Strengthening Exercises for Thumb Osteoarthritis

Overseen By Rachel Cross, BA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Massachusetts General Hospital

Must not be taking: Corticosteroids

Disqualifiers: Rheumatoid arthritis, Post-traumatic CMC osteoarthritis

Compensation: Varies

Number of Visits: 1

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if strengthening exercises for a specific hand muscle can benefit individuals with thumb osteoarthritis, a type of arthritis affecting the base of the thumb. Participants will either use a thumb splint alone or a splint combined with exercises to strengthen the first dorsal interosseous muscle, a muscle in the hand. Individuals with thumb osteoarthritis who already use a splint might be well-suited for this study. As an unphased trial, this study allows participants to contribute to innovative research that may enhance future treatment options for thumb osteoarthritis.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these strengthening exercises and splints are safe for thumb osteoarthritis?

Research shows that exercises to strengthen hand muscles are generally safe for people with thumb osteoarthritis. These exercises target the muscles around the thumb joint to increase strength.

Studies have found that people usually tolerate these exercises well, experiencing no serious side effects. Many participants report improved thumb stability and reduced pain. Since these exercises don't involve surgery or medication, they often carry fewer risks and complications.

Overall, these exercises provide a safe option for managing symptoms of thumb osteoarthritis. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about FDI strengthening exercises for thumb osteoarthritis because they offer a unique approach compared to the usual care, which often involves splinting or medication. Unlike standard treatments that mainly focus on immobilizing the thumb to alleviate pain, FDI strengthening combines this with exercises aimed at enhancing the strength and stability of the thumb's first dorsal interosseous muscle. This could potentially improve thumb function and reduce pain more effectively by actively addressing muscle weakness. By integrating targeted exercises, this approach not only aims to manage symptoms but also to improve thumb functionality, which may lead to better long-term outcomes for patients.

What evidence suggests that FDI strengthening exercises might be an effective treatment for thumb osteoarthritis?

Studies have shown that strengthening the first dorsal interosseous (FDI) muscle in the hand can reduce pain and improve thumb function in individuals with thumb osteoarthritis. This muscle stabilizes the thumb joint. Research indicates that tightening the FDI muscle can better align the thumb joint, potentially relieving symptoms. Participants who performed exercises to strengthen this muscle reported less pain and improved thumb use. In this trial, one group will receive a splint combined with FDI strengthening exercises, while another group will receive a splint only. These findings suggest that focusing on the FDI muscle might effectively manage thumb osteoarthritis symptoms. ^{1 3 6 7 8}

Who Is on the Research Team?

Neal Chen, MD

Principal Investigator

Massachusetts General Hospital

Are You a Good Fit for This Trial?

This trial is for English-speaking adults over 18 with thumb carpometacarpal (CMC) osteoarthritis who have been treated with a splint. It's not for those who've had corticosteroid injections for CMC osteoarthritis or have rheumatoid arthritis or post-traumatic CMC osteoarthritis.

Inclusion Criteria

Language: English-speaking

You have arthritis in your thumb that is being treated with a splint.

Exclusion Criteria

Treatment: Corticosteroid injection received during appointment for treatment of thumb carpometacarpal (CMC) osteoarthritis

You have either Rheumatoid Arthritis or osteoarthritis in your carpometacarpal joint that was caused by a previous injury.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either splinting alone or splinting combined with first dorsal interosseous (FDI) strengthening exercises for thumb carpometacarpal osteoarthritis

12 weeks

Regular visits for exercise supervision and assessment

Follow-up

Participants are monitored for changes in lateral pinch strength, 3-point chuck strength, VAS for pain, and PROMIS Upper Extremity CAT

12 weeks

1 visit (in-person) at 12 weeks

What Are the Treatments Tested in This Trial?

Interventions

• FDI Strengthening Exercises
• Splint

Trial Overview The study aims to see if strengthening the first dorsal interosseous (FDI) muscle helps people with thumb CMC osteoarthritis. Participants will either use a splint alone or combine it with specific strengthening exercises.

How Is the Trial Designed?

Group I: Splint with first dorsal interosseous (FDI) strengthening Active Control 1 Intervention

Subjects with carpometacarpal (CMC) osteoarthritis treated by splinting of their thumb combined with first dorsal interosseous (FDI) strengthening stabilization exercises.

Group II: Splint Only Placebo Group 1 Intervention

Subjects with carpometacarpal (CMC) osteoarthritis treated by splinting of their thumb.

Who Is Running the Clinical Trial?

Massachusetts General Hospital

Lead Sponsor

Trials

3,066

Recruited

13,430,000+

Published Research Related to This Trial

Hand therapy may help reduce pain in thumb base osteoarthritis, but the evidence is weak due to a lack of high-quality trials with long follow-up periods.

Intra-articular injections of hyaluronate are generally considered more effective than steroid injections for pain relief, although most studies have short follow-up times and varied designs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Conservative treatment of thumb base osteoarthritis: a systematic review. Spaans, AJ., van Minnen, LP., Kon, M., et al.[2022]

Individuals with thumb base osteoarthritis (OA) who also experience pain in the interphalangeal (IP) joints and have erosive OA show significantly worse hand function compared to those with isolated thumb base OA, indicating the importance of considering joint involvement in treatment assessments.

The presence of erosive OA is linked to reduced grip and tip-pinch strength, suggesting that comprehensive evaluations of hand strength and function should include assessments of all affected joints to better inform treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of Comorbid Interphalangeal Joint Pain and Erosive Osteoarthritis With Worse Hand Function in Individuals With Symptomatic Thumb Base Osteoarthritis. Deveza, LA., Robbins, SR., Duong, V., et al.[2020]

In a study of 62 patients with thumb basilar joint osteoarthritis (TBJA), the radiographic stage of the disease did not correlate with patient-reported symptom severity as measured by the QuickDASH and SF-12 surveys.

This lack of correlation suggests that radiographic findings alone may not adequately reflect a patient's experience of symptoms, indicating a need for better metrics that combine both objective and subjective assessments for improved treatment decisions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Radiographic Stage Does Not Correlate With Symptom Severity in Thumb Basilar Joint Osteoarthritis. Hoffler, CE., Matzon, JL., Lutsky, KF., et al.[2016]

In a study of 42 women with thumb base osteoarthritis, adding splints, hot packs, and home exercises to a joint protection program significantly reduced pain and stiffness and improved grip force and daily activities, both immediately after treatment and at a 1-year follow-up.

The control group, which only received the joint protection program, showed some initial improvements but did not maintain these benefits at the 1-year mark, highlighting the long-term efficacy of the combined treatment approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a hand-joint protection programme with an addition of splinting and exercise: one year follow-up. Boustedt, C., Nordenskiöld, U., Lundgren Nilsson, A.[2021]

A systematic review of ten moderate- to high-quality studies found that therapeutic exercise programs, including range of motion and functional exercises, are effective in managing hand osteoarthritis, showing improvements in pain, stiffness, and physical function.

The expert panel provided 46 positive recommendations for exercise interventions, particularly noting their effectiveness in short-term trials (less than 12 weeks) for various outcomes like grip strength and range of motion, while also highlighting the need for more research to understand the specific effects of different exercise components.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis. Brosseau, L., Thevenot, O., MacKiddie, O., et al.[2019]

A study of 1456 patients with basal thumb osteoarthritis showed significant improvements in health-related quality of life after surgery, with notable gains in both the EQ5D index and Patient Evaluation Measure by one year postoperatively.

The results indicated no meaningful difference in outcomes between two surgical techniques: simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition, suggesting that both methods are effective in improving patient quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Basal thumb osteoarthritis surgery improves health state utility irrespective of technique: a study of UK Hand Registry data. Lane, JCE., Rodrigues, JN., Furniss, D., et al.[2021]

A surgical technique for arthrodesis of the carpometacarpal joint of the thumb was successfully performed on 16 patients with idiopathic basal joint osteoarthritis, resulting in complete pain relief for all cases over an average follow-up of 6 years.

The method involved stable fixation using a bent plate and compression screws, with only one patient experiencing nonunion, indicating a high efficacy and safety profile for this surgical intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Arthrodesis of small joints, illustrated by the carpometacarpal joint of the thumb. Marti, RK., Schröder, J.[2006]

Osteoarthritis of the thumb basal joint is a common cause of pain and functional impairment, and its diagnosis relies on clinical examination and radiographic staging.

Initial treatment options include medications, orthoses, and steroid injections, but the condition often progresses, leading to various surgical options like trapeziectomy and arthroplasty, none of which have been shown to be definitively superior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Thumb Basal Joint Arthritis. Weiss, AC., Goodman, AD.[2018]

In a study involving 17 participants, contraction of the first dorsal interosseus (FDI) muscle was found to significantly reduce radial subluxation of the thumb metacarpal joint during stress, indicating its stabilizing role.

The research suggests that strengthening the FDI could be beneficial for stabilizing thumb joints, particularly in non-arthritic conditions, and highlights the need for further studies on its effects in arthritic thumbs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint. McGee, C., O'Brien, V., Van Nortwick, S., et al.[2016]

Exercise may provide small to moderate improvements in hand pain, function, and finger joint stiffness for individuals with hand osteoarthritis, based on a systematic review of 7 trials involving 381 participants.

The evidence for these benefits is considered low quality, and while adverse events from exercise were minimal and not severe, the clinical significance of the improvements remains uncertain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise for Hand Osteoarthritis: A Cochrane Systematic Review. Østerås, N., Kjeken, I., Smedslund, G., et al.[2018]

After performing two sets of 50 maximal contractions of the first dorsal interosseus (FDI) muscle, subjects experienced significant motor impairment, with a 19% decline in maximal abduction torque and a 15% decline in maximal flexion torque 24 hours post-exercise.

The study suggests that the exercise preferentially injured type II muscle fibers in the FDI, as indicated by changes in EMG activity and torque performance, while non-exercised synergist muscles compensated for the impaired muscle during sub-maximal contractions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor impairment in the human hand following eccentric exercise. Leger, AB., Milner, TE.[2006]

This study is a randomized controlled trial involving participants with hand osteoarthritis, aiming to assess the effectiveness of a 12-week exercise intervention on improving self-reported hand activity performance, with outcomes measured at 3 and 6 months.

The primary outcome will be evaluated using the Functional Index for Hand Osteoarthritis (FIHOA), and the study will also analyze secondary outcomes such as pain, hand function, and quality of life, contributing valuable insights into the management of hand OA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise programme with telephone follow-up for people with hand osteoarthritis - protocol for a randomised controlled trial. Østerås, N., Hagen, KB., Grotle, M., et al.[2021]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT03177577

Strengthening of the First Dorsal Interosseous for Thumb ... First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint. J Hand Ther. 2015 Oct-Dec;28(4):375 ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8892410/

Effect of first dorsal interosseous strengthening on clinical ... First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint. J Hand Ther. 2015;28 ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0894113015000988

First dorsal interosseous muscle contraction results in ... Clinically, reduced pain and improved function has been demonstrated through targeting the FDI as a component of a thumb stability program.25. It is theorized ...

4. researchgate.net researchgate.net/publication/358996643_Effect_of_first_dorsal_interosseous_strengthening_on_clinical_outcomes_in_patients_with_thumb_osteoarthritis_a_study_protocol_for_a_randomized_controlled_clinical_trial

a study protocol for a randomized controlled clinical trial A recent specific protocol for the treatment of OA proposes the strengthening of the first dorsal interosseous muscle. This protocol, still awaiting ...

5. jhandtherapy.org jhandtherapy.org/article/S0894-1130%2815%2900098-8/abstract

First dorsal interosseous muscle contraction results in ... Conclusions. Contraction of the FDI appears to radiographically reduce subluxation of the healthy thumb CMC joint. Further exploration on the FDI's reducibility ...

6. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0894113024001741

Comparative electromyographic study of the stabilizing ... The first dorsal interosseous (FDI) and opponens pollicis (OP) muscles are the main stabilizers of the trapeziometacarpal joint.

7. mdpi.com mdpi.com/1660-4601/19/6/3592

The Effect of Proprioception Training on Pain Intensity in ... The main purpose of this clinical trial is to test the effect of proprioception training on pain intensity in subjects with thumb osteoarthritis.

8. asht.org asht.org/sites/asht/files/images/Research/Proprioceptive%20Neuromuscular%20Facilitation%20Protocol%20for%20Thumb%20Osteoarthritis%20A%20Pilot%20Study_article.pdf

Proprioceptive Neuromuscular Facilitation Protocol for ... The purpose of this study was to evaluate the effectiveness of a proprioceptive training program on pain and function in individuals with early-stage thumb ...