Effect of first dorsal interosseous strengthening on clinical outcomes in patients with thumb osteoarthritis: a study protocol for a randomized controlled clinical trial

BACKGROUND

Thumb carpometacarpal osteoarthritis (CMC OA) is characterized by chronic progressive degeneration of the joint cartilage, with high prevalence. Patients present with pain at the base of the thumb, morning stiffness, and muscle weakness, symptoms that affect hand function and therefore interfere in activities and social participation. Movements that involve grip or lateral pinch are the most affected and directly impact independence, self-care, and leisure activities. In the literature consulted, several protocols with exercises for these patients were found. However, most do not compare the same intervention modality and only provide basic methodological information, with no consistent information on training load and load progression. In addition, most protocols only address the strengthening of the abductor and extensor thumb muscles and pinching or grasping exercises. However, some biomechanical and electromyographic studies have demonstrated the important role of the first dorsal interosseous muscles as stabilizers of the thumb carpometacarpal joint.

METHODS

This is a randomized, controlled, double-blind, and parallel clinical trial that will include 56 participants, over 40 years old, with radiographic evidence of thumb base osteoarthritis. Participants will be randomly allocated into two groups: control and intervention. The following evaluations will be conducted: the Australian/Canadian Hand Osteoarthritis Index, Canadian Occupational Performance Measure, Nine-Hole Peg Test, grip and pinch strength associated with muscle activation assessment, and Bilateral Upper Limb Function Test at four different times: baseline, session 13, session 18, and follow-up. Treatment will take place over 6 weeks, with reassessments in the fourth and sixth weeks and 3 months after the end of the intervention (follow-up). Qualitative variables will be expressed as frequency and percentage, and quantitative variables as mean and standard deviation. Intergroup comparison of the intervention will be performed by repeated measures ANOVA, considering the effect of the two groups and four assessments, and interactions between them.

DISCUSSION

This study will demonstrate whether the specific strengthening of the first dorsal interosseous muscle has a superior and positive effect on the clinical picture of patients with CMC OA. Additionally, if specific strengthening of the muscle is not superior to the traditional protocol in the literature, it will also be determined whether the two protocols are equivalent in terms of the best clinical picture.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials (ReBEC) RBR-8kgqk4 . Prospectively registered on 15 January 2020.

Motor unit firing rates of the first dorsal interosseous differ between male and female children aged 8-10 years

The purpose of this study was to examine possible differences in motor unit action potential amplitudes (MUAP_AMPS) and firing rates of the first dorsal interosseous (FDI) in male and female children aged 8-10 years. Eight male (mean ± SD, age = 8.8 ± 0.7 yrs; BMI = 16.5 ± 1.3 kg/m²) and eight female (age = 9.3 ± 0.9 yrs; BMI = 16.1 ± 1.5 kg/m²) children volunteered to complete isometric trapezoidal muscle actions of the first dorsal interosseous at 50% of maximal voluntary contraction (MVC). Electromyographic signals were decomposed to yield MUAP_AMPS and mean firing rates (MFR) at the targeted force. An exponential model was fitted to the MUAP_AMPS vs. recruitment threshold (RT) while linear models were fitted to the MFRs vs. RT relationships for each subject. Ultrasonography determined the muscle cross-sectional area (CSA) of the FDI. Independent samples t-tests were used to examine possible differences between the male and female children for MVC strength, CSA, and the coefficients from the MU relationships. There were no differences in MVC strength, CSA, or the MUAP_AMP vs. RT relationships between the male and female children (P < 0.05). Males, however, had greater MFRs of lower-threshold MUs as evident by significantly larger y-intercepts (P = 0.019) and more negative slopes (P = 0.004) from the MFR vs. RT relationships. Despite no differences in muscle strength, CSA, and MUAP_AMPS, differences in firing rates existed between male and female children aged 8-10 years. Neural mechanisms may primarily contribute to sex-related differences in firing rates.

First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint

INTRODUCTION

Hand therapists selectively strengthen the first dorsal interosseus (FDI) to stabilize arthritic joints yet the role of the FDI has not yet been radiographically validated.

PURPOSE

To determine if FDI contraction reduces radial subluxation (RS) of the thumb metacarpal (MC).

METHODS

Fluoroscopy was used to obtain true anterior-posterior radiographs of non-arthritic CMC joints: 1) at rest, 2) while stressed and 3) while stressed with maximal FDI contraction. Maximal FDI strength during CMC stress and thumb MC RS and trapezial articular width were measured. The ratio of RS to the articular width was calculated.

RESULTS

Seventeen participants (5 male, 12 female) participated. Subluxation of a stressed CMC significantly reduced and the subluxation to articular width ratio significantly improved after FDI activation.

CONCLUSIONS

Contraction of the FDI appears to radiographically reduce subluxation of the healthy thumb CMC joint. Further exploration on the FDI's reducibility and its carry-over effects in arthritic thumbs is needed.

LEVEL OF EVIDENCE

4.

Muscle force, work and cost: a novel technique to revisit the Fenn effect

Muscle produces force by forming cross-bridges, using energy released from ATP. While the magnitude and duration of force production primarily determine the energy requirement, nearly a century ago Fenn observed that muscle shortening or lengthening influenced energetic cost of contraction. When work is done by the muscle, the energy cost is increased and when work is done on the muscle the energy cost is reduced. However, the magnitude of the 'Fenn effect' and its mirror ('negative Fenn effect') have not been quantitatively resolved. We describe a new technique coupling magnetic resonance spectroscopy with an in vivo force clamp that can directly quantify the Fenn effect [E=I+W, energy liberated (E) equals the energy cost of isometric force production (I) plus the work done (W)] and the negative Fenn effect (E=I-W) for one muscle, the first dorsal interosseous (FDI). ATP cost was measured during a series of contractions, each of which occurred at a constant force and for a constant duration, thus constant force-time integral (FTI). In all subjects, as the FTI increased with load, there was a proportional linear increase in energy cost. In addition, the cost of producing force greatly increased when the muscle shortened, and was slightly reduced during lengthening contraction. These results, though limited to a single muscle, contraction velocity and muscle length change, do quantitatively support the Fenn effect. We speculate that they also suggest that an elastic element within the FDI muscle functions to preserve the force generated within the cross-bridges.