Occupational Therapy - Osteoarthritis of the Carpometacarpal Thumb Joint

This leaflet has been written to provide you with information about your thumb arthritis and give you a better understanding of your thumb joint, why you experience pain and how you can manage your symptoms.

It contains information about:

• Anatomy of the thumb carpometacarpal joint
• Osteoarthritis of the thumb carpometacarpal joint
• Exercises
• Joint protection
• Assistive devices
• Splints to support the thumb carpometacarpal joint
• Pain relief
• Surgery
• Resources for further information
• Contact numbers

Anatomy of the thumb carpometacarpal joint

The thumb carpometacarpal (CMC) joint is where the metacarpal bone of the thumb attaches to the trapezium (carpal) bone of the wrist (see diagram below). It is sometimes called the ‘basal’ joint.

CMC (basal) joint arthritis

What is osteoarthritis?

Osteoarthritis (OA) is the most common form of arthritis and mainly affects the joint’s cartilage and surrounding bone tissue. There are many factors that can increase the risk of developing OA; for example, it is more common in females over the age of forty, and is more likely to develop in a joint that has had a previous injury or operation.

A joint is where two bones meet. Movement is produced at the joint by the muscles which attach to the bone by tendons.

The ends of the bones are covered in a smooth tissue called cartilage, which cushions the joint and creates a space between the two ends of bone making up the joint.

The joint is held together within a joint capsule, which contains a thick fluid (synovial fluid), providing lubrication to allow smooth movement. Surrounding ligaments and muscles also maintain the stability of the joint.

When OA develops in a joint, the cartilage gradually roughens and becomes thin and the bone underneath thickens. The bones at the edge of the joint grow outwards in bony ‘spurs’ (see diagrams) and excess synovial fluid can be produced, causing the joint to swell. This can mean that you avoid using these joints, subsequently causing the surrounding muscles to weaken.

In severe OA the cartilage starts to weaken and can also lead to stiffness and become so thin that it no longer covers the joint surfaces. These changes to the joint means they won't glide as smoothly during movement. This can, over time, change the shape of the joint by creating a deformity, as the joint is no longer held in its natural position.

Healthy Joint

Joint with Osteoarthritis

Common symptoms of CMC OA are:

• Pain - Usually felt as a sharp or aching pain at the base of the thumb. The pain is usually worse during movement and relieved by rest
• Reduced grip strength - It may be difficult to grip or pick up objects
• Stiffness - Following periods of rest (e.g. in mornings)
• Swelling - Around the base of the thumb
• Muscle weakness and instability
• Deformity - In the later stages of the condition the thumb joint may collapse inwards into a subluxed position (see diagram on next page)

Thumb Deformity

Exercises, joint protection techniques and use of splints can help reduce your symptoms, can help improve movement and improve the strength of the hand and help slow progression of this condition.

Exercises

Instructions

Aim to complete the following exercises twice daily. They will help to reduce joint stiffness and maintain the range of movement of your thumb. Exercise within a comfortable and pain free range. If you find the exercises difficult or uncomfortable check that you are doing them correctly and reduce the number of repetitions. If you continue to experience any problems, please contact the department.

1. Place hand and forearm palm up on a table. Using the other hand, stretch the affected thumb out to the side, away from the palm, pushing from the base. Hold for 10 seconds and repeat three times.

2.    Place hand palm down on a table. Slide the thumb out to the side along the table as far away from the index finger as comfortable and hold for 10 seconds. Repeat three times.

3.    Touch the tip of your thumb to the tip of each finger alternately to make an ‘O’ shape between the thumb and each finger. Repeat three times

4.    Touch the tip of your thumb to the base of your little finger and hold for 10 seconds. Repeat three times.

Strengthening Exercises

These exercises can help improve the strength of your thumb. These strengthening exercises should only be completed if advised to do so by your therapist. Your therapist may indicate that it’s ok to do some of the exercises but not all of them.

When completing these exercises, we ask that you do these 3 times a week and do each exercise with 15 repetitions, with the resistance set so your muscles feel tired after doing the exercises.

When completing these exercises, it’s important that they are done slowly and gently so not to aggravate any joint pain. If they do cause pain, then reduce the amount of effort or repetitions. If the pain continues after this, then contact your therapist.

If doing exercises with an elastic band, then please ensure exercises are not directed towards the face, due to the risk of the band snapping. When doing these exercises, it's important that they are done in a stable position and not pushing into positions of deformity, as demonstrated in the pictures below.

Gently squeeze the peg and gently release. Ensure your thumb remains in a stable curved position like in the top picture and not collapsing inwards like the below picture.

Gently move your thumb to the side against the resistance from the elastic band and then relax. Ensuring your thumb is slightly curved like to top picture and not collapsing inwards like the bottom picture.

Move the weight up and down slowly and gently.

Joint protection

Most people find their own ways of doing activities that are less painful for their joints. It is important that you are aware of the activities that cause your thumb joint to be painful, so that you know when to wear your splints and consider other ways of performing these activities that place less strain on the painful joints.

Each time you experience thumb pain when doing an activity, stop and consider whether the way you are doing it is causing stress on the joint. Think about if there is another way the activity can be performed that is better for your joints. This is called ‘joint protection’ and is not about stopping doing activities, but about finding different ways of doing things to take the strain off painful joints.

For example:

• When doing activities that involve a pinch grip (e.g. writing, opening clothes pegs etc.) keep the joint nearest the palm of the thumb bent and the wrist extended

• When doing activities that involve turning or twisting (e.g. turning key to unlock door, turning taps, unfastening jar tops etc.) avoid fully straightening the joint of the thumb nearest the palm and the thumb crossing in front of the palm

The following are joint protection techniques that may help to reduce the pain you experience when doing activities and prevent further damage to the joints:

• Take notice of any pain you feel as it can serve as a warning sign
• Spread the load over several joints (e.g. by carrying items on two flat hands rather than gripping with your thumb - see pictures)
• Use larger stronger joints rather than putting the strain through your thumb joints
• Use less effort (e.g. push or slide heavy items rather than carrying)

Examples of joint protection techniques

Assistive devices

There are a variety of small aids that are available to assist you in maintaining your independence completing daily activities.

For example:

Jar twisters to help you open tight jars

Pen grips to support your grip or writing

Key turners if you have difficulty turning key in door

Wide grip cutlery if you find it difficult or painful to hold cutlery

Tap turners attach onto your taps to make them easier to turn on and off

Plug pulls assists grip if you have difficulty removing plugs

Your therapist can discuss specific activities that you are finding painful or difficult and advise you whether any assistive devices are available to help. There are details listed of organisations that can advise you about other equipment available. You can also find a lot of adaptive equipment for sale on the internet.

Splints to support the thumb CMC joint

The OT will have provided you with a splint to support your thumb joint during activities that cause you pain. You may also have been provided with a resting splint to wear at night.

Some splints are made from soft material (e.g. neoprene), others from a thermoplastic material (that is moulded when heated then sets hard) and some are a combination of the two. Your therapist will have chosen the type of splint to meet your individual needs.

Splints which are designed to be worn during painful activities to help to reduce the pain you are experiencing and also support the joint. You should not wear these splints for all activities, as they restrict the movement of the thumb.

You should wear the splint for activities you find painful, but complete light functional activities without the splint to maintain your joint range of movement and muscle strength.

It is important that you complete the exercises and apply the joint protection techniques.

You have been provided with the following splint(s):
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Important information about your splint

• You should wear the splint at the times indicated by your therapist
• DO NOT alter the splint in any way
• DO NOT leave the splint where it will get too hot, as the splint material or thermoplastic insert may melt (e.g. sun, radiator, hot water)
• The splint and straps may be washed in lukewarm soapy water, rinse well and allow to dry naturally. Splints made of neoprene will have washing instructions on the inside label. If the splint has a plastic insert, then this should be removed prior to washing and replaced once the splint is dry
• If you experience any redness, swelling, numbness, discomfort or increased pain then stop wearing the splint and contact the department
• If you want to wear the splint when driving, then this must be with prior agreement of your insurance company or your insurance may be invalid
• You should not wear the splint when operating machinery unless it has been made for this purpose

Pain relief

Some people find that paracetamol, anti-inflammatory medications (such as aspirin or ibuprofen) or anti-inflammatory creams can help to reduce the pain experienced.

This should always be discussed with your GP or pharmacist as they will recommend appropriate pain relief and dosage for you, depending upon any other medical conditions you may have.

Where symptoms are severe, cortisone injections may provide temporary relief. Your care provider will decide whether this is indicated.

Surgery

If your symptoms cannot be adequately managed with the methods described in this leaflet, you may want to consider surgery. You can request a referral to a Hand Surgeon from your GP.

Common surgical procedures include removal of arthritic bone, replacement of the joint (arthroplasty) or fusion of the bone.

Your consultant may have arranged to see you again following a period of splinting, or if you have been discharged from their care but feel that you may require surgical intervention then you should request referral by your GP.

Follow up/future care

• You may be asked to attend a follow-up appointment or alternatively you may be contacted by telephone or by letter within the next few weeks to check how you are managing with the splint(s) provided and whether any further therapy intervention is needed
• If in the future there are any problems with your splint (e.g. if it is lost/damaged, needs replacement straps, is no longer providing sufficient support etc.) then please contact the Hand Therapy Department on 0161 206 5319

Contact

Hand Therapy Department
Salford Royal, Salford
0161 206 5319
This is an answerphone service. Please leave a message with your name, hospital number and a contact number.

Hospital Switchboard
0161 789 7373
Ask for Bleep 3564 or 3423 Monday to Friday 8am - 4pm

Ask for:
Hand Therapist:………………………………………................ Therapy Assistant:……………………………..........................
 
Further information
Organisations providing information and support for people who have arthritis.

Versus Arthritis
https://www.versusarthritis.org

Disabled Living
A self-funding voluntary organisation offering a range of services, including advice and equipment.
Burrows House 10 Priestley Road
Wardley Industrial Estate Worsley, Manchester M28 2LY
0161 214 4590
www.disabledliving.co.uk

The Care Team
An independent Occupational Therapy led service specialising in assessment and supply of equipment and home adaptations. Also provide service/repair and hire equipment.
53a Higher Road Manchester, M41 9AP
0161 746 7566
www.thecareteam.co.uk