Strengthening of the First Dorsal Interosseous for Thumb Carpometacarpal Osteoarthritis

Mass General Brigham

Status: Enrolling

Conditions: First Dorsal Interosseous Strengthening; Thumb Osteoarthritis

Treatments: Device: Splint with strengthening exercises; Device: Splint

Study type: Interventional

Funder types: Other

Identifiers

NCT03177577

2016P002710

Details and patient eligibility

About

To determine the effect of first dorsal interosseus (FDI) strengthening in patients with thumb carpometacarpal (CMC) osteoarthritis.

Full description

Thumb CMC osteoarthritis is a normal part of aging. Most patients are able to adapt to symptoms of pain and disability, other patients might benefit from non-operative interventions; e.g. splinting, corticosteroid injections, pain medication, and multiple hand exercises.

The dorsal ligament complex is one of the components for stability of the thumb CMC joint. These ligaments specifically create stability for pinch and grip during the final phase of opposition. Both, the opponens pollicis (OP) and the first dorsal interosseous (FDI) play a key role in centralizing the metacarpal on the trapezium. A retrospective study showed that a dynamic stability modeled approach, including targeting the FDI, reduced pain and improved function in patients with thumb CMC osteoarthritis. Recently, another study demonstrated that reduction of radial subluxation - the thumb metacarpal versus the trapezium CMC joint - was achieved by contraction of the dynamic stabilizers of the healthy hand, specifically with the focus on the FDI.

More clinical research is needed to determine if there are efficacious (effective and low-cost) evidence-based exercise programs for pain reduction and functional improvement in patients with thumb CMC osteoarthritis. The investigators are interested in the effect of FDI strengthening in patients with thumb CMC osteoarthritis. Therefore, the investigators hypothesized that there is no difference in the change of lateral pinch strength at 12 weeks between patients treated with a splint versus patients treated with a splint and FDI strengthening for thumb CMC osteoarthritis. We also tested the same hypothesis for 3-point chuck strength, VAS for pain, and PROMIS Upper Extremity CAT.

Enrollment: 30 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• At least 18 years old
• English-speaking
• Splint treatment for thumb carpometacarpal (CMC) osteoarthritis

Exclusion criteria

• Less than 18 years old
• Rheumatoid Arthritis or post-traumatic carpometacarpal (CMC) osteoarthritis
• Patients that received a corticosteroid injection during the appointment for treatment of thumb carpometacarpal (CMC) osteoarthritis

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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30 participants in 2 patient groups, including a placebo group

Splint Only

Placebo Comparator group

Description:

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

Treatment:

Device: Splint

Splint with first dorsal interosseous (FDI) strengthening

Active Comparator group

Description:

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

Treatment:

Device: Splint with strengthening exercises