The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial

Periarticular Proprioception: Analyzing the Three-Dimensional Structure of Corpuscular Mechanosensors in the Dorsal Part of the Scapholunate Ligament

INTRODUCTION

Sensory nerve endings transmit mechanical stimuli into afferent neural signals and form the basis of proprioception, giving rise to the self-perception of dynamic stability of joints. We aimed to analyze the three-dimensional structure of periarticular corpuscular sensory nerve endings in a carpal ligament to enhance our understanding of their microstructure.

METHODS

Two dorsal parts of the scapholunate ligament were excised from two human cadaveric wrist specimens. Consecutive cryosections were stained with immunofluorescence markers protein S100B, neurotrophin receptor p75, protein gene product 9.5 (PGP 9.5), and 4',6-diamidino-2-phenylindole. Three-dimensional images of sensory nerve endings were obtained using confocal laser scanning microscopy, and subsequent analysis was performed using Imaris software.

RESULTS

Ruffini endings were characterized by a PGP 9.5-positive central axon, with a median diameter of 4.63 μm and a median of 25 cells. The p75-positive capsule had a range in thickness of 0.94 μm and 15.5 μm, consisting of single to three layers of lamellar cells. Ruffini endings were significantly smaller in volume than Pacini corpuscles or Golgi-like endings. The latter contained a median of three intracorpuscular structures. Ruffini endings and Golgi-like endings presented a similar structural composition of their capsule and subscapular space. The central axon of Pacini corpuscles was surrounded by S100-positive cells forming the inner core which was significantly smaller than the outer core, which was immunoreactive for p75 and PGP 9.5.

CONCLUSION

This study reports new data regarding the intricate outer and intracorpuscular three-dimensional morphology of periarticular sensory nerve endings, including the volume, number of cells, and structural composition. These results may form a basis to differ between normal and pathological morphological changes in periarticular sensory nerve endings in future studies.

Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: -21.91; 95% confidence interval [CI]: -36.59, -7.24; p = 0.003) and wrist disability (MD: -8.1, 95% CI: -4.6, -11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: -0.76; 95% CI: -1.30, -0.21; p = 0.007) and short-term (SMD: -0.93; 95% CI: -1.86, -0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: -0.94; 95% CI: -1.68, -0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term.

Test-retest reliability of joint position sense in the carpometacarpal joint among healthy adults

BACKGROUND

Accurate proprioception in the thumb carpometacarpal (CMC) joint is necessary during activities such as performing fine manipulative tasks, such as coin handling, opening doors, using keys, and pressing control buttons.

PURPOSE

The primary aim of the present study was to examine the test-retest reliability of CMC joint position sense (JPS) in healthy subjects. The secondary aim was to determine the most reliable JPS testing position for the thumb CMC joint.

STUDY DESIGN

This was a cross-sectional study of a convenience sample of healthy adults.

METHODS

Three thumb positions (20°, 30°, and 40° of thumb abduction) were measured twice on the same day by a single rater using a universal goniometer. The absolute error in degrees between each position and reposition was calculated. The intraclass correlation coefficient (2,1) was calculated for relative reliability. The standard error of the measurement was calculated.

RESULTS

Sixty-four healthy adults (mean age 27.8 years, standard deviation = 8.7) were assessed. The intraclass correlation coefficients were poor (-0.08 to 0.22), and the standard error of the measurement was 1.4° for all positions.

CONCLUSIONS

The joint position reproduction test for JPS using goniometry demonstrated poor test-retest reliability and acceptable measurement error in healthy adults.

Effect of physical therapy interventions in individuals with primary thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to investigate the effect of physiotherapeutic interventions in individuals with thumb primary CMC OA on the outcomes of pain, hand function, grip or pinch strength.

METHODS

RCTs that used some type of physiotherapeutic intervention compared to a passive or active control group were included. The quality of the evidence was assessed using the GRADE approach and, for the calculation of the meta-analysis, the standardized difference of means (SMD) was used.

RESULTS

Nineteen studies (n = 1477) were included and eight studies (n = 568) underwent meta-analysis. Orthosis intervention was superior to passive control group for pain improvement (SMD = -1.02, p = 0.03, very low evidence), grip strength (SMD = 0.45, p = 0.02, very low evidence) and pinch strength (SMD = 1.78, p = 0.01, very low evidence), but there was no improvement in hand function (p = 0.54). The use of a neoprene orthosis was similar to the use of a thermoplastic orthosis in improving pain (p = 0.38), hand function (p = 0.50), grip strength (p = 0.42) and pinch strength (p = 0.14). The use of short thermoplastic orthosis was also similar to long thermoplastic orthosis in improving pain (p = 0.88) and hand function (p = 0.58).

CONCLUSION

The use of orthoses is superior to no intervention in all outcomes, exception hand function.IMPLICATIONS FOR REHABILITATIONThe use of orthosis is recommended for the treatment of patients with rhizoarthrosisUse of orthosis is better than no intervention in improving pain, grip and pinch strength.The type of orthosis (neoprene or thermoplastic, short or long thermoplastic) does not affect the clinical improvement of the individual to the outcomes of pain, hand physical function, grip and pinch strength.

Effectiveness of proprioception training in functional recovery of thumb osteoarthritis. Single, multicenter, non-blind randomized clinical trial

BACKGROUND AND OBJECTIVES

Osteoarthritis at the base of the thumb (CMC-1 OA) is a pathology that mainly affects postmenopausal women. The main symptoms including pain, decreased hand-thumb strength and fine motor capacity. Although a proprioceptive deficit has already been demonstrated in people with CMC-1 OA, there is insufficient evidence regarding the effects of proprioceptive training. The main objective of this study is to determine the effectiveness of proprioceptive training in functional recovery.

MATERIALS AND METHODS

A total of 57 patients were included in the study, 29 in the control group and 28 in the experimental group. Both groups underwent the same basic intervention programme, but the experimental group included a proprioceptive training protocol. Variables of the study were pain (VAS), perception of occupational performance (COMP), sense position (SP) and force sensation (FS).

RESULTS

Statistically significant improvement was observed in the experimental group in pain (p < .05) and occupational performance (p < .001) after 3 months of treatment. No statistical differences were found in sense position (SP) or sensation of force (FS).

DISCUSSION AND CONCLUSIONS

The results concord with previous studies focussing on proprioception training. The incorporation of a proprioceptive exercise protocol reduces pain and significantly improves occupational performance.

Assessment and treatment of nonsurgical thumb carpometacarpal joint osteoarthritis: A modified Delphi-based consensus paper of the American Society of Hand Therapists

BACKGROUND

While the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus.

PURPOSE

This study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting.

STUDY DESIGN

This was a consensus paper via the modified Delphi approach.

METHODS

A modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist's research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel.

RESULTS

The expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient's unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention.

CONCLUSIONS

The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA.

Clinical aspects and outcomes in osteoarthritis

Osteoarthritis (OA) is the most prevalent type of arthritis worldwide, and its incidence significantly increases with age. It commonly affects the knees, hips, spine, big toes, and hands. OA can be identified through clinical examination, symptoms, and imaging methods. Its main symptoms include pain, stiffness, and limitations in joint movement. Examinations may reveal coarse crepitus, bony enlargement, and tenderness at the joint line. In severe cases of OA, rest pain, night pain, and deformity may occur. OA can lead to decreased physical activity, function, and quality of life due to symptoms such as pain and stiffness. To evaluate these impacts, patient-reported outcome measures (PROMs) are necessary. Various generic, disease-specific, and joint-specific PROMs have been developed and used in clinical practice to assess the outcomes of OA.

Incorporation of occupational based intervention into joint protection education for individuals with thumb carpometacarpal osteoarthritis: A case series

BACKGROUND

To our knowledge, the use of occupational performance in education on joint protection techniques has not been studied for individuals with thumb carpometacarpal (CMC) osteoarthritis.

PURPOSE

This case series was designed to investigate if occupation-based instruction inside the clinic was useful and found satisfactory as an educational tool for individuals with thumb CMC joint arthritis.

METHODS

Three participants with thumb CMC joint osteoarthritis performed washing, rinsing, and drying a dish, moving a pot and pan, maneuvering a laundry basket, and pouring from a pitcher during joint protection education in the therapy clinic with a skilled hand therapist in addition to routine treatment. Satisfaction with this intervention was assessed via a 3-question satisfaction survey. Pain with activity and function via the Thumb Disability Examination were assessed at baseline and a 4week follow up.

RESULTS

Patients in this study expressed satisfaction with the inclusion of the performance of occupations in their joint protection education in the clinic. Pain with activity improved by an average of 1.7/10 on a 10-point Numeric Pain Rating Scale and function improved by an average of 10.04 on the Thumb Disability Examination.

CONCLUSIONS

Although no causal relationships can be assumed in this study, hand therapists should consider adding occupation-based intervention as a component of patient education on joint protection for individuals with thumb CMC joint osteoarthritis.

The biomechanics of osteoarthritis in the hand: Implications and prospects for hand therapy

BACKGROUND

The unique anatomy of the human hand makes it possible to carefully manipulate tools, powerfully grasp objects, and even throw items with precision. These apparent contradictory functions of the hand, high mobility for manual dexterity vs high stability during forceful grasping, imply that daily activities impose a high strain on a relatively instable joint. This makes the hand susceptible to joint disorders such as osteoarthritis. Both systemic (eg, genetics, hormones) and mechanical factors (eg, joint loading) are important in the development of osteoarthritis, but the precise pathomechanism remains largely unknown. This paper focuses on the biomechanical factors in the disease process and how hand therapists can use this knowledge to improve treatment and research.

CONCLUSION

Multiple factors are involved in the onset and development of osteoarthritis in the hand. Comprehension of the biomechanics helps clinicians establish best practices for orthotics intervention, exercise, and joint protection programs even in de absence of clear evidence-based guidelines. The effect and reach of hand therapy for OA patients can be expanded substantially when intervention parameters are optimized and barriers to early referrals, access reimbursement, and adherence are addressed. Close and early collaboration between hand therapists and primary care, women's health, rheumatology, and hand surgery providers upon diagnosis, and with hand surgeons pre and postoperatively, combined with advances in the supporting science and strategies to enhance adherence, appear to be a promising way forward.