Geoff, in Leeds, England asks:
"I have had pain on the inside of my wrists and thumbs for many years and an x-ray has shown there is degeneration in the joints. Are there any exercises I can do that will help me?"
Chris Smith, Occupational Therapist, HealthSouth Sports Medicine and Rehab Center, Birmingham, Alabama responds:
"Carpo-Metacarpal degenerative joint disease (CMC DJD) is the most common condition in cases of wrist degeneration. As the thumb is involved most during gripping activities it is usually the CMC joint of the thumb that suffers from degeneration. Pain at the base of the thumb can be a considerable problem, with the patient frequently unable to unscrew jars and bottles.
"Degeneration can be due to systemic disease such as Rheumatoid Arthritis, or due to 'wear and tear' which is medically classed as Osteoarthritis. Osteoarthritis of the CMC joint of the thumb is more prevalent in older people, and affects women at a much higher rate than men (approximately 5 to 1).
"The thumb CMC joint complex is comprised of the Scaphoid and Trapezium (two of the eight 'carpal' bones of the wrist), and the thumb Metacarpal (the long bone of the base of the thumb).
"Due to the large range of movement required at the base of the thumb, several ligaments, and the boney structures mentioned above, are relied upon to maintain stability while also allowing extensive movement in all planes of motion. Damage or overuse of these structures can place high loads through the base of the thumb and lead to degeneration.
"Studies have shown that thumb tip pressures are multiplied by around 6 times during pressing activities, so if the pressure through the thumb tip is 2kg of force, then there is around 12kg of force going through the CMC joint. Rotational forces during gripping activities also place large stresses on this joint. In cases of CMC degeneration of the thumb, the bone that has degenerated is most commonly the Trapezium, although the Metacarpal is also affected.
"Specific x-ray views ordered by a doctor can be helpful in ascertaining the extent of the degeneration. Even if the x-rays confirm degeneration, other conditions such as Carpal Tunnel Syndrome will have to be ruled out, although in some patients the two conditions exist concurrently.
"The most advantageous treatment intervention for thumb CMC joint degeneration is immobilization of the thumb joint with splinting. This can be accomplished by simply purchasing an off-the-shelf hand based thumb spica splint or having a custom splint made (shown below). The splint should be worn at all times excluding showers and while performing the designated home exercise program.
"The patient needs to remove the splint numerous times throughout the day (5-8) to perform thumb range of movement exercises to prevent muscle wasting and the formation of scar tissue that can limit range of movement. These exercises are very straightforward, simply moving the thumb through it's available range - touching each of the other fingers in turn with the thumb, then circling the thumb several times.
"Attempts to strengthen the muscles around the thumb in cases of thumb degeneration only exacerbate the symptoms and prolong the necessity of splint use. If there is pain, modalities such as icing for 15-20 minutes can be used under the supervision of a physiotherapist in conjunction with the splint wear to decrease acute symptoms.
"If a reduction in pain is not noticed within 1-3 months, the patient should consult an orthopedist. Surgical options are available in more advanced cases."
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