Strengthening Exercises for Thumb Osteoarthritis

Recruiting in Palo Alto (17 mi)

Overseen by Neal Chen, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Massachusetts General Hospital

Must not be taking: Corticosteroids

Disqualifiers: Rheumatoid arthritis, Post-traumatic CMC osteoarthritis

Trial Summary

What is the purpose of this trial?

To determine the effect of first dorsal interosseus (FDI) strengthening in patients with thumb carpometacarpal (CMC) 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 data supports the effectiveness of the treatment for thumb osteoarthritis?

Research shows that adding splints and exercises to a joint protection program significantly reduces pain and stiffness, and improves grip strength and daily activities for people with thumb base osteoarthritis, compared to joint protection alone. ^{1 2 3 4 5}

Is it safe to do strengthening exercises for thumb osteoarthritis?

Strengthening exercises for thumb osteoarthritis, including those involving the first dorsal interosseous muscle, are generally safe, but they may cause temporary muscle soreness or reduced muscle function, as seen in some studies. However, these effects are typically mild and resolve over time. ^{4 6 7 8 9}

How is the FDI Strengthening Exercises treatment different from other treatments for thumb osteoarthritis?

FDI Strengthening Exercises focus on strengthening the muscles around the thumb, which may help improve hand function and reduce pain by enhancing joint stability. Unlike medications or surgical options, this treatment is non-invasive and involves specific exercises targeting the first dorsal interosseous muscle, which is not commonly emphasized in other therapies for thumb osteoarthritis. ^{3 4 10 11 12}

Research Team

Neal Chen, MD

Principal Investigator

Massachusetts General Hospital

Eligibility Criteria

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

Age: At least 18 years old

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

Age: Less than 18 years old

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

Trial Timeline

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

Treatment Details

Interventions

• FDI Strengthening Exercises (Behavioural Intervention)
• Splint (Procedure)

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.

Participant Groups

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+

Dr. William Curry

Massachusetts General Hospital

Chief Medical Officer

MD from Harvard Medical School

Dr. Anne Klibanski

Massachusetts General Hospital

Chief Executive Officer since 2019

MD from Harvard Medical School

Findings from Research

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Radiographic Stage Does Not Correlate With Symptom Severity in Thumb Basilar Joint Osteoarthritis. [2016]

2. England pubmed.ncbi.nlm.nih.gov

The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis. [2019]

3. United States 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. [2020]

4. Germany pubmed.ncbi.nlm.nih.gov

Effects of a hand-joint protection programme with an addition of splinting and exercise: one year follow-up. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Basal thumb osteoarthritis surgery improves health state utility irrespective of technique: a study of UK Hand Registry data. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint. [2016]

7. Canada pubmed.ncbi.nlm.nih.gov

Exercise for Hand Osteoarthritis: A Cochrane Systematic Review. [2018]

8. Germany pubmed.ncbi.nlm.nih.gov

Motor impairment in the human hand following eccentric exercise. [2006]

9. England pubmed.ncbi.nlm.nih.gov

Exercise programme with telephone follow-up for people with hand osteoarthritis - protocol for a randomised controlled trial. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

Conservative treatment of thumb base osteoarthritis: a systematic review. [2022]

11. Germany pubmed.ncbi.nlm.nih.gov

Arthrodesis of small joints, illustrated by the carpometacarpal joint of the thumb. [2006]

12. United States pubmed.ncbi.nlm.nih.gov

Thumb Basal Joint Arthritis. [2018]