Combination of dynamic stability approach and manual therapy for thumb carpometacarpal joint pain: A case report

Thumb carpometacarpal joint (1^st CMCJ) arthritis is the second most common hand arthritis secondary to 

This case report described a 58-year-old right hand dominant male (Mr. A) suffered from right basal thumb pain with radiological classification as Eaton stage III. This patient was not improved by traditional treatment of resting bracing, mobilization exercise and joint protection. In search of alternative treatment, dynamic stabilization program and manual therapy were added on top on existing treatments. Dynamic stabilization program suggested by O'Brien and Giveans (5) was used on this patient which suggested three components including maintaining supple first webspace, activation of muscular stabilizer including First Dorsal Interosseous (FDI) and Opponent Pollicis(OP) and educating the needs of lift long exercises. 1^st CMCJ manual mobilization technique including traction, radial and volar gliding were applied as suggested by Porretto-Loehrke (6) to restore stable thumb mechanics and reduce pain.

After a 9 months physiotherapy treatment program, Mr. A reported overall 70 precent improvement with much decreased pain in holding chopsticks and pinching. His pain level decreased from 8/10 to 2/10 by Visual Analogue Scale(VAS). The grip strength and lateral pinch strength of Mr. A improved from 18kg to 33kg and 2kg to 5kg respectively. For upper limb functional assessment, The QuickDASH score improved from 70.5 to 29.5 which indicated a significant improvement of hand function in activities of daily living (ADLs).

The addition of dynamic stabilization program and manual therapy may have extra beneficial effect on top of traditional conservative treatment in patient with 1^st CMCJ pain.

Keywords: Basal thumb arthritis, 1st CMCJ pain, Dynamic Stabilization, Manual Therapy