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Dynamic stabilization of the painful thumb: A historical and evidence-informed synthesis

Published:August 16, 2022DOI:https://doi.org/10.1016/j.jht.2022.06.007

      Highlights

      • Multimodal intervention with individualized assessment of impairment and function
      • Mounting evidence supports a dynamic stability modeled approach for thumb pain
      • Proprioceptive neuromuscular re-education and exercises involve all thumb muscles
      • Strengthening the first dorsal interosseous and opponens pollicis appears effective

      Abstract

      Study Design

      Expert opinion

      Introduction

      Thumb carpometacarpal joint (CMC) osteoarthritis is a common condition seen in the hand therapy clinic. Prevalence is generally higher in females, and the percentage rises for post-menopausal females. Patients typically present with pain and functional difficulties. Conservative management is recommended before a surgical consult. Evidence is mounting that a dynamic stability modeled approach has a significant effect on pain and improving function.

      Purpose

      The purpose of this paper is two-fold: first, to present the history and development of a dynamic stabilization model for treatment of the patient with thumb CMC osteoarthritis (OA), and second, to provide expert clinical commentary and recommendations for the treatment of thumb CMC OA in light of the best available evidence.

      Methods

      Expert clinical commentary is based on an extensive review of relevant literature.

      Results

      The current literature and expert opinion supports an evidence-informed multimodal intervention: modalities, pain relief techniques, manual release, joint mobilizations as deemed necessary, neuromuscular re-education through proprioceptive exercises, and education in joint protection principles.

      Conclusion

      A rationale for a dynamic stabilization approach is presented. The unique anatomy of the thumb deserves finely tuned care based on high quality research. To advance our knowledge and clinical skills we must not become stagnant, but continue to generate high level evidence. The standard for future thumb CMC OA studies should be well-defined intervention parameters, consistent documentation, and the use of appropriate patient-rated outcome measures.

      Keywords

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