong V
        • Nicolson PJA
        • Robbins SR
        • et al.
        High baseline pain is associated with treatment adherence in persons diagnosed with thumb base osteoarthritis: an observational study.
        J Hand Ther. 2021; ([Published online: May 12, 2021])
        • Garfinkel MS
        • Schumacher HR
        • Husain A
        • Levy M
        • Reshetar RA.
        Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands.
        J Rheumatol. 1994; 21: 2341-2343
        • Rogers MW
        • Wilder FV.
        The effects of strength training among persons with hand osteoarthritis: a two-year follow-up study.
        J Hand Ther. 2007; 20 (quiz 250): 244-249
        • Hennig T
        • Hæhre L
        • Hornburg VT
        • Mowinckel P
        • Norli ES
        • Kjeken I.
        Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial.
        Ann Rheum Dis. 2015; 74: 1501-1508
        • Lefler C
        • Armstrong JW.
        Exercise in the treatment of osteoarthritis in the hands of the elderly.
        Clinical Kinesiology: J of the Am Kinesiotherapy Assoc. 2004; 58: 13-17
        • Davenport BJ
        • Jansen V
        • Yeandle N.
        Pilot randomized controlled trial comparing specific dynamic stability exercises with general exercises for thumb carpometacarpal joint osteoarthritis.
        Hand Ther. 2012; 17: 60-67
        • Wouters RM
        • Tsehaie J
        • Slijper HP
        • et al.
        Exercise therapy in addition to an orthosis reduces pain more than an orthosis alone in patients with thumb base osteoarthritis: a propensity score matching study.
        Arch Phys Med Rehabil. 2019; 100: 1050-1060
        • Tsehaie J
        • Spekreijse KR
        • Wouters RM
        • et al.
        Outcome of a hand orthosis and hand therapy for carpometacarpal osteoarthritis in daily practice: a prospective cohort study.
        J Hand Surg Am. 2018; 43 (e1): 1000-1009
        • Tsehaie J
        • Spekreijse KR
        • Wouters RM
        • et al.
        Predicting outcome after hand orthosis and hand therapy for thumb carpometacarpal osteoarthritis: a prospective study.
        Arch Phys Med Rehabil. 2019; 100: 844-850