How do we manage thumb carpometacarpal osteoarthritis? A survey of clinical practice trends for hand therapists in the Spain

Corresponding Author:

Raquel Cantero-Téllez
University Orthopaedics Therapy Center, University of Málaga
Tecan Hand Center, Spain
Tel: +34 952226453
E-mail: cantero@uma.es

Abstract

Keywords

thumb, carpometacarpal joint, osteoarthritis, survey

Introduction

Thumb basilar arthritis is a common and often debilitating condition seen in more than half of women aged over 71 years. It manifests as pain localized to the base of the thumb and patients often have weakness that may affect their ability to work, perform activities of daily living (ADLs). They may also develop adduction deformity of their thumb during the later stages of the disease [1,2].

Clinical symptoms of degenerative (CMC) joint include pain, stiffness and weakness. This symptom appears when ligamentous laxity structures can’t continue performing its function, and develop when ligamentous laxity at the trapezium metacarpal joint causes dorsovolar translation and recurrent synovitis with a loss of grip, strength and mobility deficits [3].

There have been numerous randomized controlled trials and systematic reviews on conservative management of thumb carpometacarpal (CMC) osteoarthritis (OA) over the past years, several with high-level evidence [4-6]. More recently, guidelines for therapeutic interventions have been developed in Europe, [7,8] where the incidence of thumb CMC OA is high.

Because of the recent developments, we decided to perform a national survey to gain a better understanding of the quality of conservative care provided to adults for thumb CMC OA in Spain.

Methods

An online 21 item survey was developed and distributed to members of the Spanish Society of Hand Therapists (Aetema) and students enrolled in the Master of Hand program from Universidad Rey Juan Carlos, Universidad of Lasalle, Madrid, and Gimbernat of Barcelona. The survey was open from February to April 2016.

The protocol was approved by the Ethical Committee. The survey will explore hand therapists and student specialist opinions and knowledge of the present trends in treatment of the thumb and current practice guidelines. The items were grouped into the following 3 main areas:

• Evaluation measures

• Orthoses applications

• Interventions techniques

Results

A total of 290 questionnaires were returned, indicating a response rate of 37.9%, 42.7% female. Of the respondents, 52.9% were physical therapists and the remaining 47.1% were occupational therapists (Table 1). National distribution showed the majority of participants are currently working in private practice (78.6%). A large percentage of therapists measured functional outcomes, ROM, strength, pain and joint- or disease-specific provocative tests. Therapists and students used the QuickDASH (42.9%), MCP (71.4%), manual muscle test (50%), VAS (78.6%) and Kapandji opposition scale (42.9%), respectively. The majority of hand therapists reported that custom orthoses (forearm based thumb spica and CMC thenar-based MCP/IP free) was a part of their intervention plan (71.4%). More than half of the respondents used a orthotic for pain relief and heavy tasks, a home exercise program, followed by strengthening of thumb stabilization muscles (abductor pollicis brevis, 1st dorsal interosseous, opponens pollis, 57.1%), Neuromuscular reeducation (Flexion at MCP with open kinetic chain exercises, 58.3%) and manual therapy were reportedly used by slightly more than half of the therapists (Neurodynamic mobilization, 50%).

Table 1. General information about questionnaire provision (results are expressed as percentage of total answers per item).

Discussion

Our study identified variability in the management of the thumb CMC OA by Spanish hand therapists and hand specialist students. This variability in conservative treatment may be due in part to the limited detail provided by the recommendations of Aetema guidelines pertaining specifically to conservative management on patients with thumb CMC OA. Perhaps some variability is due to physician orders for modalities. Further studies are necessary in order to establish standardized guidelines for conservative treatment programs. This survey should be repeated to document further developments and even extended internationally to compare these results with more countries and to discover potential for future collaboration. Management of OA of the first CMC joint remains a challenge for occupational therapy (OT) and physical therapy (PT), despite the development of new techniques for conservative management.

Statement of human and animal rights

This article does not contain any studies with human or animal subjects.

Statement of informed consent

Informed consent was obtained from all participants, and all procedures were conducted according to the Declaration of Helsinki.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

1. Faour-Martín O, Martín-Ferrero MÁ, Valverde-García JA, et al. Rhizarthrosis fourth grade of eaton with hyperextension of the metacarpophalangeal joint. Int. J. Surg. Case. Rep. 4(10), 929–932 (2013).
2. Arazpour M, Soflaei M, Ahmadi Bani M et al. The effect of thumb splinting on thenar muscles atrophy, pain, and function in subjects with thumb carpometacarpal joint osteoarthritis. Prosthet. Ortho. Int.(2016).
3. Cantero-Téllez R, Medina-Porqueres I, Such-Sanz A, et al. Relationship between DASH questionnaire and objective variables in carpometacarpal joint osteoarthritis. J. Arthritis. S1 (004), 1-4 (2015).
4. Bertozzi L, Valdes K, Vanti C, et al. Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis. Disabil. Rehabil. 37(22), 2025-2043 (2015).
5. Spaans AJ, van Minnen LP, Kon M, et al. Conservative treatment of thumb base osteoarthritis: a systematic review. J. Hand. Surg. 40(1), 16-21(2015).
6. Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. J. Hand. Ther. 23(4), 334-350 (2010).
7. Villafane JH, Herrero P. Conservative treatment of Myofascial Trigger Points and joint mobilization for management in patients with thumb carpometacarpal osteoarthritis. J. Hand. Ther. 29(1), 89-92 (2015).
8. Villafane JH, Valdes K, Berjano P, et al. Clinical Update: Conservative management of carpometacarpal joint osteoarthritis. J. Rheumatol. 42(9), 1728-1729 (2015).