The influence of an abductor pollicis longus strengthening programme on symptoms experienced by elderly females with osteoarthritis of the 1st carpo-metacarpal joint

Abstract

Elderly females with osteoarthritis on the first carpo-metacarpal (CMC) joint are left impaired by this degenerative condition and develop functional limitations which hinder their everyday activities. The first CMC joint relies strongly on the stability offered by the surrounding muscles predominantly the Abductor Pollicis Longus (APL) muscle. Early stage conservative management including strengthening exercises of surrounding muscles is advocated to improve function in the hand. This study aimed to pilot an investigation of the influence of an APL strengthening programme on the symptoms experienced by elderly females presenting with early stage osteoarthritis of the first CMC joint. Pre-test/post-test design supplemented by logbooks and field notes with 25 residents from 3 retirement homes was conducted. Fifteen were allocated to the experimental group and 10 to the control group. The experimental group participated in an 8 week exercise programme; while the control group received an assistive device. Both groups were assessed at baseline; 4 weeks and after 8 weeks. The assessment battery included the Kapandji index for thumb opposition, voluntary isometric total grip, 2-point pincer, 3-point pincer and key grasp strength, Visual Analogue Scale for pain and the Michigan Hand Outcome Questionnaire (MHQ). Data were summarized and tested with the Generalized Estimating Equations (GEE) to detect possible changes over time. Qualitative data were analysed and themes were extracted to describe processes in the study. Results included adjusting the assessment battery: using a Numerical Rating Scale for pain; and adding a goniometer assessment for the thumb as the Kapandji scale for opposition provided limited information. Compliance was affected by poor memory, poor health and caregiving responsibilities. Participants were encouraged to comply due to improvement in their symptoms and personal contribution to the research initiative.

Keywords: Osteoarthritis, elderly, carpo-metacarpal joint, abductor pollicis longus, exercise